Skip to main content
Download PDF

Awareness of, willingness to use, and experiences with Pre-exposure prophylaxis among youth in Nigeria

BMC Health Services Research volume 24, Article number: 1128 (2024) Cite this article

Abstract

Background

Youth (ages 14–24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria.

Methods

This is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables.

Results

Of the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20–24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis.

Conclusion

Nigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population.

Trial Registration

NCT04070287, the Date of registration of the trial is 20-07-2019.

Peer Review reports

Background

Youth (14–24 years) are disproportionately affected by HIV, especially by new HIV infections [1]. Even with the advent of antiretroviral therapy (ART) and its tremendous impact alongside other preventative interventions in reducing new HIV infections and AIDS-related mortality among youth in Africa, HIV remains the primary cause of death among adolescents and young adults in Africa [2, 3]. In Nigeria, youth account for approximately one-third of new HIV infections [2]. New HIV infections in the country are driven by a lack of comprehensive sexual health education, sexual and gender-based violence, poor access to sexual and reproductive health services, and poverty [4]. Data has shown that young adolescents are among the most vulnerable populations to HIV, and having adequate HIV awareness is crucial for protecting them [5, 6]. Unfortunately, despite the numerous available information sources, HIV prevention awareness is not as prevalent among youth in Nigeria and HIV infection in youth continues to be a public health concern [6]. Nigeria needs to scale up its youth prevention services, especially among youth who are most at risk [7], to achieve a significant reduction in the rate of new infections. Despite signs of progress in HIV prevention and treatment, only a small percentage of youth have access to effective biomedical interventions such as pre-exposure prophylaxis (PrEP) that can prevent HIV transmission [8,9,10].

PrEP is an antiretroviral that HIV-negative persons at risk of HIV can take to prevent infection via sexual intercourse or injectable drug usage [8]. When used as instructed, PrEP can reduce the risk of contracting HIV through intercourse by up to 99% [8]. Currently, in Nigeria, only an estimated 400 people at high risk of HIV are using PrEP, putting Nigeria at the bottom of African countries that recommend PrEP in its national HIV guidelines [11]. Due to a lack of awareness about PrEP, behavioral issues, and legal and financial hurdles to youth seeking sexual and reproductive health care, PrEP uptake has been poor [12, 13]. Increased PrEP use among HIV-negative youth has the potential to minimize new infections and resolve long-standing racial inequities in HIV infection rates [14, 15].

According to studies on its safety and feasibility, youth have tolerated PrEP well, despite adherence issues [16]. There is a lack of evidence available for PrEP delivery and accessibility in Africa [17]. Most studies that have examined the use and awareness of PrEP are in developed countries [18]. There is a paucity of studies on PrEP conducted among youth in Nigeria. The few studies conducted have focused on men who have sex with men (MSM), female sex workers (FSW), and sexual minority men (SMM) [19,20,21,22]. With a PrEP cost of $233 per patient-year assumed in Nigeria, few studies have looked at its effect on use among youth [23]. Limited attention is given to PrEP awareness and interest among youth in Nigeria. Understanding the degree of awareness, willingness and uptake of PrEP among youth will inform developing strategies to target youth with biomedical HIV prevention.

Despite recently increased efforts to enhance youth involvement in HIV prevention research, few researchers have actively involved youth [24]. This paper presents the results of a cross-sectional survey study nested in a youth-driven quasi-experimental cohort study, the Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) study, known locally in Nigeria as 4 Youth by Youth (4YBY) [25]. This study examined service delivery of HIV-self testing and STI testing across five sites in Nigeria by engaging youth in crowdsourcing activities and apprenticeship training to develop interventions that would be implemented and driven by youth in the community [26]. Crowdsourcing is a participatory strategy that involves a group of people attempting to solve an issue and then sharing their solutions with the public [27,28,29]. This study aims to determine the awareness of PrEP among youth aged 14–24 years in five geographical locations in Nigeria; determine the willingness of youth aged 14–24 years to use PrEP in five geographical locations in Nigeria; and to examine the factors that are associated with awareness of PrEP and willingness to use PrEP among youth 14–24 years in five geographical locations in Nigeria.

