Motivations for Starting and Stopping PrEP: Experiences of Adolescent Girls and Young Women in the HPTN 082 Trial.

Oral PrEP effectiveness depends on consistent use during periods of potential HIV exposure, but adolescent girls and young women (AGYW) find this challenging. Data on PrEP use decision-making and alignment with risk among AGYW are limited. From 2016 to 2018, we conducted in-depth interviews with participants in HPTN 082, an open-label PrEP study in South Africa and Zimbabwe, to explore reasons for PrEP starts, stops, and restarts. Of 60 PrEP acceptors, 12 delayed acceptance, 15 used PrEP intermittently, 18 paused and restarted PrEP, and 13 permanently discontinued PrEP during 12-month follow-up. Perceived HIV vulnerability motivated PrEP start, but there was little evidence that fluctuating risk perception motivated prevention-effective use. PrEP stops were motivated by stigma, misconceptions and side effects; PrEP restarts were prompted by support from family, peers and clinic staff. Decision-making was related to social, gendered and normative influences, highlighting opportunities for psycho-educational support and multimedia campaigns to normalise HIV prevention.