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Placebo\u2010controlled trials of tenofovir\u2010based pre\u2010exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth\u2010friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and\/or gonorrhoea; (4) provision of youth\u2010friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer\u2010acting and less adherence\u2010dependent strategies which are currently in clinical trials.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25298","type":"journal-article","created":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T07:02:05Z","timestamp":1563778925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":222,"title":["HIV pre\u2010exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8813-3419","authenticated-orcid":false,"given":"Connie L","family":"Celum","sequence":"first","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Medicine University of Washington Seattle WA USA"},{"name":"Department of Epidemiology University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinead","family":"Delany\u2010Moretlwe","sequence":"additional","affiliation":[{"name":"Wits Reproductive Health and HIV Institute University of Witswatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-8438","authenticated-orcid":false,"given":"Jared M","family":"Baeten","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Medicine University of Washington Seattle WA USA"},{"name":"Department of Epidemiology University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8536-648X","authenticated-orcid":false,"given":"Ariane","family":"van der Straten","sequence":"additional","affiliation":[{"name":"RTI International Women's Global Health Imperative (WGHI) Program San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Hosek","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Stroger Hospital Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Kenya Medical Research Institute Nairobi Kenya"},{"name":"Departments of Obstetrics\u2010Gynecology University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"McConnell","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. 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