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A novel “HIV salience and Perception” scale is associated with PrEP dispensing and adherence among adolescent girls and young women in Kampala, Uganda

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Abstract

Low perceived HIV risk is a barrier to effective pre-exposure prophylaxis (PrEP) use among African adolescent girls and young women (AGYW). Single-item risk perception measures are stigmatizing and alienating to AGYW and may not predict PrEP use. There is a need for a tool capturing domains of perceived HIV risk and salience that align with PrEP use among AGYW. This HIV PrEP study was conducted in Kampala, Uganda. We developed and piloted the 9-item “HIV Salience and Perception” (HPS) scale (range: 9–36); higher scores indicate beliefs of higher vulnerability to HIV. We administered the scale to Ugandan AGYW participating in an ongoing cohort study at enrollment, one, three and six months. PrEP dispensing was measured quarterly and adherence was measured daily via Wisepill (high adherence: ≥80% of expected pill bottle openings). We assessed scale performance and used generalized estimating equations to determine associations between scale score and PrEP use. Among 499 AGYW, 54.1% of our sample was ≥ 20 years (range:16–25). The median HPS score was 18 (range:8–33; α = 0.77). Higher score was associated with PrEP dispensing (aRR = 1.07 per point increase; 95% CI = 1.01–1.13; p-value = 0.02) in the overall cohort and among only those ≥ 20 years (aRR = 1.10; 95% CI = 1.03–1.19; p-value = 0.01). We did not observe an association between scale score and PrEP adherence. AGYW scoring higher on a novel HPS scale were more likely to initiate and obtain PrEP refills through 6 months. This scale may capture drivers of PrEP dispensing and could inform PrEP delivery and counseling for AGYW.

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Funding

This work was supported by the Eunice K. Shriver National Institute of Child Health and Human Development (R01HD089843). RH was supported by a career mentoring award from the NIMH (K24MH123371). JV was supported by the NIAID of the NIH (grant T32 AI007140-42) and by a career development award from the NIMH (K99 MH123369). RMS was supported by an NIH institutional training grant (T32AI007140). JMB is an employee of Gilead Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Global Health, University of Washington, Seattle, WA, USA

    Jennifer Velloza, Andrew Mujugira, Jade Boyer, Randy M. Stalter, Gabrielle Stein, Jared M. Baeten, Connie Celum & Renee Heffron

  2. Infectious Diseases Institute, Makerere University, Kampala, Uganda

    Andrew Mujugira, Timothy Muwonge, Olivia Nampewo, Josephine Badaru & Timothy Ssebuliba

  3. Gilead Sciences, Foster City, CA, USA

    Jared M. Baeten

  4. International Clinical Research Center, University of Washington, 325 Ninth Avenue, Box 359927, 98104, Seattle, WA, USA

    Jennifer Velloza

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  1. Jennifer Velloza
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Contributions

Renee Heffron acquired funding for the study. Renee Heffron, Andrew Mujugira, Jared Baeten, and Connie Celum contributed to the study conception and design. Jade Boyer managed study operations. Gabrielle Stein and Randy Stalter managed data collection. Andrew Mujugira, Timothy Muwonge, Olivia Nampewo, Josephine Badaru, and Timothy Ssebuliba managed study operations. Data analysis was performed by Jennifer Velloza. The first draft of the manuscript was written by Jennifer Velloza and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jennifer Velloza.

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The authors report no potential conflicts of interest.

Ethics approval:

Protocols were approved by ethical review boards at the Uganda National Council for Science and Technology and the University of Washington. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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All participants ≥ 18 years provided written informed consent in their preferred language. Participants 16–17 years old who were emancipated or mature minors provided written informed consent for participation or provided assent while a parent/guardian provided informed consent in their preferred language.

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Velloza, J., Mujugira, A., Muwonge, T. et al. A novel “HIV salience and Perception” scale is associated with PrEP dispensing and adherence among adolescent girls and young women in Kampala, Uganda. AIDS Behav 27, 279–289 (2023). https://doi.org/10.1007/s10461-022-03762-x

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