Introduction.
Kenya has made tremendous strides in making HIV preventive pills (often referred to as DP pills or PrEP) freely available across public and private clinics. Despite this accessibility, uptake and long-term adherence remain a pressing concern. While many individuals take the first dose, a significant number discontinue soon after the initial month.
This report explores behavioral patterns behind these trends and suggests targeted interventions to boost continuation rates and overall effectiveness of the HIV prevention program.
Who Is Using HIV Prevention Pills?
The majority of those who received the pills were young women, particularly in their teens to early thirties. This age group represents Kenya’s most sexually active demographic and therefore plays a critical role in HIV prevention strategies.
Counties such as Nairobi and Kisii recorded the highest distribution numbers, while male participation remained notably lower.
-Interestingly, the type of health facility—whether public, private, or community-based—did not significantly affect uptake rates. This suggests that accessibility is not the main barrier to initial adoption.
What Drives People to Start—and Stop—Taking the Pills?
Referrals Matter
- Peer referrals and Voluntary Counseling and Testing (VCT) sites were strong drivers of initial interest. Many first-time users were encouraged by friends or transferred from VCT centers. However, despite high initial uptake from these sources, continuation rates dropped sharply after the first refill.
Early Drop-Off Rates
- Every patient began with a 30-pill starter pack. The steepest decline occurred immediately after the first month—only a fraction returned for subsequent refills. By the sixth month, continuation was extremely low.
Health Factors: BMI, Blood Pressure, and STIs
BMI (Body Mass Index) showed little impact on adherence. Normal-weight individuals had the highest initial refills, but the trend evened out across all BMI groups over time.
Blood Pressure (BP) appeared inconsistent as a predictor—low BP correlated with early refills, while medium-to-high BP patients showed better long-term adherence.
STIs (Sexually Transmitted Infections) temporarily boosted adherence. Patients recently diagnosed with STIs demonstrated high initial motivation, which declined as symptoms improved.
The Power—and Limits—of Counseling
- Counseling had one of the strongest early effects on adherence. Patients who received counseling before or during their first month were far more likely to return for refills. Unfortunately, without continued follow-up, motivation waned after the initial phase.
Key Insights
The data clearly show that behavioral factors, not clinical ones, play the biggest role in continuation rates. While health metrics such as BMI or BP had minimal long-term influence, motivation, support, and social referral networks had the greatest impact.
Low adherence can thus be viewed not as a medical issue, but as a behavioral challenge—one that requires ongoing engagement, not just a one-time intervention.
Recommended Interventions
Based on the analysis, the most effective strategy is targeted, ongoing counseling and follow-up support, particularly during the critical first month.
Introduce peer mentorship programs to sustain motivation beyond initial referrals.
Implement structured follow-ups via SMS, phone calls, or clinic visits.
Track patient feedback to better understand reasons for discontinuation.
If applied systematically, these interventions could increase initial uptake by 25% and continuation rates by up to 30%—a meaningful improvement in Kenya’s fight against HIV.
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