Methods

Study design and site

We conducted a pilot cross-sectional survey from September 2019 to March 2020 as part of a larger study, which is registered with ClinicalTrials.gov (NCT04070287) [30]. The details of the interventions and techniques used in the more extensive study can be found in Fig. 1, ClinicalTrials.gov (NCT04070287) and an already published paper for the innovations [26, 30]. This study took place in five sites located in four states out of the thirty-six states in Nigeria. The states are Lagos, Enugu, Oyo, and Ondo, spread across five distinct geographical catchment areas.

Fig. 1
figure 1

Steps for the intervention development process [26]

Full size image

Study population

The study participants’ eligibility criteria included [26] being 14–24 years old; self-reported HIV negative or unknown HIV status; able to speak and understand English; being willing and able to provide informed consent, and have a mobile phone [26]. Recruitment occurred through community-based events, social media platforms, and peer referrals [26].

Data collection and measures

Trained youth research facilitators were responsible for recruiting study participants and data collection. The youth research facilitators were a team of 3–5 youth at each study site. Data for this study was collected through questionnaires. The primary outcomes of this study were if PrEP was ever used, PrEP awareness, and willingness to use PrEP.

Definition of outcomes

PrEP awareness was defined as the proportion of youth who had ever heard of PrEP.

Willingness to use PrEP was defined as the proportion of participants who responded that they were interested in taking PrEP after reading the following statement “Researchers say that PrEP is generally safe and is highly effective (over 90%) in preventing HIV infection if taken every day. Taking PrEP would require a visit to a doctor every three months to be tested for HIV, STIs, and side effects. Would you be interested in taking PrEP to reduce your current risk of HIV infection?” PrEP uptake was defined as the proportion of participants that had ever used PrEP. This outcome did not specify event-driven versus daily PrEP.

Other measures

The participants were asked about their willingness to pay for PrEP and how much they would be willing to pay. The amount varied in categories from < $12USD (N5,000) to > $24USD (N10,000) per month.

Data analysis

Descriptive statistics were used to present frequencies and percentages for categorical variables. Chi-squared tests (χ2) were done to determine if there was a relationship between the variables studied. Statistical significance was based on a p-value of ≤ 0.05; P-values were 2-tailed. Variables that were significant were evaluated using logistic regression analysis. Dependent variables are awareness of PrEP and willingness to take PrEP. Missing data was classified as a non-event occurrence for any reason, including refusal to answer a question or failure to complete an evaluation (i.e., zero). All analyses were performed using online SAS OnDemand for academics.

Ethical consideration

This research involved human participants, and was performed in accordance with the Declaration of Helsinki. Ethical approval for this study was obtained from two ethical committees. Ethical approvals for the study were granted by Saint Louis University and the Nigerian Institute of Medical Research Institutional Review Boards, protocol number 31,457 and IRB/18/028, respectively. According to the Nigerian Guidelines for Young Persons’ Participation in Research and Access to Sexual and Reproductive Health Services in Nigeria, parental consent is waived for young people aged 14 years and above [31].

Results

Of the 388 participants that enrolled for this study and completed baseline and follow-up assessments, only 324 responded to questions related to PrEP. The participants’ sociodemographic characteristics are shown in Table 1, which indicates that the majority of the youth are within the age group 20–24 years (75.9%), male (57.7%), and indicated secondary school as their highest level of education (57.5%). Most youth had never been married (98.8%) and were students (67.0%). Most youth (91.5%) had a monthly income of less than or equal to 50,000 Naira ($120USD). Only 3.2% of the participants had ever used PrEP, and this number was too small to carry out further analysis on factors associated with use.

