Peer support helps young women in Uganda stay on PrEP

A pilot study that used peers to support young women who were struggling to stay on PrEP has found adherence significantly improved. 

What is the research about? 

The study looks at whether peer support could help improve adherence. It involved 30 young women (ages 18-24) in Kampala who had been on PrEP for at least three months through a sexual health clinic but were not taking it properly. (PrEP must be taken every day to work.) More than half the young women sold sex. 

The young women were asked to return to the sexual health clinic after three months and six months. In between visits they received support in-person and over the phone from women their own age. Peers were trained to help participants self-test for HIV. They gave them monthly PrEP refills if they were HIV-negative. They also provided counselling, advice and encouragement to keep taking PrEP, plus practical reminders to take medication.  

Why is this research important? 

Young women in East and Southern Africa are at high risk of HIV. PrEP is an HIV prevention method that young women can control (unlike condoms which must be negotiated with a male partner). But in trials, many young women stop taking PrEP within six months even if their risk of HIV has not fallen. Understanding if peer support could help improve adherence is therefore important. 

What did they find out? 

Peer support helped young women keep taking PrEP. At month three, 93% of participants had detectable PrEP in their urine. At month six, 57% did, including all the young women who sold sex. 

The reasons participants gave for no longer taking PrEP were: 

• becoming pregnant  
• thinking they were less at risk of HIV 
• stopping sex work 
• no longer involved with their partner. 

Peers successfully supported all participants to self-test for HIV each month. All results were HIV-negative. 

At month six, 93% of participants were still meeting a peer supporter. Young women said they liked peer support for these reasons: 

• It was private, confidential, friendly and non-judgemental. This was better than clinic experiences where some young women experienced a lack of privacy, stigma and discrimination. 
• Peers had more time and flexibility to provide support than busy healthcare workers. 
• It was easier to talk to peers about sensitive topics and ask questions. 
• Participants could spend less time and money travelling to the clinic and waiting to be seen.  

One 18-year-old’s comment summed up many participants’ views. She said: “…with my peer, we [are] the same age and so I can share with her whatever I want. I may find a health worker who is older, and I fear her because of her appearance and fail to tell her why I had gone to her.” 

What does this mean for HIV services? 

Providing peer support could help young women stay on PrEP and regularly test for HIV. It could be particularly effective with young women who see themselves as being at high risk of HIV and those who experience or fear stigmatising experiences in clinics. 

Some participants said they stopped taking PrEP as they felt they were no longer at risk of HIV. While this may have been the case it also shows how important it is to provide young women with clear, relevant and non-judgemental information about factors that increase HIV risk so they can make informed decisions.  

Frequent stock-outs of PrEP and self-testing kits were an issue in the study. Advocating for these supply-chain problems to be addressed is also important so that young women who want to keep taking PrEP have the chance to do so.