Barriers and Facilitators to PrEP Uptake and Adherence among Adolescent Girls and Young Women Attending Family Planning Clinics in Mulanje District, Malawi: A Qualitative Study

Abstract Introduction Adolescent girls and young women (AGYW) in Malawi, with an 8% HIV prevalence, are disproportionately affected by HIV (1), making PrEP a fundumental prevention mechanism. However, PrEP uptake is affected by individual, interpersonal, community, institutional, and structural factors. Identifying these factors is important to improving HIV prevention and achieving the 95-95-95 HIV goals. This study aims to explore these factors influencing PrEP uptake and adherence among AGYW in Mulanje District, providing understing for targeted interventions to increase PrEP coverage and reduce HIV incidence. Methods This research employed a Hybrid Type 1 qualitative design, focusing on Adolescent Girls and Young Women (AGYW) aged 15–24. The study was stratified based on PrEP status, including current users, those identified as eligible but not initiated, and those who have discontinued PrEP. Data collection involved interviews with 30 participants and one focus group discussion with healthcare providers. Thematic analysis was conducted to identify patterns and insights, and the results are presented through a comprehensive narrative and tables highlighting key themes and quotes. Results Our analysis revealed several barriers and facilitators to PrEP uptake and adherence among AGYW. Barriers included stigma and social perception, Healthcare accessibility challenges, and limited awareness and education. Facilitators involved social and peer support, healthcare provider engagement, and convenient and responsive services by staffs. Strategies to enhance PrEP adherence included increasing accessibility, awareness campaigns, integrating PrEP with other health services, and peer and social support initiatives. These findings highlight the need for multi-faceted approaches to address barriers and strengthen facilitators to improve PrEP uptake and adherence, and also implement the suggested interventions. Conclusion Addressing barriers to PrEP uptake among AGYW in Mulanje District requires a complex approach. Key barriers include stigma, healthcare access issues, and low awareness, while facilitators like involved social and peer support, healthcare provider engagement, and convenient and responsive services by staffs. Recommendations to improve PrEP use include enhancing healthcare access, using peer support, and integrating PrEP with other services, and initiating community awareness campaigns. These strategies are important for overcoming barriers, improving adherence, and supporting HIV prevention in Malawi.