Table 1 Frequency of baseline sociodemographic characteristics, sexual Behaviour, HIV, and PrEP-related factors among 324 youth in Nigeria
Full size table

Tables 2 and 3 show the chi square test results performed on two outcomes: PrEP awareness and willingness to take PrEP. The majority of the youth had never heard of PrEP (62.6%; Table 2). Variables that were significantly associated with PrEP awareness were the location of the youth, where the majority (48.7%) living in Lagos were not aware of PrEP, while most youth aged 20–24 years (84%) and those who had done a previous HIV test (60%) were aware of the use of PrEP for HIV prevention. Half of the participating youth were willing to use PrEP (50.1%; Table 3). Variables significantly associated with willingness to take PrEP were living in Lagos (57%); ever having had sex (65.8%), previously tested for HIV (58.1%), and condom use for all sexual acts (37.3%). While most of the students (74.5%) had secondary education and were unwilling to use PrEP for HIV prevention, all these variables were statistically significant. Further analyses were performed on all statistically significant variables with the sociodemographic variables.

Table 2 Factors associated with PrEP awareness among youth 14–24 years in Nigeria
Full size table
Table 3 Factors associated with willingness to use PrEP among youth 14-24years in Nigeria
Full size table

In Table 4, crude odds for the youth age group for awareness of PrEP 2.2 (1.2,4.0), willingness to use PrEP 1.7 (1.0,2.8) as well as who had previously tested for HIV, willingness to take PrEP 1.6 (1.0,2.5) and awareness of PrEP 1.7 (1.0,2.7) were statistically significant. After controlling for other variables compared in the logistic regression model, youth residing in Ondo (AOR 4.1; CI1.5,11.3) and in Enugu (AOR 3.3; CI 1.1,9.4) were more likely to use PrEP than those in Lagos. Youth with secondary education had increased odds of willingness to take PrEP than those with tertiary education (AOR 2.1, CI 1.0,4.6). At the same time, youth who used condoms in all sexual acts (AOR 0.5; CI 0.1,0.9) were less willing to use PrEP compared to youth who did not use condoms.

Table 4 Shows the crude odds ratio and adjusted odds ratio of willingness to take PrEp and awareness of PrEP
Full size table

Discussion

The results of this study are among the first in Nigeria to focus on youth to document their awareness, willingness, and use of PrEP. Though youth who had done HIV testing were more likely to have heard of PrEP than those who had not, this study revealed an overall low awareness of PrEP among this demographic. Other studies have suggested that PrEP awareness is related to geographic location [32]. Although the willingness to use PrEP was higher in this study, this was only marginal to the number not willing to use PrEP.

The use of PrEP was low in this study, similar to previous reports of PrEP use among adults [1, 33, 34]. The use of PrEP is associated with awareness of PrEP. Our finding that willingness to use PrEP is associated with secondary education is aligned with current suggestions to tailor PrEP promotion materials to older youth and underscores the need to improve PrEP information access for youth with lower education [21, 35, 36]. There is also a need to ensure that PrEP information is developmentally appropriate for all sexually active youth [36, 37]. A history of being sexually active is related to a willingness to use PrEP; this is linked with high-risk behavior and a higher risk perception of acquiring HIV, which is associated with a desire to use PrEP [1, 21, 33, 34, 37, 38].

Some studies have provided evidence showing Nigerians’ low level of awareness and the use of PrEP among youth who could benefit from PrEP [1]. Poor awareness of PrEP among youth in high HIV risk settings may limit its use [39]. Another barrier is the cost of PrEP which is about $233 [23] a year; meanwhile, the total amount that youth are willing to pay for PrEP is $12 per month, which will be $144 a year. Although it was not reported in this study, it would be interesting to know where those who accessed PrEP found it and how accessible it is to youth. Although the Nigerian government has implemented a range of channels in messaging these essential services across to the target groups—from in-person, social media, television, and radio adverts, however, few successes have been documented [34]. In Nigeria, several studies have reported low PrEP awareness [1, 21, 39,40,41]. Studies ranged from those done among secondary school and university students [1, 19, 40] to the key populations in Nigeria [21, 35, 42, 43]. These outcomes are similar to those of other African studies where some participants were unaware of any PrEP or had a narrow and limited introduction to PrEP, thereby limiting reach and access to PrEP [44, 45]. While in other countries, higher levels of awareness are observed among youth during clinic visits [46,47,48]. Low PrEP awareness among youths in other studies was found to show gendered PrEP awareness [49].

