{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T05:12:45Z","timestamp":1791695565197,"version":"4.3.4"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004097","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000}}],"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD094682"],"award-info":[{"award-number":["R01HD094682"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["3R01HD094682-02S1"],"award-info":[{"award-number":["3R01HD094682-02S1"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent &lt;10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate\/emtricitabine (TDF\/FTC) can be highly effective, low persistence in PrEP programs and poor adherence have limited its ability to reduce HIV incidence among women.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>A total of 336 AGYW participating in the PEPFAR-funded DREAMS PrEP program in western Kenya were enrolled into a study of PrEP use conducted between 6\/2019 to 1\/2020. AGYW, who used daily oral TDF\/FTC, completed interviews and provided dried blood spots (DBS) for measurement of tenofovir-diphosphate (TFV-DP) concentrations at enrollment and 3 months later, and 176\/302 (58.3%, 95% confidence interval [95% CI 52.3 to 63.8]) met our definition of PrEP persistence: having expressed intention to use PrEP and attended both the second interview and an interim refill visit. Among AGYW with DBS taken at the second interview, only 9\/197 (4.6%, [95% CI 1.6 to 7.5]) had protective TFV-DP levels (\u2265700 fmol\/punch) and 163\/197 (82.7%, [95% CI 77.5 to 88]) had levels consistent with no recent PrEP use (&lt;10 fmol\/punch). Perception of being at moderate-to-high risk for HIV if not taking PrEP was associated with persistence (adjusted odds ratio, 10.17 [95% CI 5.14 to 20.13], <jats:italic>p<\/jats:italic> &lt; 0.001) in a model accounting for county of residence and variables that had <jats:italic>p<\/jats:italic>-value &lt;0.1 in unadjusted analysis (age, being in school, initiated PrEP 2 to 3 months before the first interview, still active in DREAMS, having children, having multiple sex partners, partner aware of PrEP use, partner very supportive of PrEP use, partner has other partners, AGYW believes that a partner puts her at risk, male condom use, injectable contraceptive use, and implant contraceptive use). Among AGYW who reported continuing PrEP, &gt;90% indicated they were using PrEP to prevent HIV, although almost all had non-protective TFV-DP levels. Limitations included short study duration and inclusion of only DREAMS participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Many AGYW persisted in the PrEP program without taking PrEP frequently enough to receive benefit. Notably, AGYW who persisted had a higher self-perceived risk of HIV infection. These AGYW may be optimal candidates for long-acting PrEP.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004097","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T17:46:47Z","timestamp":1663004807000},"page":"e1004097","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":43,"title":["Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study"],"prefix":"10.1371","volume":"19","author":[{"given":"Jean de Dieu","family":"Tapsoba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Cover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7932-3309","authenticated-orcid":true,"given":"Christopher","family":"Obong\u2019o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Brady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8106-0974","authenticated-orcid":true,"given":"Tim R.","family":"Cressey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kira","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Okomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Kariithi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rael","family":"Obanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1109-0104","authenticated-orcid":true,"given":"Daniel","family":"Oluoch-Madiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2726-3391","authenticated-orcid":true,"given":"Ying Qing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-4097","authenticated-orcid":true,"given":"Paul","family":"Drain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-2208","authenticated-orcid":true,"given":"Ann","family":"Duerr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"key":"pmed.1004097.ref001","author":"UNAIDS","year":"2019","journal-title":"Women and HIV, A spotlight on adolescent girls and young women"},{"issue":"11","key":"pmed.1004097.ref002","doi-asserted-by":"crossref","first-page":"e1521","DOI":"10.1016\/S2214-109X(19)30410-3","article-title":"Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis","volume":"7","author":"I Birdthistle","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"27","key":"pmed.1004097.ref003","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men","volume":"363","author":"RM Grant","year":"2010","journal-title":"N Engl J