{"doi":"10.1002/jia2.26372","title":"Pre‐exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross‐sectional analysis in two communities in western Kenya, 2021–2023","abstract":"INTRODUCTION: Despite the increasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya. METHODS: We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14-55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP. RESULTS: Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19-24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15-19 years more often reported never taking PrEP compared with those 25-36 years (aPR 1.31, 95% CI: 1.06-1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04-0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60-0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02-1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03-2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40-0.92). CONCLUSIONS: We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.","journal":"Journal of the International AIDS Society","year":2024,"id":445881,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7484,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1262260,"name":"Glenna Schluck","orcid":"0000-0001-5311-9636","position":1,"is_corresponding":false},{"id":347966,"name":"Josphat Kosgei","orcid":"0000-0002-0106-524X","position":2,"is_corresponding":false},{"id":1262261,"name":"Christine Akoth","orcid":"0000-0002-1586-7315","position":3,"is_corresponding":false},{"id":1262682,"name":"Rael Bor","orcid":null,"position":4,"is_corresponding":false},{"id":691266,"name":"Deborah Langat","orcid":"0000-0003-0439-1099","position":5,"is_corresponding":false},{"id":496670,"name":"Curtisha Charles","orcid":null,"position":6,"is_corresponding":false},{"id":1262262,"name":"Paul Adjei","orcid":"0000-0002-3778-6559","position":7,"is_corresponding":false},{"id":957025,"name":"Britt Gayle","orcid":"0000-0001-5729-6090","position":8,"is_corresponding":false},{"id":1203092,"name":"Elyse LeeVan","orcid":"0000-0002-2581-9747","position":9,"is_corresponding":false},{"id":1254619,"name":"David Chang","orcid":"0000-0002-6944-5695","position":10,"is_corresponding":false},{"id":437698,"name":"Adam Yates","orcid":"0000-0002-6045-8334","position":11,"is_corresponding":false},{"id":803859,"name":"Margaret Yacovone","orcid":"0000-0002-6983-8560","position":12,"is_corresponding":false},{"id":288616,"name":"Julie A. Ake","orcid":"0000-0003-3831-5828","position":13,"is_corresponding":false},{"id":399562,"name":"Fred Sawe","orcid":"0000-0002-0748-8032","position":14,"is_corresponding":false},{"id":288618,"name":"Trevor A. Crowell","orcid":"0000-0001-5947-265X","position":15,"is_corresponding":false},{"id":1262683,"name":"for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group","orcid":null,"position":16,"is_corresponding":false},{"id":640720,"name":"Matthew L. Romo","orcid":"0000-0002-3038-0644","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:01:46.243344Z","pmid":"39496511","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}