# PrEP Adherence Among AGYW: A Multidimensional Evaluation

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2020 · $596,294

## Abstract

PrEP is being scaled up for adolescent girls and young women (AGYW) as a way to prevent the
unacceptably high HIV incidence in this group in South and East Africa. While PrEP is a highly
effective intervention, its efficacy is threatened by non-adherence – it only works if AGYW take it. In
order to use and adhere to PrEP, AGYW need to understand their potential risk for acquiring HIV,
believe in the use of PrEP for prevention, and be able to navigate to get PrEP and continue PrEP.
Unfortunately, these steps are not easy for AGYW, and particularly those at highest risk for HIV.
Thus, it is critical to determine what levels of adherence will be in demonstration projects of PrEP in
AGYW. In addition, it is important to understand whether user factors and health care worker
counseling influences PrEP adherence.
We are currently conducting projects that involve delivering PrEP in public sector maternal child
health (MCH) and family planning (FP) clinics. These projects involve understanding programmatic
systems to deliver PrEP to women, including AGYW. We propose to leverage these projects to
understand adherence in AGYW. Using the Information-Motivation-Behavior Model, we propose in
AIM 1: to conduct longitudinal analyses to discern patterns of adherence (both with self-reported data
and drug level monitoring), and identify correlates of adherence (including knowledge about PrEP,
HIV risk perception, depression, and self-efficacy). Qualitative evaluation of women with consistently
high adherence, intermittent adherence or consistently low adherence will be undertaken to
understand personal narratives underlying adherence patterns. In AIM 2, we propose to adapt our
mHealth SMS platform (Mobile WACh-X) to understand issues facing AGYW on PrEP. In our
previous studies, 2-way SMS result in active engagement of AGYW, with conversations that discuss
social and health issues relevant to medications. We hypothesize that this 2-way interactive SMS
approach provides a tool to amplify ascertainment of `real-time real-life' issues relevant to PrEP use
beyond what can be ascertained at routine clinic visits. In AIM 3, we propose to use simulated
patients (SPs) trained in scripted scenarios to pose as AGYW who will evaluate health care workers'
(HCWs) approach to counseling AGYW – specifically, HCW empathy, information, decision-advice,
and advice regarding PrEP adherence. In addition, SPs will work with HCWs in training sessions to
evaluate and refine HCW counseling and youth friendly skills.
This study will provide a unique multi-dimensional evaluation of PrEP adherence in AGYW
and provide insights and tools to improve PrEP adherence in this at-risk population.

## Key facts

- **NIH application ID:** 9964516
- **Project number:** 5R01HD094630-04
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Grace C. John-Stewart
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $596,294
- **Award type:** 5
- **Project period:** 2017-09-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9964516

## Citation

> US National Institutes of Health, RePORTER application 9964516, PrEP Adherence Among AGYW: A Multidimensional Evaluation (5R01HD094630-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9964516. Licensed CC0.

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