PrEP and Contraceptive Persistence Among Young Women Receiving Sexual and Reproductive Health Services Through Hair Salons in South Africa

BACKGROUND: Young women have high HIV incidence and risk for unintended births in sub-Saharan Africa. Hair salons may be useful settings for HIV prevention and family planning. We assessed PrEP and contraceptive persistence in South African hair salons. METHODS: We conducted a pilot randomized trial to evaluate uptake and persistence of pre-exposure prophylaxis (PrEP) and contraception in 3 salons in KwaZulu-Natal. Women could start or stop medication at any visit. We defined persistence as 1 additional visit within 6 months with continued use. We assessed age, self-perceived HIV risk, partner 5 years older, primary partner having other partners, intimate partner violence, STI at enrolment, contraception persistence, mental health, and alcohol use using contingency tables. RESULTS: Among 159 intervention participants, the median age was 26 years (IQR 22-29). Thirty-five (26%) were HIV positive, and 42/158 (27%) were using contraception at enrolment. 32/111 (29%) described at least moderate HIV risk in the following year, and 46/142 (32%) reported partners with other partners. 63/124 (51%) accepted PrEP; among 60 with follow-up data, 32 (53%) persisted. 138/159 (87%) took contraception; among 134 with follow-up data, 95 (71%) persisted. Persistence on PrEP was associated with age 25 and older (RR: 1.83 [95% CI: 1.03 to 4.00]), alcohol use (RR: 1.68 [95% CI: 1.03 to 2.92]), partner concurrency (RR: 0.49 [95% CI: 0.14 to 0.95]), and contraceptive persistence (RR: undefined). CONCLUSIONS: Women accepted PrEP and contraception through hair salons, with contraception persistence higher than PrEP. PrEP persistence was associated with age, alcohol use, partner concurrency, and contraceptive persistence. Hair salons are a novel venue for service delivery.