Meeting adolescent girls and young women who experience intimate partner violence where they are: Developing an implementation strategy for linkage to PrEP options

Intimate partner violence is a serious public health concern affecting adolescent girls and young women in sub-Saharan Africa, with over one-third of girls aged 15-19 years reporting physical or sexual partner violence. Intimate partner violence is also a significant contributor to the HIV epidemic among women globally and in sub-Saharan Africa in particular, where young women with violent or controlling male partners are 1.5 times as likely to acquire HIV. Biomedical HIV prevention options that do not require participation from both partners, such as antiretroviral pre-exposure prophylaxis (PrEP), are critical. Further, providing options for approved long-acting PrEP modalities, including the dapivirine ring and injectable cabotegravir, for young women who perceive barriers to daily oral PrEP use may provide violence-exposed young women with greater agency over their sexual health. Pathways for entry to PrEP care from existing public health touchpoints that engage with young women who report experiencing intimate partner violence (e.g., rape crisis centers, centers for women and children) are not currently available. However, integrating discussions surrounding HIV prevention into existing violence care can ultimately serve a population experiencing intersectional stigma to address both intimate partner violence and HIV risk. The current project proposes to conduct formative work to develop a multi-component implementation strategy to link young African women (15-24 years) who experience intimate partner violence with PrEP options, including long-acting PrEP. Guided by the Exploration, Preparation, Implementation, Sustainment framework and the Health Belief Model, this study aims to conduct qualitative in-depth interviews and a brief cross-sectional survey among violence-exposed young women (AIM 1) and key informants (AIM 2), including potential program implementers and policymakers, to investigate 1) knowledge and opinions of PrEP; 2) preferences for approved PrEP modalities (e.g., oral PrEP, the dapivirine ring, and injectable PrEP); 3) perceived barriers/facilitators to PrEP uptake and adherence; and 4) inner and outer setting factors influencing PrEP delivery. Participants will be asked about barriers/facilitators to PrEP uptake, adherence, and delivery relative to approved PrEP-linkage strategies (e.g., providing education and/or training, placing a peer navigator at touchpoints, care integration), and suggestions for novel strategies will also be explored. Additionally, we will probe participants to discuss the role that stigma may play in PrEP implementation to inform potential resilience resources that can be incorporated into the strategy. This formative work will be used in AIM 3 to develop a multi-component PrEP-linkage implementation strategy through iterative consultation with young women and key stakeholders (AIM 3), that will be tested in a future pilot trial. In summary, this research aims to respond to young women in a generalized HIV epidemic setting who are experiencing intimate partner violence by optimizing the implementation of approved PrEP modalities.