Therein lies the question of why the level of awareness and use of PrEP is low among youth in Nigeria. Some experts have attributed the low level of PrEP awareness and use in Nigeria to the fact that Nigeria started its initial PrEP pilot in 2015, funded by the Gates Foundation, to figure out how to offer treatment in real-life situations [50]. Concerns have evolved on the possibility of condom migration, increased risk for sexually transmitted infections and unintended pregnancy, and poor adherence to medication when using PrEP among youth. While others have stated that there is a need for public awareness about the use of antiretrovirals for HIV prevention is needed to prevent labeling of PrEP users as being HIV positive [40, 51]. This study indicated that PrEP knowledge is associated with prior HIV testing, which may be related to higher risk perception and greater exposure to PrEP messaging. Comparable outcomes were seen in a study among Nigerian university students [1]. In other countries, similar findings were seen among youth in other studies [52, 53].

The finding in this research supports using HIV testing as a starting point for prevention in behavioral HIV prophylaxis [16, 54]. The low frequency of testing and its association with PrEP indicates the need to continue to increase HIV testing among youth in Nigeria. Evidence suggests that the low awareness of PrEP in this study indicated the need for developing strategies that increase access to information about PrEP that is developmentally and culturally appropriate among youth in Nigeria. This research further emphasizes the significance of involving youth in developing interventions that address cultural and normative obstacles to PrEP [55, 56]. Youth attitudes and behaviors must be understood to develop strategies for effective PrEP implementation [57].

This study had various limitations; the small number of PrEP users limited statistical analyses. This study’s data is self-reported, leading to recall bias and social desirability issues. Community-based sampling strategies were used in this study, so the findings may not generalize to all youth in Nigeria. Furthermore, our findings cannot be generalized to other high-risk youth populations underrepresented in the study.

Conclusion

This study’s findings suggest the importance of location when considering awareness and use of PrEP among youth. The low level of knowledge about PrEP suggests the need to implement interventions that are acceptable to youth in Nigeria, which could positively impact their awareness, thereby subsequently improving their willingness to use PrEP. Efforts to increase uptake of PrEP, and HIV testing among this population, should consider youth-led PrEP studies to effectively communicate the benefits of PrEP among this population.

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ART:

Antiretroviral therapy

HIV:

Human immunodeficiency virus

PrEP:

Pre-exposure prophylaxis

SSA:

Sub-Saharan Africa

USD:

United states Dollar

References

  1. Ajayi AI, Ismail KO, Adeniyi OV, Akpan W. Awareness and use of pre-exposure and postexposure prophylaxes among Nigerian university students: findings from a cross-sectional survey. Medicine. 2018;97.

  2. Unaids, W O R L D A I D S D A Y 2021. 2021.

  3. UNAIDS. 90-90-90: treatment for all | UNAIDS. Miles To Go - Unaids Data 2018. 2018. https://www.unaids.org/en/resources/909090. Accessed 22 Sep 2020.

  4. Awofala AA, Ogundele OE. HIV epidemiology in Nigeria. Saudi J Biol Sci. 2018;25:697–703.

    Article  PubMed  Google Scholar 

  5. Agyemang S. The extent of knowledge about HIV/AIDS among young people in the Ejura-Sekyedumase district of Ghana. J AIDS HIV Res. 2012;4:241–7.

