BACKGROUND: Adolescent girls and young women (AGYW) in Kenya experience heightened risk for HIV, which is compounded by high rates of gender-based violence (GBV). We used a participatory process involving AGYW in developing an intervention to support their pre-exposure prophylaxis (PrEP) use in the context of GBV and gender inequality in Siaya County, Kenya.
DESCRIPTION: We conducted formative research with 24 AGYW to understand PrEP and GBV related challenges and intervention preferences.Through a series of 3 consultations with our youth advisory board (YAB), youth guided our formative research, interpreted results, and participated in a human-centred design workshop to identify appropriate interventions and contribute to their design. Additional workshops following intervention development helped pre-test the manualized components, including specific activities, language, and implementation factors.
LESSONS LEARNED: YAB engagement in the design of formative research, interpretation of results, intervention design and testing led to an intervention responsive to AGYW's stated needs for PrEP support in the context of their relationships. While the intervention conceptualized at the proposal stage of the research was clinic-based GBV screening and counselling, the formative research and YAB feedback identified a need to work at the community level, engage men in the intervention, and provide peer support. This led to the development of a manualized support club for AGYW interested in PrEP, community-based male sensitization sessions addressing male partner concerns with PrEP and couples-based community events. Intervention pre-testing with YAB and AGYW helped further refine the intervention, including specific stories for drama-based activities and the implementation of these performances at the couples' events. The intervention is being evaluated for acceptability and effectiveness through a six-month pilot community randomized control trial nested within the DREAMS program. Thus far nearly all (94%) participants reported they would recommend it to a friend.
CONCLUSIONS: Youth engagement is critical to designing appropriate interventions addressing complex issues that affect them such as PrEP use in the context of GBV. Formative research with AGYW and early feedback from our YAB resulted in significant changes to the intervention design, as well as contextual changes to improve its implementation. While the pilot RCT is ongoing, preliminary findings suggest its acceptability.