{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:57:40Z","timestamp":1787237860064,"version":"build-2736575974"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/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":["R01HD094630"],"award-info":[{"award-number":["R01HD094630"]}],"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":["R01HD100201"],"award-info":[{"award-number":["R01HD100201"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI125498"],"award-info":[{"award-number":["R01AI125498"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000194","name":"U.S. Department of State","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000194","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    From 10\/2018 to 04\/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15\u201324 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of \u22655 (corresponding to 5\u201315% HIV incidence) defined \u201chigh\u201d HIV risk.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20\u201323], median completed education was 12 years (IQR 10\u201312); 23% of AGYW had HIV risk scores of \u22655. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09\u20131.29,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001]; LARC use was not associated with HIV risk scores \u22655. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09\u20132.10,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.012); injectable use was not associated with HIV risk scores \u22655.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.\n                  <\/jats:p>","DOI":"10.3389\/frph.2021.667413","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T02:26:22Z","timestamp":1626834382000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention"],"prefix":"10.3389","volume":"3","author":[{"given":"Edward","family":"Nyaboe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Sila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kinuthia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Owiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Abuna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Kohler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"John-Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Pintye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1363\/4014414","article-title":"Contraceptive method skew and shifts in method mix in low- and middle-income countries","volume":"40","author":"Bertrand","year":"2014","journal-title":"Int Perspect Sex Reprod Health."},{"key":"B2","doi-asserted-by":"publisher","first-page":"658","DOI":"10.9745\/GHSP-D-17-00121","article-title":"Harmonizing methods for estimating the impact of contraceptive use on unintended pregnancy, abortion, and maternal health","volume":"5","author":"Askew","year":"2017","journal-title":"Glob Health Sci Pract."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1007\/s10995-016-2014-0","article-title":"Evaluating a LARC expansion program in 14 Sub-Saharan African countries: a service delivery model for meeting FP2020 goals","volume":"21","author":"Ngo","year":"2017","journal-title":"Matern Child Health J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.contraception.2012.10.002","article-title":"Revitalizing long-acting reversible contraceptives in settings with high unmet need: a multicountry experience matching demand creation and service delivery","volume":"87","author":"Blumenthal","year":"2013","journal-title":"Contraception."},{"key":"B5","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/S0140-6736(19)31288-7","article-title":"HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial","volume":"394","year":"2019","journal-title":"Lancet."},{"key":"B6","article-title":"PrEP uptake among pregnant and postpartum women: results from a large implementation program within routine maternal child health (MCH) clinics in Kenya","volume-title":"Conference on Retroviruses and Opportunistic Infections (CROI). Abstract 7484","author":"Kinuthia","year":"2018"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1002885","DOI":"10.1371\/journal.pmed.1002885","article-title":"Integrating preexposure prophylaxis delivery in routine family planning clinics: a feasibility programmatic evaluation in Kenya","volume":"16","author":"Mugwanya","year":"2019","journal-title":"PLoS Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1016\/S2352-3018(19)30335-2","article-title":"Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme","volume":"7","author":"Kinuthia","year":"2019","journal-title":"Lancet HIV."},{"key":"B9","volume-title":"Kenya HIV Country Profiles 2016","year":"2016"},{"key":"B10","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1177\/0956462414563625","article-title":"Correlates of prevalent HIV infection among adults and adolescents in the Kisumu incidence cohort study, Kisumu, Kenya","volume":"26","author":"Gumbe","year":"2015","journal-title":"Int J STD AIDS."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0178907","DOI":"10.1371\/journal.pone.0178907","article-title":"Prevalence, incidence and correlates of HSV-2 infection in an HIV incidence adolescent and adult cohort study in western Kenya","volume":"12","author":"Akinyi","year":"2017","journal-title":"PLoS ONE."},{"key":"B12","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1177\/0956462420920423","article-title":"Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya","volume":"31","author":"Larsen","year":"2020","journal-title":"Int J STD AIDS."},{"key":"B13","doi-asserted-by":"publisher","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":"Sila","year":"2020","journal-title":"AIDS Patient Care STDS."},{"key":"B14","unstructured":"Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya2016"},{"key":"B15","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/QAI.0000000000000974","article-title":"An empiric HIV risk scoring tool to predict HIV-1 acquisition in African women","volume":"72","author":"Balkus","year":"2016","journal-title":"J Acquir Immune Defic Syndr."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s10461-011-0003-2","article-title":"Development of the perceived risk of HIV scale","volume":"16","author":"Napper","year":"2012","journal-title":"AIDS Behav."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1001\/jama.2020.23330","article-title":"Long-acting Cabotegravir shot prevents HIV among women","volume":"324","author":"Abbasi","year":"2020","journal-title":"JAMA."},{"key":"B18","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/S1473-3099(14)71052-7","article-title":"Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies","volume":"15","author":"Ralph","year":"2015","journal-title":"Lancet Infect Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1007\/s10461-014-0741-z","article-title":"Are hormonal contraceptive users more likely to misreport unprotected sex? Evidence from a biomarker validation study in Zimbabwe","volume":"18","author":"McCoy","year":"2014","journal-title":"AIDS Behav."},{"key":"B20","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1001\/jamapediatrics.2016.0007","article-title":"Long-Acting reversible contraception and condom use among female US high school students: implications for sexually transmitted infection prevention","volume":"170","author":"Steiner","year":"2016","journal-title":"JAMA Pediatr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e25094","DOI":"10.1002\/jia2.25094","article-title":"The Tablets, Ring, Injections as Options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention","volume":"21","author":"van der Straten","year":"2018","journal-title":"J Int AIDS Soc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1080\/09540121.2016.1234679","article-title":"Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients","volume":"29","author":"Garfinkel","year":"2017","journal-title":"AIDS Care."},{"key":"B23","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.contraception.2018.01.007","article-title":"Family planning providers' role in offering PrEP to women","volume":"97","author":"Seidman","year":"2018","journal-title":"Contraception."},{"key":"B24","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1097\/QAI.0000000000001850","article-title":"Integration of PrEP services into routine antenatal and postnatal care: experiences from an implementation program in Western Kenya","volume":"79","author":"Pintye","year":"2018","journal-title":"J Acquir Immune Defic Syndr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12978-019-0714-9","article-title":"Integration of HIV testing services into family planning services: a systematic review","volume":"16","author":"Narasimhan","year":"2019","journal-title":"Reprod Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/sifp.12018","article-title":"Integration of family planning services into HIV care and treatment services: a systematic review","volume":"48","author":"Haberlen","year":"2017","journal-title":"Stud Fam Plann."},{"key":"B27","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.amepre.2018.06.010","article-title":"Youth-friendly family planning services for young people: a systematic review update","volume":"55","author":"Brittain","year":"2018","journal-title":"Am J Prev Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e035689","DOI":"10.1136\/bmjopen-2019-035689","article-title":"Standardised patient encounters to improve quality of counselling for pre-exposure prophylaxis (PrEP) in adolescent girls and young women (AGYW) in Kenya: study protocol of a cluster randomised controlled trial","volume":"10","author":"Larsen","year":"2020","journal-title":"BMJ Open."}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2021.667413\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T02:26:29Z","timestamp":1626834389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2021.667413\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,21]]},"references-count":28,"alternative-id":["10.3389\/frph.2021.667413"],"URL":"https:\/\/doi.org\/10.3389\/frph.2021.667413","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,21]]},"article-number":"667413"}}