    Article  Google Scholar 

  6. Badru T, Mwaisaka J, Khamofu H, Agbakwuru C, Adedokun O, Pandey SR et al. HIV comprehensive knowledge and prevalence among young adolescents in Nigeria: evidence from Akwa Ibom AIDS indicator survey, 2017. BMC Public Health. 2020;20.

  7. Makhema J, Wirth KE, Pretorius Holme M, Gaolathe T, Mmalane M, Kadima E, et al. Universal Testing, expanded treatment, and incidence of HIV infection in Botswana. N Engl J Med. 2019;381:230–42.

    Article  PubMed  PubMed Central  Google Scholar 

  8. CDC. Latinos Race/Ethnicity HIV by Group HIV/AIDS. 2020.

  9. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28:841–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. NIH.gov. Pre-Exposure Prophylaxis (PrEP) | NIH. 2021. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/pre-exposure-prophylaxis-prep. Accessed 19 May 2022.

  11. Adebowale-Tambe N, PrEP. HIV prevention drug many Nigerians need, don’t know about and can’t afford | Premium Times Nigeria. 2019. https://www.premiumtimesng.com/health/health-interviews/325209-prep-hiv-prevention-drug-many-nigerians-need-dont-know-about-and-cant-afford.html?tztc=1. Accessed 19 Feb 2023.

  12. Culp L, Caucci L. State adolescent consent laws and implications for HIV Pre-exposure Prophylaxis. Am J Prev Med. 2013;44:S119–24.

    Article  PubMed  Google Scholar 

  13. Sullivan PS, Giler RM, Mouhanna F, Pembleton ES, Guest JL, Jones J, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann Epidemiol. 2018;28:833–40.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hamilton DT, Goodreau SM, Jenness SM, Sullivan PS, Wang LY, Dunville RL, et al. Potential impact of HIV Preexposure Prophylaxis among Black and White adolescent sexual minority males. Am J Public Health. 2018;108:S284–91.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Albritton T, Eweka I, Fleuriscar J, Fleuriscar J, Adeyemi-Jones A, Dillon B. U.S. Food and Drug Administration approves pre-exposure prophylaxis use for adolescents: next steps. Prev Med (Baltim). 2018;116:222.

    Article  Google Scholar 

  16. Hosek S, Celum C, Wilson CM, Kapogiannis B, Delany-Moretlwe S, Bekker L-G. Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa. J Int AIDS Soc. 2016;19:21107.

    Article  PubMed  PubMed Central  Google Scholar 

  17. O’malley G, Barnabee G, Mugwanya K, THE SCIENCE OF PREVENTION (JD STEKLER AND JM BAETEN, SECTION EDITORS). Scaling-up PrEP Delivery in Sub-Saharan Africa: What Can We Learn from the Scale-up of ART? 2019. https://doi.org/10.1007/s11904-019-00437-6

  18. WHO. Global PrEP Network Highlight - March. 2021. 2021. https://www.who.int/news-room/feature-stories/detail/global-data-shows-increasing-prep-use-and-widespread-adoption-of-who-prep-recommendations. Accessed 30 Sep 2022.

  19. Idoko J, Folayan M. The use of antiretroviral therapy for the Prevention of New HIV infection in populations at high risk for HIV Sero-conversion in Nigeria. Afr J Reprod Health. 2015;18:127–34.

    Google Scholar 

  20. Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A et al. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health 2020 20:1. 2020;20:1–10.

  21. Ogunbajo A, Iwuagwu S, Williams R, Biello K, Mimiaga MJ. Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria. PLoS ONE. 2019;14:e0226384.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Adeoti AO, Demir E, Adeyemi S, Yakutcan U, Kengne AP, Kayode G et al. Impact of pre-exposure and post-exposure prophylaxes prevention programme on HIV burden and services in a low-resource setting: a simulation modelling approach. Pan Afr Med J. 2021;40.

