ConceptPrEP-on-Demand: Digital, on-Demand HIV Prevention and Contraceptive Delivery Intervention for Adolescent Girls and Young Women in Southwestern Kenya

Abstract

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa experience high rates of HIV infection
and unintended pregnancy, yet continuation of pre-exposure prophylaxis (PrEP) and non-barrier contraception remains
suboptimal. Digital health interventions (DHIs) offer promise for improving access and autonomy, but their effectiveness
in sustaining prevention behaviours remains not well established.
Objectives: To evaluate the acceptability, feasibility, and 6-month continuation of PrEP and non-barrier contraceptive
use among AGYW using ConceptPrEP-on-demand, a digital, on-demand HIV prevention and contraceptive delivery
intervention, compared with standard facility-based care.
Methods: We conducted a prospective quasi-experimental pilot study between February and December 2023 among
205 AGYW aged 16 to 24 years in Kisumu County, Kenya, at two health facilities providing primary-level sexual
and reproductive health services. Participants self-selected into the digital intervention or the standard-of-care arm in
a non-randomised 1:1 allocation (104 digital; 101 standard). The digital platform provided tele-counselling, online
ordering of SRH commodities, and discreet delivery. The standard-of-care arm received clinic-based PrEP according
to the Kenya national guidelines. Structured surveys were administered at baseline, 3 months, and 6 months post
enrolment via REDCap. Primary outcomes were continuation of PrEP and non-barrier contraceptive methods at 3 and 6
months. Secondary outcomes included intervention acceptability and predictors of continuation. Data were analysed
using descriptive statistics and multivariable Poisson regression with generalised estimating equations (GEE) using an
exchangeable working correlation structure and robust standard errors. Analyses were performed in Stata 18.1, with
statistical significance set at P<.05.
Results: Among 205 participants (104 digital, 101 standard), PrEP continuation at 6 months was lower in the digital
arm (34.4%) compared with the standard-of-care arm (72.0%) (P<.001). Contraceptive continuation also declined in
the digital arm (84.5% vs. 94.7%, P=.036). Multivariable analysis showed that participants in the standard arm were
31% more likely to continue PrEP (adjusted IRR,1.31; 95% CI, 1.05 to1.63). Acceptability of the digital intervention was
high, with 85.1% expressing interest in future use.
Conclusion: These hypothesis-generating findings suggest that digital, on-demand platforms in this context may require
accountability mechanisms and adaptive support to sustain prevention behaviours. Future adequately powered
randomized trials are needed to confirm these signals.