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Choices in motion: how young people in the PrEPared to Choose study (Cape Town, South Africa) navigate PrEP product switching
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BACKGROUND: The introduction of novel, long-acting HIV pre-exposure prophylaxis (PrEP), including injectables and the vaginal ring, ushers in an era of PrEP choice. While much focus has been on the initial choice of PrEP product, PrEP users are likely to show dynamic PrEP product preference and use over time. PrEPared to Choose (PtC) is one of the first implementation studies allowing for unscheduled PrEP product switching between three available PrEP formulations.
METHODS: PtC delivers PrEP choice, including oral PrEP, Cabotegravir long-acting (CAB-LA) injectable PrEP, and the Dapivirine-containing vaginal ring (DVR), to 1164 adolescents and young people (15-29 years) and their intimate male partners in Cape Town, South Africa. HIV counsellors provide comprehensive PrEP counselling that prioritizes accurate PrEP information and supports individual choice. Participants can switch between PrEP products, if clinically eligible, at any time over the 18-month study period. We report early product switching patterns between baseline and month three follow-up.
RESULTS: 1164 individuals initiated PrEP, including oral PrEP (n=290), DVR (n=12), and CAB-LA (n=862). The median age was 24 (20'28) years, with adolescent girls and young women (AGYW) comprising 62.8% of participants. Of 82 oral PrEP users that returned at month 1, 25.61% transitioned to CAB-LA, with 71.43% of those transitioning being AGYW (see Diagram 1). Of 21 individuals who switched to CAB-LA, 15 (71.43%) continued with CAB-LA at month 3. Of 608 individuals who initiated and continued CAB-LA at month 1, 97.37% remained on CAB-LA.
CONCLUSIONS: Early continuation on PrEP overall and on the initiated PrEP product was substantially greater amongst PrEP users initiating CAB-LA compared to oral PrEP. With a quarter of persistent oral users at month 1 opting to switch to CAB LA, it is evident that true choice is an ongoing process that requires appropriate counselling support and clinical management for transitioning between products.
METHODS: PtC delivers PrEP choice, including oral PrEP, Cabotegravir long-acting (CAB-LA) injectable PrEP, and the Dapivirine-containing vaginal ring (DVR), to 1164 adolescents and young people (15-29 years) and their intimate male partners in Cape Town, South Africa. HIV counsellors provide comprehensive PrEP counselling that prioritizes accurate PrEP information and supports individual choice. Participants can switch between PrEP products, if clinically eligible, at any time over the 18-month study period. We report early product switching patterns between baseline and month three follow-up.
RESULTS: 1164 individuals initiated PrEP, including oral PrEP (n=290), DVR (n=12), and CAB-LA (n=862). The median age was 24 (20'28) years, with adolescent girls and young women (AGYW) comprising 62.8% of participants. Of 82 oral PrEP users that returned at month 1, 25.61% transitioned to CAB-LA, with 71.43% of those transitioning being AGYW (see Diagram 1). Of 21 individuals who switched to CAB-LA, 15 (71.43%) continued with CAB-LA at month 3. Of 608 individuals who initiated and continued CAB-LA at month 1, 97.37% remained on CAB-LA.
CONCLUSIONS: Early continuation on PrEP overall and on the initiated PrEP product was substantially greater amongst PrEP users initiating CAB-LA compared to oral PrEP. With a quarter of persistent oral users at month 1 opting to switch to CAB LA, it is evident that true choice is an ongoing process that requires appropriate counselling support and clinical management for transitioning between products.