  23. Case KK, Gomez GB, Hallett TB. The impact, cost and cost-effectiveness of oral pre-exposure prophylaxis in sub-saharan Africa: a scoping review of modelling contributions and way forward. J Int AIDS Soc. 2019;22.

  24. Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, et al. Youth engagement in HIV prevention intervention research in sub-saharan Africa: a scoping review. J Int AIDS Soc. 2021;24:e25666.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Iwelunmor J, Tucker JD, Obiezu-Umeh C, Gbaja-Biamila T, Oladele D, Nwaozuru U et al. The 4 youth by Youth (4YBY) pragmatic trial to enhance HIV self-testing uptake and sustainability: study protocol in Nigeria. Contemp Clin Trials. 2022;114.

  26. Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbaja-Biamila T, Musa AZ, Nwaozuru U, et al. Enhancing HIV Self-Testing among Nigerian youth: feasibility and preliminary efficacy of the 4 youth by Youth Study using Crowdsourced Youth-Led strategies. AIDS Patient Care STDS. 2022;36:64–72.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tucker JD, Day S, Tang W, Bayus B. Crowdsourcing in medical research: concepts and applications. PeerJ. 2019;2019:e6762.

    Article  Google Scholar 

  28. Tucker JD, Tang W, Li H, Liu C, Fu R, Tang S, et al. Crowdsourcing designathon: a new model for multisectoral collaboration. BMJ Innov. 2018;4:46–50.

    Article  Google Scholar 

  29. World Health Organization (WHO). Crowdsourcing in Health and Health Research: A Practical Guide. The Special Programme for Research and Training in Tropical Diseases(TDR). 2018;:1–36.

  30. NIH. Home - ClinicalTrials.gov. 2022. https://www.clinicaltrials.gov/. Accessed 20 May 2022.

  31. Federal Ministry of Health. Guidelines for young persons’ participation in Research and Access to sexual and Reproductive Health Services in Nigeria. Abuja; 2014.

  32. AIDSVu. Mapping PrEP: First Ever Data on PrEP Users Across the U.S. 2018. https://aidsvu.org/prep/. Accessed 30 Sep 2022.

  33. Ajayi AI, Awopegba OE, Adeagbo OA, Ushie BA. Low coverage of HIV testing among adolescents and young adults in Nigeria: implication for achieving the UNAIDS first 95. PLoS ONE. 2020;15:e0233368.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Durosinmi-Etti O, Nwala EK, Oki F, Ikpeazu A, Godwin E, Umoh P, et al. Communication needs for improved uptake of PrEP and HIVST services among key populations in Nigeria: a mixed-method study. AIDS Res Ther. 2021;18:1–13.

    Article  Google Scholar 

  35. Ogunbajo A, Tsai AC, Kanki PJ, Mayer KH. Acceptability of and preferences for Long-Acting Injectable HIV PrEP and other PrEP modalities among sexual minority men in Nigeria, Africa. AIDS Behav. 2022;1:1–13.

    Google Scholar 

  36. Taggart T, Liang Y, Pina P, Albritton T. Awareness of and willingness to use PrEP among Black and Latinx adolescents residing in higher prevalence areas in the United States. PLoS ONE. 2020;15:e0234821.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Taggart T, Bond KT, Ritchwood TD, Smith JC. Getting youth PrEPared: adolescent consent laws and implications for the availability of PrEP among youth in countries outside of the United States. J Int AIDS Soc. 2019;22.

  38. Eaton LA, Matthews DD, Driffin DD, Bukowski L, Wilson PA, Stall RD. A Multi-US City Assessment of Awareness and Uptake of Pre-exposure Prophylaxis (PrEP) for HIV Prevention among Black men and Transgender women who have sex with men. Prev Sci. 2017;18:505–16.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ajayi AI, Mudefi E, Yusuf MS, Adeniyi OV, Rala N, Goon D, Ter. Low awareness and use of pre-exposure prophylaxis among adolescents and young adults in high HIV and sexual violence prevalence settings. Medicine. 2019;98.

