{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:55:13Z","timestamp":1789523713072,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T00:00:00Z","timestamp":1693094400000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["OAA\u2010A\u201015\u201000034"],"award-info":[{"award-number":["OAA\u2010A\u201015\u201000034"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre\u2010exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients\u2019 risk perception, knowledge about PrEP, informed decision\u2010making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We designed MyPrEP, a client\u2010facing DST about PrEP and HIV prevention, with youth\u2010friendly information and images. The impact of the MyPrEP tool was assessed among HIV\u2010negative women aged 18\u201325 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 386 AGYW screened, 353 were randomized (DST<jats:italic>n<\/jats:italic>= 172, control<jats:italic>n<\/jats:italic>= 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199\/353) attending the clinic for HIV testing, 46% (164\/353) using contraception, 15% (53\/353) using condoms consistently and 37% (108\/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79\u20131.53), of whom two\u2010thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08\u20133.69). Ninety\u2010nine percent randomized to the DST reported satisfaction with MyPrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among AGYW attending a South African PHC clinic, PrEP uptake was &gt;90% with two\u2010fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26154","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T01:33:50Z","timestamp":1693186430000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8813-3419","authenticated-orcid":false,"given":"Connie","family":"Celum","sequence":"first","affiliation":[{"name":"Departments of Global Health Medicine and Epidemiology University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Seidman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology &amp; Reproductive Sciences University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Travill","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Dehlendorf","sequence":"additional","affiliation":[{"name":"Department of Family &amp; Community Medicine University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanele","family":"Gumede","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2999-733X","authenticated-orcid":false,"given":"Kidist","family":"Zewdie","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division Fred Hutchinson Cancer Research Center Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Family &amp; Community Medicine University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle Washington USA"}],"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":"Departments of Global Health Medicine and Epidemiology University of Washington Seattle Washington USA"},{"name":"Gilead Sciences Inc. Foster City California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Donnell","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division Fred Hutchinson Cancer Research Center Seattle Washington USA"},{"name":"Department of Global Health University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-1019","authenticated-orcid":false,"given":"Sinead","family":"Delany\u2010Moretlwe","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,27]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).2021 UNAIDS Global AIDS Update \u2014 confronting inequalities \u2014 lessons for pandemic responses from 40 years of AIDS.Geneva CH;2021."},{"key":"e_1_2_11_3_1","unstructured":"WHO.Policy brief: pre\u2010exposure prophylaxis (PrEP): WHO expands recommendation on oral pre\u2010exposure prophylaxis of HIV infection (PrEP).Geneva CH;2015."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.2007"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(22)00195-3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402269"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2044-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000362"},{"issue":"4","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25298","article-title":"HIV pre\u2010exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery","volume":"22","author":"Celum CL","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"e_1_2_11_11_1","article-title":"Decision aids for people facing health treatment or screening decisions","volume":"4","author":"Stacey D","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2019.08.034"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.015"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2019.08.001"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2019.09.003"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2018.07.118"},{"key":"e_1_2_11_17_1","unstructured":"RensburgR.Healthcare in South Africa: how inequity is contributing to inefficiency.2021[cited 2022 Jun 1]https:\/\/theconversation.com\/healthcare\u2010in\u2010south\u2010africa\u2010how\u2010inequity\u2010is\u2010contributing\u2010to\u2010inefficiency\u2010163753."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25962"},{"key":"e_1_2_11_19_1","unstructured":"Department of Health Republic of South Africa.Guidelines for the provision of pre\u2010exposure prophylaxis (PrEP) to persons at substantial risk of HIV infection. PrEPWatch [Internet].2020[cited 2021 Jun 1]https:\/\/www.prepwatch.org\/wp\u2010content\/uploads\/2020\/07\/South\u2010Africa\u2010PrEP\u2010Guidelines_Jan2020.pdf."},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X19851345"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000974"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002598"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(22)00030-3"},{"key":"e_1_2_11_24_1","unstructured":"Population Council FP2020.Contraceptive discontinuation: reasons challenges and solutions. FP2030Resources Publications[Internet].2015[cited 2021 Jun 1].https:\/\/fp2030.org\/resources\/contraceptive\u2010discontinuation\u2010reasons\u2010challenges\u2010and\u2010solutions."}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T02:49:27Z","timestamp":1703040567000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/jia2.26154"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26154","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]},"assertion":[{"value":"2022-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26154"}}