Integrating HIV and STI prevention with family planning services for adolescent girls and young women in Kisumu, Kenya

Thesis (Master's)--University of Washington, 2020Introduction: Expedited partner treatment (EPT) is effective for preventing STI reinfection, but concerns about intimate partner violence and missed opportunities for HIV testing have limited its use in African settings. Methods: We conducted a pilot prospective evaluation of EPT among adolescent girls and young women (AGYW) accessing HIV pre-exposure prophylaxis in an implementation project in Kisumu, Kenya. Those diagnosed with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) by nucleic acid amplification testing were treated and given the option of delivering STI treatment and HIV self-test kits to their current sexual partner(s). Three months after the index AGYW was enrolled, we assessed their experience with delivery of EPT and uptake of services by partners. We compared STI reinfection rates among those successfully delivering EPT to those who did not. Results: Between September 2018 and March 2020, 63 AGYW with 74 STIs (68 CT, 13 NG and 7 both CT and NG positive) were enrolled. The majority 59/63 (94%) accepted EPT and 50/63 (79%) partner HIVST. Three-quarters (46/59) of those accepting EPT returned for the assessment visit with 41/46 (89%) successfully delivering treatment to 54 partners, of whom 49/54 used it. Seventy percent (35/50) who took partner HIVST kits returned for the assessment with 80% (28/35) reporting providing kits to 40 partners, of whom 38/40 (95% ) used it. Reported barriers to EPT and HIVST distribution included fear that the partner could become angry or violent, and or loss of relationship. Conclusion: Both EPT and partner HIVST were acceptable despite the noted barriers among Kenyan AGYW with etiologic diagnosis of CT/NG and their partners