Submission ID 130470
| Issue/Objective | Adolescents and young adults (AYAs) from key and priority populations face persistent challenges with sustained engagement in HIV pre-exposure prophylaxis (PrEP) care, with early disengagement undermining the effectiveness of HIV prevention efforts. While PrEP initiation has expanded across sub-Saharan Africa, inequities in retention remain, shaped by social vulnerabilities, relationship dynamics, and differences in service delivery models. Evidence on long-term retention and drivers of disengagement using routine program data remains limited. This study examined time to PrEP disengagement and associated factors among AYAs in eastern Uganda. By identifying patterns of disengagement within real-world service settings, this research contributes to advancing global health equity by informing evidence-driven, context-responsive strategies to strengthen retention and improve HIV prevention outcomes among marginalized youth. |
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| Methodology/Approach | We conducted a retrospective longitudinal analysis of routinely collected program data for AYAs aged 15-29 years from key and priority populations who initiated PrEP between 2019 and 2025 at Mbale Regional Referral Hospital. Time to PrEP disengagement was assessed using Kaplan-Meier survival analysis and Cox proportional hazards regression. Multivariable models adjusted for sociodemographic, relational, behavioral, and service delivery factors. Sensitivity analyses redefined the time origin to day 91 following PrEP initiation to reflect the programmatic 90-day grace period. |
| Results | Among 3,553 AYAs initiating PrEP, the median time to disengagement was 284 days (95% CI: 273-295), and the median age was 24 years (interquartile range [IQR]: 20-26). The probability of remaining engaged in PrEP care declined from 60.1% at 90 days to 20.2% at 365 days. Survival patterns differed significantly by population category and sex at birth, but not by age group. In adjusted analyses (N = 3,391), knowledge of a partner's HIV status (adjusted hazard ratio [aHR] = 2.04; 95% CI: 1.82-2.29) and initiation through community-based services (aHR = 1.42; 95% CI: 1.17-1.72) were associated with a higher hazard of disengagement. Married participants had lower hazards of disengagement compared with single participants (aHR = 0.69; 95% CI: 0.64-0.76). Reporting an STI syndrome (aHR = 0.42; 95% CI: 0.32-0.55) or recent gender-based violence (aHR = 0.76; 95% CI: 0.60-0.96) was associated with reduced disengagement. Findings were consistent in sensitivity analyses. |
| Discussion/Conclusion | These findings highlight early PrEP disengagement among adolescents and young adults and the need for equity-driven, differentiated approaches to improve retention. Strengthening community-based delivery, integrating STI and GBV services, and expanding peer support can enhance sustained engagement. Using routine program data to guide adaptive, youth-centered strategies can address retention gaps. Scaling these interventions can improve equitable access to PrEP and support evidence-informed action to advance global health equity. |
| Presenters and Affiliations | Bosco Mukubba Alliance of Women Advocating for Change Stephen Walwo Mbale Regional Referal Hospital Winnie Namukambi Uganda Christian University |