Med"},{"issue":"9","key":"pmed.1004097.ref004","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study","volume":"14","author":"RM Grant","year":"2014","journal-title":"Lancet Infect Dis"},{"issue":"8","key":"pmed.1004097.ref005","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1089\/aid.2016.0202","article-title":"Differences in cumulative exposure and adherence to tenofovir in the VOICE, iPrEx OLE, and PrEP demo studies as determined via hair concentrations","volume":"33","author":"CA Koss","year":"2017","journal-title":"AIDS Res Hum Retroviruses"},{"issue":"9","key":"pmed.1004097.ref006","doi-asserted-by":"crossref","first-page":"e402","DOI":"10.1016\/S2352-3018(17)30089-9","article-title":"Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study","volume":"4","author":"J Molina","year":"2017","journal-title":"Lancet HIV"},{"issue":"10246","key":"pmed.1004097.ref007","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0140-6736(20)31065-5","article-title":"Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial","volume":"396","author":"KH Mayer","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"pmed.1004097.ref008","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1056\/NEJMoa1202614","article-title":"Preexposure prophylaxis for HIV infection among African women","volume":"367","author":"L Van Damme","year":"2012","journal-title":"N Engl J Med"},{"issue":"7","key":"pmed.1004097.ref009","doi-asserted-by":"crossref","first-page":"F13","DOI":"10.1097\/QAD.0b013e3283522272","article-title":"Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention","volume":"26","author":"A Van der Straten","year":"2012","journal-title":"AIDS"},{"issue":"6","key":"pmed.1004097.ref010","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1056\/NEJMoa1402269","article-title":"Tenofovir-based preexposure prophylaxis for HIV infection among African women","volume":"372","author":"JM Marrazzo","year":"2015","journal-title":"N Engl J Med"},{"key":"pmed.1004097.ref011","first-page":"1","article-title":"Barriers to Oral HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Pregnant and Post-partum Women from Cape Town, South Africa","author":"I Beesham","year":"2022","journal-title":"AIDS Behav"},{"issue":"7","key":"pmed.1004097.ref012","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1007\/s10461-021-03159-2","article-title":"Multilevel barriers to HIV PrEP uptake and adherence among black and Hispanic\/Latinx transgender women in southern California","volume":"25","author":"A Ogunbajo","year":"2021","journal-title":"AIDS Behav"},{"issue":"7","key":"pmed.1004097.ref013","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1056\/NEJMoa2101016","article-title":"Cabotegravir for HIV prevention in cisgender men and transgender women","volume":"385","author":"RJ Landovitz","year":"2021","journal-title":"N Engl J Med"},{"key":"pmed.1004097.ref014","article-title":"Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial","author":"S Delany-Moretlwe","year":"2022","journal-title":"Lancet"},{"issue":"Suppl Suppl 1","key":"pmed.1004097.ref015","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/padr.12051","article-title":"Contraceptive practice in sub-Saharan Africa","volume":"43","author":"AO Tsui","year":"2017","journal-title":"Popul Dev Rev."},{"issue":"12","key":"pmed.1004097.ref016","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1097\/QAD.0000000000002598","article-title":"Oral preexposure prophylaxis continuation, measurement and reporting","volume":"34","author":"K Stankevitz","year":"2020","journal-title":"AIDS"},{"issue":"3","key":"pmed.1004097.ref017","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1007\/s10461-019-02654-x","article-title":"PrEP implementation and persistence in a county health department setting in Atlanta, GA","volume":"23","author":"C-P Rolle","year":"2019","journal-title":"AIDS Behav"},{"issue":"3","key":"pmed.1004097.ref018","doi-asserted-by":"crossref","first-page":"e0265434","DOI":"10.1371\/journal.pone.0265434","article-title":"Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016\u20132020","volume":"17","author":"A Rao","year":"2022","journal-title":"PLoS ONE"},{"issue":"2","key":"pmed.1004097.ref019","doi-asserted-by":"crossref","first-page":"e25252","DOI":"10.1002\/jia2.25252","article-title":"Persistence on HIV preexposure prophylaxis medication over a 2-year period among a national sample of 7148 PrEP users, United States, 2015 to 2017","volume":"22","author":"KC Coy","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pmed.1004097.ref020","author":"Kenya Ministry of Health","year":"2016","journal-title":"Kenya AIDS Response Progress Report, 2016"},{"key":"pmed.1004097.ref021","volume-title":"The alcohol use disorders identification test (AUDIT)","author":"World Health Organization","year":"2001"},{"key":"pmed.1004097.ref022","first-page":"508","article-title":"HITS: a short domestic violence screening tool for use in a family practice setting","volume":"30","author":"KM