Title: Barriers to PrEP use and adherence among adolescent girls and young women in Eastern,
Southern, and Western Africa: A scoping review
Version: 1 Date: 22 Aug 2024
Reviewer's report:
Thank you for this very interesting paper that I enjoyed reading. This is a vital topic, and I’m
pleased to see it being covered in this review. The paper is well written and structured, and I
only have relatively minor comments that I hope are useful.
A couple of very minor layout suggestions:
• My version had occasional spacing before parentheses - this will need correcting.
• Line 94 (‘This scoping review…’ should ideally start as a new paragraph).
INTRODUCTION
This section provides a helpful background and justifies why your review is relevant. I
appreciated the structure of this section (description of the issue, and then focus on PrEP).
One comment – for me, PrEP is only one of several components of a combination prevention
approach (we shouldn’t only rely on medicating ourselves out of this epidemic). I recommend
adding a sentence or two describing how PrEP fits in a matrix of prevention methodologies.
METHODS
Your approach seems robust and logical, and the text makes very clear the processes you used
to select the appropriate studies for the review. I have no additional comments – your criteria
are clear and using the HIV prevention cascade is useful.
RESULTS
You describe the final selection process for the 25 studies you finally included, and I’m pleased
that you include qualitative studies in addition to those with quantitative and mixed approach
methodologies.
It is interesting that the bulk of the studies gathered data from Kenya and South Africa –
clearly indicating further research is required in other African countries on this topic. I was
also interested in papers reporting side effects, pill burden, etc. as barriers to PrEP initiation.
Cognitively, it can be hard for people currently with no HIV to begin taking a type of medication
also used by those who are infected. It’s useful to know that this component is found in AGYW
as well. The ‘Access to PrEP’ section is especially interesting.
I did note that there are some overlaps between the sections (Motivation, Access, Effective Use)
but I guess this is not surprising. It may be useful to make sure there is no redundant material
that could be removed.
DISCUSSION/CONCLUSION
You summarise your findings and cite other relevant studies in this section, and you make some
very valid points. You also include several recommendations to address the issues that you
highlight, which are helpful. These could be expanded even further if you have further points
to make.
I appreciate especially your point that ‘AGYW are not a homogenous group’, and the various
initiatives that could provide support in the many types of circumstances in which AGYW live
and work.
You note limitations, which is useful – and (as you indicate) the gradual rollout of injectable
PrEP (and other nascent initiatives) could change the PrEP picture once again.
REVIEWER RECOMMENDATIONS
1. OVERALL: Check spacing around parentheses.
2. INTRODUCTION: Add a short note that PrEP fits into a wider matrix of combination
prevention methodologies. I also recommend starting a new paragraph at line 94.
3. DISCUSSION: Your review has highlighted several important features of PrEP use in
AGYW, and your recommendations could be expanded further if you believe there are
additional points to make (perhaps especially around building PrEP into the broader sexual and
reproductive health of AGYW).