Youth health programme doubles HIV prevention embrace
A landmark SAMRC study shows adolescent girls and young women in programme areas were twice as likely to use PrEP, though long-term adherence gaps remain.
Young women living in South African communities reached by the My Journey programme were twice as likely to have used HIV pre-exposure prophylaxis (PrEP) as their peers in comparable communities, according to a study led by the South African Medical Research Council (SAMRC) and published in The Lancet Regional Health – Africa.
The HERStory 3 study surveyed 5 025 adolescent girls and young women aged 15–24 across 24 subdistricts in eight provinces between February and May 2024.
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Twelve subdistricts that implemented the programme were matched to 12 comparison areas.
Participation exceeded 97%, and HIV status was confirmed by laboratory testing of dried blood spot samples.
To the authors’ knowledge, this is the first controlled evaluation of a large-scale combination HIV prevention programme for adolescent girls and young women in South Africa to use contemporaneous matched comparison areas and laboratory-confirmed outcomes.
In programme areas, 26.4% of young women reported using PrEP, compared with 13% elsewhere.
Knowledge of HIV status was 84.7% against 80.5%, with the gap clearest among girls aged 15 to 19. HIV prevalence was 9.5% in programme areas and 10.4% in comparison areas — a difference that was not statistically significant.
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Starting PrEP, however, did not always lead to continued use. Among sexually active young women living without HIV, 22.2% in programme areas had used PrEP, but only 7.1% were using it at the time of the survey, compared with 6.1% in comparison areas.
“Where the My Journey Programme was implemented, twice as many young women had used PrEP and more knew their HIV status,” said SAMRC health systems research unit principal investigator and lead author Dr Kim Jonas. “These findings show that young women are willing to use effective HIV prevention tools when they are accessible. However, initiating PrEP is only part of the prevention journey.”
The authors said long-acting options, including the twice-yearly injectable Lenacapavir, delivered through youth-friendly services, could help overcome barriers to continued use.
SAMRC chief scientific officer Prof Glenda Gray said few large-scale programmes are evaluated this way under routine conditions.
The study shows what combination prevention can achieve at scale, while highlighting persistent gaps.
She called for stronger integration of economic empowerment and structural interventions to address poverty, educational disruption, and unequal gender relations.
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