Integrating STI screening into PrEP services for adolescent girls and young women

Background: High rates of STIs have been demonstrated in AGYW initiating PrEP. Most infections are asymptomatic and missed by stan-dard-of-care STI syndromic management. We assessed the prevalence and factors associated with return for STI treatment following urine STI screening during the POWER study in Johannesburg, South Africa. Methods: POWER aimed to demonstrate models of PrEP delivery to AGYW. We enrolled a cohort of HIV negative AGYW aged 18 to 25 at a dedicated adolescent PHC clinic or a conventional PHC clinic. Urine from participants was tested for chlamydia (CT) and gonorrhoea (GC) by GeneXpert at enrolment. Participants with positive results were contacted by phone or WhatsApp (at least 3 attempts) and offered treatment. We assessed associations between baseline characteristics and treatment return using logistic regression. Results: Of 776 screened, 763 (98%) were enrolled and 737 (96%) initiated PrEP. Median age was 21, 11% reported >1 partner in past 3 months, 18% reported consistent condom use, and 3% reported genital symptoms at enrollment. 622/763 (82%) were screened for STI, and 211 (34%) had any curable STI, 27% CT, 3% GC, and 3% both CT/GC at enrollment. Of those with any STI, 136 (65%) were successfully contacted and treated. Participants were more likely to return for treatment if they had reported consistent condom usage (OR 4.9, 95% CI 1.5 to 16.1) compared to those that never used condoms, or reported using any form of contraception at enrolment compared to those that did not (OR 2.04; 95% 1.33 to 3.66). Despite apparent lower STI prevalence at the dedicated adolescent clinic (29% vs 37%), participants were more than three times likely to return for STI treatment as compared to the conventional PHC (OR 3.08, 95% 1.66 to 5.73). Conclusions: Prevalence of asymptomatic curable STIs is high in this PrEP initiating population. A third of participants did not return for treatment highlighting the need for point of care diagnostics and novel STI control interventions especially for those at highest risk for STIs and HIV, to interrupt transmission and prevent complications. More research is needed to determine reasons for low uptake of STI treatment. Quality, integrated, adolescent-responsive health services are an essential component of AGYW STI/HIV prevention.