{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T05:12:42Z","timestamp":1791695562440,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","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":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre\u2010exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3967 participants, 44.9% were AGYW (15\u221224 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and\/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants \u2264\u00a024 years (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.007) and participants who were pregnant (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.002) or breastfeeding (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Of participants returning for \u2265\u00a01 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) and those \u2264\u00a024 years (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), PrEP na\u00efve at enrolment (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) or not currently using contraception (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26457","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T07:25:53Z","timestamp":1751441153000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub\u2010Saharan Africa"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9005-3549","authenticated-orcid":false,"given":"Virginia A.","family":"Fonner","sequence":"first","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Irungu","sequence":"additional","affiliation":[{"name":"Jhpiego  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Conlon","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyne A.","family":"Akello","sequence":"additional","affiliation":[{"name":"FHI 360 Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4209-7645","authenticated-orcid":false,"given":"Emily","family":"Gwavava","sequence":"additional","affiliation":[{"name":"Pangaea Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"K'Orimba","sequence":"additional","affiliation":[{"name":"LVCT Health Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolette P.","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6287-5289","authenticated-orcid":false,"given":"Patriciah","family":"Jeckonia","sequence":"additional","affiliation":[{"name":"LVCT Health Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imelda","family":"Mahaka","sequence":"additional","affiliation":[{"name":"Pangaea Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiqa","family":"Mullick","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamatli","family":"Chabela","sequence":"additional","affiliation":[{"name":"Jhpiego  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roisin","family":"Drysdale","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Kabongo","sequence":"additional","affiliation":[{"name":"Pangaea Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Millicent","family":"Kiruki","sequence":"additional","affiliation":[{"name":"LVCT Health Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Segawa","sequence":"additional","affiliation":[{"name":"FHI 360 Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munyaradzi","family":"Dobbie","sequence":"additional","affiliation":[{"name":"Zimbabwe Ministry of Health Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nthuseng","family":"Marake","sequence":"additional","affiliation":[{"name":"Lesotho Ministry of Health Maseru Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Mudiope","sequence":"additional","affiliation":[{"name":"Uganda Ministry of Health Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasina","family":"Subedar","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"},{"name":"National Department of Health  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Wafula","sequence":"additional","affiliation":[{"name":"Kenya Ministry of Health Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kazibwe","sequence":"additional","affiliation":[{"name":"TASO Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8001-1150","authenticated-orcid":false,"given":"Jason","family":"Reed","sequence":"additional","affiliation":[{"name":"Jhpiego, Baltimore  Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8228-4577","authenticated-orcid":false,"given":"Katharine","family":"Kripke","sequence":"additional","affiliation":[{"name":"Avenir Health Takoma Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Taylor","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8855-5769","authenticated-orcid":false,"given":"Mu\u2010Tien","family":"Lee","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glory","family":"Chidumwa","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"},{"name":"School of Public Health, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adatia","family":"Chivafa","sequence":"additional","affiliation":[{"name":"Pangaea Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramatsoai","family":"Soothoane","sequence":"additional","affiliation":[{"name":"Jhpiego  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Eichleay","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Mayo","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"McGuire","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"McClure","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1489-627X","authenticated-orcid":false,"given":"Tatenda","family":"Yemeke","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Torjesen","sequence":"additional","affiliation":[{"name":"FHI 360 Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CATALYST study team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"UNAIDS.The urgency of now: AIDS at a crossroads.Joint United Nations Programme on HIV\/AIDS;2024."},{"key":"e_1_2_12_3_1","unstructured":"UNAIDS.HIV and Adolescent Girls and Young Women: 2024 Global AIDS Update.Joint United Nations Programme on HIV\/AIDS;2024."},{"key":"e_1_2_12_4_1","unstructured":"World Health Organization.Guidelines on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV.2015."},{"key":"e_1_2_12_5_1","unstructured":"The Global PrEP Tracker [Internet]. [cited August 15 2024]. Available from:https:\/\/data.prepwatch.org\/."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26103"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003670"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25962"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2023.08.004"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25872"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03205-z"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506110"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30300-3"},{"key":"e_1_2_12_14_1","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"World Health Organization","year":"2021"},{"key":"e_1_2_12_15_1","unstructured":"PrEPwatch.The dapivirine vaginal ring.2024. Accessed October 1 2024. Available from:https:\/\/www.prepwatch.org\/products\/dapivirine\u2010vaginal\u2010ring\/."},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000003494"},{"key":"e_1_2_12_17_1","volume-title":"Guidelines on long\u2010acting injectable cabotegravir for HIV prevention","author":"World Health Organization","year":"2022"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00227-8"},{"key":"e_1_2_12_19_1","volume-title":"Randomized trial of SEARCH dynamic choice HIV prevention including injectable cabotegravir (CAB\u2010LA)","author":"Kamya MR","year":"2024"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00026-7"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26115"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-021-00577-8"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-024-00704-1"},{"key":"e_1_2_12_24_1","unstructured":"HIV Prevention User Journey Tool: PrEP Watch. Accessed February 4 2025. Available from:https:\/\/www.prepwatch.org\/resources\/hiv\u2010prevention\u2010user\u2010journey\u2010tool\/."},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26121"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0287525"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.17.3.19356"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002777"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2407001"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00538-4"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000362"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0310489"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-20975-y"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2024.100496"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02733-z"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-076545"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T10:56:59Z","timestamp":1752145019000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":35,"journal-issue":{"issue":"S2","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/jia2.26457"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26457","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2024-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26457"}}