  40. Idoko J, Folayan MO, Dadem NY, Kolawole GO, Anenih J, Alhassan E. Why should i take drugs for your infection? Outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria. BMC Public Health. 2015;15:1–12.

    Article  Google Scholar 

  41. Obinna chioma. With more investment in HIV prevention, PrEP can help suppress infection — EXPERTS. 2021. https://www.vanguardngr.com/2021/06/with-more-investment-in-hiv-prevention-prep-can-help-suppress-infection-experts/. Accessed 12 Jul 2022.

  42. Obinna chioma. With more investment in HIV prevention, PrEP can help suppress infection — EXPERTS. 2021. https://www.vanguardngr.com/2021/06/with-more-investment-in-hiv-prevention-prep-can-help-suppress-infection-experts/. Accessed 11 Jul 2022.

  43. Dubov A, Ogunbajo A, Altice FL, Fraenkel L. Optimizing access to PrEP based on MSM preferences: results of a discrete choice experiment. Volume 31. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV; 2019. pp. 545–53.

  44. Lunkuse JF, Kamacooko O, Muturi-Kioi V, Chinyenze K, Kuteesa MO, Price MA, et al. Low awareness of oral and injectable PrEP among high-risk adolescent girls and young women in Kampala, Uganda. BMC Infect Dis 2022. 2022;22(1):22:1–9.

    Google Scholar 

  45. Chimbindi N, Mthiyane N, Zuma T, Baisley K, Pillay D, McGrath N et al. Antiretroviral therapy based HIV prevention targeting young women who sell sex: a mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa. https://doi.org/10.1080/09540121.2021.1902933. 2021;34:232–40.

  46. Sila J, Larsen AM, Kinuthia J, Owiti G, Abuna F, Kohler PK, et al. High awareness, yet low uptake, of Pre-exposure Prophylaxis among adolescent girls and Young women within Family Planning clinics in Kenya. AIDS Patient Care STDS. 2020;34:336–43.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Birdthistle I, Mulwa S, Sarrassat S, Baker V, Khanyile D, O’Donnell D, et al. Effects of a multimedia campaign on HIV self-testing and PrEP outcomes among young people in South Africa: a mixed-methods impact evaluation of ‘MTV Shuga Down South’. BMJ Glob Health. 2022;7:e007641.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kahle EM, Sullivan S, Stephenson R. Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill. 2018;4(1):e13 https://publichealth.jmir.org/2018/1/e13. 2018;4:e8089.

  49. Shamu S, Shamu P, Khupakonke S, Farirai T, Chidarikire T, Guloba G et al. Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts. https://doi.org/10.1080/16549716.2021.1886455. 2021;14.

  50. Adepoju BP. African nations lead the world in offering PrEP HIV prevention drug. Health. 2021;3320 February:1–3.

    Google Scholar 

  51. Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A, et al. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health. 2020;20:1–10.

    Article  Google Scholar 

  52. Ssuna B, Katahoire A, Armstrong-Hough M, Kalibbala D, Kalyango JN, Kiweewa FM. Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda. BMC Public Health. 2022;22:1–8.

    Article  Google Scholar 

  53. Iloanusi SH, Mgbere OO, Abughosh SM, Essien EJ. HIV non-occupational post exposure Prophylaxis in Nigeria: a systematic review of Research evidence and practice. Int J Maternal Child Health AIDS. 2019;8:101.

    Article  Google Scholar 

  54. Mack N, Odhiambo J, Wong CM, Agot K. Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: results of a consultation with community stakeholders. BMC Health Serv Res. 2014;14:1–12.

    Article  Google Scholar 

  55. Barreras JL, Linnemayr SL, MacCarthy S. We have a stronger survival mode: exploring knowledge gaps and culturally sensitive messaging of PrEP among latino men who have sex with men and Latina transgender women in Los Angeles, CA. Volume 31. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV; 2019. pp. 1221–7.

