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Sex Health. 2018 Nov;15(6):513-521. doi: 10.1071/SH18061.

Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa.

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FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA.
Avenir Health, 7064 Eastern Avenue, NW, Washington, DC 20012, USA.
Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Suite 722, Boston, MA 02114, USA.
Office of HIV/AIDS, Bureau for Global Health, USAID, 1300 Pennsylvania Avenue, Washington, DC, 20004, USA.
World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland.
LVCT Health, Argwings Kodhek Road, PO Box 19835-00202 KNH, Nairobi, Kenya.
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow Health Precinct, Johannesburg 2001, South Africa.
Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, 1600 Clifton Road, MS E-04, Atlanta, GA 30333, USA.
Jhpiego, 1615 Thames Street, Baltimore, MD 21231, USA.
South Africa National Department of Health, Civitas Building, 222 Thabo Sehume Street, CBD, Pretoria, 0001, South Africa.
Jhpiego, 14 Riverside, off Riverside Drive, 2nd Floor, Arlington Block, PO Box 66119-00800, Nairobi, Kenya.
AVAC, 423 West 127th Street, 4th floor, New York, NY 10027, USA.


In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably. Furthermore, operationalising these measures in real-world settings is challenged by the difficulties in defining the denominator for measuring uptake and coverage among AGYW, due to the lack of data and experience required to identify the subset of AGYW at substantial risk of HIV infection. This paper proposes an intervention-centric cascade as a framework for developing a common lexicon of metrics for uptake and coverage of oral PrEP among AGYW. In codifying these indicators, approaches to clearly define metrics for uptake and coverage are outlined, and the discussion on 'low' uptake is reframed to focus on achieving the highest possible proportion of AGYW using oral PrEP when they need and want it Recommendations are also provided for making increased investments in implementation research to better quantify the sub-group of AGYW in potential need of oral PrEP.and for improving monitoring systems to more efficiently address bottlenecks in the service delivery of oral PrEP to AGYW so that implementation can be taken to scale.

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