Abstract / Summary
Abstract Background : Human Immunodeficiency Virus (HIV) remains a significant public health challenge in Kenya, with Adolescent Girls and Young Women (AGYW) at an increased risk. Although pre-exposure prophylaxis (PrEP) was integrated into Kenya’s HIV prevention program close to a decade ago, it is still underutilized among AGYW outside the key populations at high risk for HIV. Understanding PrEP acceptability is crucial for scaling prevention efforts. Objective : To determine the acceptability of PrEP and associated factors among AGYW in Kenya. Methods : This was a cross-sectional study using secondary data from the 2022 Kenya Demographic and Health Survey (KDHS), which used a two-stage stratified sampling approach. Participants were 1,668 AGYW from the 2022 KDHS who were aware of PrEP, HIV negative, and of age 16 to 24 years. Data was analyzed using STATA 17 in the survey window and acceptability of PrEP was estimated with 95% confidence intervals (CIs). Modified Poisson regression was used to determine associated factors. Results : The prevalence of PrEP acceptability among AGYWwas 73.7% (95% CI: 70.6–76.5). A higher likelihood of PrEP acceptability was observed among participants residing in Eastern (adjusted prevalence ratio [aPR] = 1.34; 95% CI: 1.07–1.68), Nyanza (aPR = 1.55; 95% CI: 1.22–1.98), and Nairobi (aPR = 1.50; 95% CI: 1.21–1.86) regions compared to Central region. Ethnicity was also associated with PrEP acceptability, with higher prevalence among Luhya (aPR = 1.26; 95% CI: 1.07–1.49) and Mijikenda/Swahili (aPR = 1.26; 95% CI: 1.01–1.57) compared to Luo. Moreover, a higher likelihood of PrEP acceptability was observed among participants belonging to other religious groups (Hindu, traditional beliefs, no religion, and other affiliations) (aPR = 1.21; 95% CI: 1.10–1.34) and among those who did not desire children (aPR = 1.11; 95% CI: 1.06–1.17). In contrast, participants with tertiary education (aPR = 0.90; 95% CI: 0.82–1.00) and those with justification of wife beating (aPR = 0.87; 95% CI: 0.79–0.96) had a lower likelihood of PrEP acceptability compared to those with secondary education and no justification of wife beating, respectively. Conclusions : PrEP acceptability among adolescent girls and young women in Kenya was high (73.7%), although 26.3% did not accept PrEP. Acceptability varied significantly by region, ethnicity, education, religion, desire for children, and attitudes towards wife beating, stressing the influence of individual and sociocultural factors on PrEP decision-making. Targeted, culturally responsive, youth-friendly, and gender-sensitive PrEP interventions are needed to address these differences and improve PrEP acceptability among AGYW.