Sherin","year":"1998","journal-title":"Fam Med"},{"issue":"8","key":"pmed.1004097.ref023","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1089\/apc.2020.0037","article-title":"High awareness, yet low uptake, of pre-exposure prophylaxis among adolescent girls and young women within family planning clinics in Kenya","volume":"34","author":"J Sila","year":"2020","journal-title":"AIDS Patient Care STDS"},{"issue":"6","key":"pmed.1004097.ref024","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/0277-9536(91)90150-B","article-title":"The MOS social support survey","volume":"32","author":"CD Sherbourne","year":"1991","journal-title":"Soc Sci Med"},{"issue":"12","key":"pmed.1004097.ref025","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1016\/j.ijnurstu.2008.06.006","article-title":"Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa","volume":"45","author":"BP Ncama","year":"2008","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"pmed.1004097.ref026","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1080\/03670244.2014.995790","article-title":"Around the table: Food insecurity, socioeconomic status, and instrumental social support among women living in a rural Kenyan island community","volume":"54","author":"JM Nagata","year":"2015","journal-title":"Ecol Food Nutr"},{"issue":"12","key":"pmed.1004097.ref027","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.socscimed.2011.09.026","article-title":"The social context of food insecurity among persons living with HIV\/AIDS in rural Uganda","volume":"73","author":"AC Tsai","year":"2011","journal-title":"Soc Sci Med"},{"issue":"9","key":"pmed.1004097.ref028","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"2","key":"pmed.1004097.ref029","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11606-008-0846-z","article-title":"Validity\/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV\/AIDS in western Kenya","volume":"24","author":"PO Monahan","year":"2009","journal-title":"J Gen Intern Med"},{"issue":"1","key":"pmed.1004097.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12888-020-2435-6","article-title":"Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya","volume":"20","author":"J Velloza","year":"2020","journal-title":"BMC Psychiatry"},{"issue":"1","key":"pmed.1004097.ref031","doi-asserted-by":"crossref","first-page":"e01710","DOI":"10.1128\/AAC.01710-17","article-title":"Intracellular tenofovir-diphosphate and emtricitabine-triphosphate in dried blood spots following directly observed therapy","volume":"62","author":"PL Anderson","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"issue":"112","key":"pmed.1004097.ref032","doi-asserted-by":"crossref","first-page":"112re4","DOI":"10.1126\/scitranslmed.3003174","article-title":"Penetration of tenofovir and emtricitabine in mucosal tissues: implications for prevention of HIV-1 transmission","volume":"3","author":"KB Patterson","year":"2011","journal-title":"Sci Transl Med."},{"key":"pmed.1004097.ref033","article-title":"Adherence to Pre-Exposure Prophylaxis in Adolescents and Young Adults: A Systematic Review and Meta-Analysis","author":"BA Allison","year":"2021","journal-title":"J Adolesc Health"},{"issue":"11","key":"pmed.1004097.ref034","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/S1473-3099(18)30428-6","article-title":"Tenofovir 1% vaginal gel for prevention of HIV-1 infection in women in South Africa (FACTS-001): a phase 3, randomised, double-blind, placebo-controlled trial","volume":"18","author":"S Delany-Moretlwe","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"pmed.1004097.ref035","doi-asserted-by":"crossref","first-page":"e1003670","DOI":"10.1371\/journal.pmed.1003670","article-title":"PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial","volume":"18","author":"C Celum","year":"2021","journal-title":"PLoS Med."},{"issue":"4","key":"pmed.1004097.ref036","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/S2352-3018(22)00030-3","article-title":"Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis","volume":"9","author":"J Zhang","year":"2022","journal-title":"Lancet HIV"},{"issue":"10","key":"pmed.1004097.ref037","doi-asserted-by":"crossref","first-page":"e1003837","DOI":"10.1371\/journal.pmed.1003837","article-title":"Evaluating the impact of DREAMS on HIV incidence among adolescent girls and young women: A population-based cohort study in Kenya and South Africa","volume":"18","author":"I Birdthistle","year":"2021","journal-title":"PLoS Med."}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1004097","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T19:38:10Z","timestamp":1664480290000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004097"}},"subtitle":[],"editor":[{"given":"Marie-Louise","family":"Newell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,12]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004097","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pmed.1004097","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,12]]}}}