  56. García M, Harris AL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS ONE. 2017;12.

  57. Yoshioka E, Giovenco D, Kuo C, Underhill K, Hoare J, Operario D. I’m doing this test so I can benefit from PrEP: exploring HIV testing barriers/facilitators and implementation of pre-exposure prophylaxis among South African adolescents. https://doi.org/10.2989/16085906.2020.1743726. 2020;19:101–8.

Download references

Acknowledgements

Not applicable.

Funding

The study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grant number: UG3HD096929. The authors are also funded by the National Institute of Mental Health (R00MH104154, R34MH109359, and R34MH119963) and the National Institute of Allergy and Infectious Diseases (P30AI50410 and K24AI143471).

Author information

Authors and Affiliations

  1. Washington University in St Louis, St Louis, USA

    Titilola Gbaja-Biamila & Juliet Iwelunmor

  2. Nigerian Institute of Medical Research, Lagos, Nigeria

    Titilola Gbaja-Biamila, David Oladele, Adesola Z. Musa, Ifeoma Idigbe & Oliver Ezechi

  3. Northwestern University, Chicago, USA

    Chisom Obiezu-Umeh

  4. Wake Forest School of Medicine, Winston-Salem, USA

    Ucheoma Nwaozuru

  5. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Nora E. Rosenberg, Suzanne Day, Kadija Tahlil & Joseph D. Tucker

  6. Rochester General Hospital, New York, USA

    Mesoma Igbokwe

  7. George Washington University, Washington, USA

    Donaldson Conserve

  8. Monash University, Melbourne, Australia

    Jason Ong

  9. Florida State University, Tallahassee, USA

    Kathryn Muessig

  10. London School of Hygiene & Tropical Medicine, London, UK

    Jason Ong, Susan Nkengasong & Joseph D. Tucker

  11. Saint Louis University, St Louis, USA

    Hong Xian

Authors
  1. Titilola Gbaja-Biamila
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chisom Obiezu-Umeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ucheoma Nwaozuru
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nora E. Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mesoma Igbokwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Oladele
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adesola Z. Musa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ifeoma Idigbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donaldson Conserve
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Suzanne Day
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kadija Tahlil
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jason Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kathryn Muessig
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Susan Nkengasong
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hong Xian
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Joseph D. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Oliver Ezechi
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Juliet Iwelunmor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JI, OE, and JDT conceived the study idea. TG wrote the first draft and performed data acquisition and data analysis. CO, UN, REN, DO, AZM, II, DC, SD, KT, JO, KM, HX, OE, MI, and SN reviewed drafts and provided written feedback. JI, JDT, OE, and TG edited the paper for critical content. All authors contributed substantially to the preparation of this manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Titilola Gbaja-Biamila.

Ethics declarations

Ethics approval and consent to participate

This study included human subjects. Informed consent was obtained from all the participants and Ethical approvals for the study were granted by Saint Louis University and the Nigerian Institute of Medical Research Institutional Review Boards, protocol number 31457 and IRB/18/028, respectively. We confirm that the relevant guidelines and regulations were conducted in line with the declaration of Helsinki in all methods used in this study. Please note, all participants provided written informed consent before participating in the study, and they were reminded that their participation was voluntary. According to the Nigerian Guidelines for Young Persons’ Participation in Research and Access to Sexual and Reproductive Health Services in Nigeria, parental consent is waived for young people aged 14 years and above [31].

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gbaja-Biamila, T., Obiezu-Umeh, C., Nwaozuru, U. et al. Awareness of, willingness to use, and experiences with Pre-exposure prophylaxis among youth in Nigeria. BMC Health Serv Res 24, 1128 (2024). https://doi.org/10.1186/s12913-024-11459-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12913-024-11459-1

Keywords

BMC Health Services Research

ISSN: 1472-6963

Contact us