Determinants for Pre-exposure Prophylaxis Discontinuation among Perceived Low Risk Populations in Homa Bay and Kisii Counties, Kenya

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DOI: 10.21522/TIJPH.2013.14.01.Art012

Authors : Muchele Polycarp Musee, Collins Ouma

Abstract:

Pre-exposure prophylaxis (PrEP) effectively prevents HIV, but early discontinuation—especially among those perceiving low risk—reduces its impact. This study explored socio-demographic and contextual factors influencing PrEP discontinuation and assessed healthcare worker engagement in Homa Bay and Kisii counties, Kenya. Using a correlational design, 293 individuals who stopped PrEP within three months were selected via stratified random sampling from LVCT Vukisha95-supported facilities. Data, collected through structured questionnaires and linked to program records, were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression to identify factors associated with discontinuation. Most participants were female (71.7%), aged 20–34 years, and from Homa Bay (68.3%). County of residence predicted discontinuation, with Kisii residents less likely to stop PrEP than Homa Bay residents (aOR = 0.09; 95% CI: 0.04–0.19; p < 0.001). Formal employment was associated with increased odds of discontinuation (aOR = 2.80; 95% CI: 1.24–6.45; p = 0.014). Individuals aged 25–29 (aOR = 0.26; p = 0.041) and 45–49 (aOR = 0.16; p = 0.038) were less likely to discontinue PrEP than adolescents 15–19 years. Education had a marginal effect, while sex, marital status, income, and HIV risk category were not significant. About 40% cited reasons differing from records, and only 15% consulted healthcare workers before stopping PrEP. PrEP discontinuation driven by perceived low HIV risk is influenced more by contextual and socioeconomic factors than actual risk, highlighting the need for personalized risk assessment, better documentation, and proactive healthcare worker engagement in high-burden areas.

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