Twice as many young women used PrEP in communities reached by South Africa's My Journey Programme

More young women knew their HIV status, but HIV prevalence remained similar to matched comparison communities

Young women living in South African communities reached by the My Journey Programme were twice as likely to have used HIV pre-exposure prophylaxis (PrEP) as their peers in comparable communities where the programme was not implemented, according to a new study led by the South African Medical Research Council (SAMRC) and published in The Lancet Regional Health – Africa.

The study contributes important evidence on the outcomes of a large-scale combination HIV prevention programme for adolescent girls and young women (AGYW) in South Africa. To the authors' knowledge, this is the first controlled evaluation of a large-scale combination HIV prevention programme for adolescent girls and young women in South Africa to use contemporaneous matched comparison areas and laboratory-confirmed HIV outcomes.

The HERStory 3 study surveyed 5,025 adolescent girls and young women aged 15-24 years across 24 subdistricts in eight provinces between February and May 2024. Twelve subdistricts had implemented the My Journey Programme and were matched to 12 comparison subdistricts without the programme. Participation exceeded 97%, and HIV status was determined using laboratory testing of dried blood spot samples.

Key findings

• PrEP uptake: 26.4% of young women in programme areas reported ever using PrEP, compared with 13.0% in comparison areas.
• Knowledge of HIV status: 84.7% of young women in programme areas knew their HIV status, compared with 80.5% in comparison areas. The difference was most evident among adolescent girls aged 15-19 years.
• HIV prevalence: HIV prevalence was 9.5% in programme areas and 10.4% in comparison areas, a difference that was not statistically significant.

Starting PrEP is only the first step

While the programme appeared to improve access to and uptake of PrEP, the findings suggest that challenges remain in supporting sustained use. Among sexually active young women living without HIV, 22.2% in programme areas had ever used PrEP. However, only 7.1% reported current use at the time of the survey, compared with 6.1% in comparison areas.

The authors argue that increasing the availability of long-acting HIV prevention options through platforms already used by young women could help overcome barriers to continued PrEP use. This is particularly important as South Africa expands access to new HIV prevention technologies, including lenacapavir, the twice-yearly injectable PrEP.

"Where the My Journey Programme was implemented, twice as many young women had used PrEP and more knew their HIV status," said Dr Kim Jonas, lead author and Principal Investigator of the study at the SAMRC Health Systems Research Unit. "These findings show that young women are willing to use effective HIV prevention tools when they are accessible. However, initiating PrEP is only part of the prevention journey. The next challenge is ensuring that young women can continue using prevention methods that best fit their lives, including long-acting options delivered through youth-friendly services."

Addressing the social and structural drivers of HIV risk

Although the programme improved important prevention outcomes, the study highlights the ongoing influence of broader social and economic factors on HIV vulnerability among young women.

"Few large-scale HIV prevention programmes are evaluated using matched comparison areas and laboratory-confirmed HIV outcomes under routine implementation conditions. This study provides important evidence on what combination prevention programmes can achieve at scale, while highlighting persistent gaps in HIV outcomes among young women. We need stronger integration of economic empowerment and structural interventions within prevention programmes if we are to make meaningful in-roads into addressing the underlying drivers of HIV vulnerability, including poverty, educational disruption and unequal gender relations," said Prof Glenda Gray, Chief Scientific Officer at the SAMRC.

Informing the future of HIV prevention

The findings underscore both the potential and limitations of large-scale combination HIV prevention programmes. While the My Journey Programme appears to have strengthened uptake of HIV prevention services and increased knowledge of HIV status, the study also points to the need for greater investment in sustained prevention use, HIV care engagement, and interventions that address the underlying social and economic conditions that shape HIV risk among young women.

What the study can and cannot tell us

As with all observational evaluations, the findings should be interpreted within the study context. Programme areas were selected by funders and implementers before the evaluation was conducted, and the study collected data at a single point in time after programme implementation. As a result, the observed differences represent associations and cannot conclusively demonstrate causation.

In addition, the evaluation focused on areas with intensive programme implementation and was not designed to measure HIV incidence, or new HIV infections over time.

About the study and team
Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2016, My Journey combines HIV testing, condom and PrEP provision, prevention education, life-skills, school-retention and economic-strengthening support, delivered through schools and community Safe Spaces in high HIV-burden subdistricts. The study was funded by the Global Fund through the Networking HIV and AIDS Community of Southern Africa (NACOSA), and partially by the SAMRC

The study was led by the SAMRC Health Systems Research Unit with the National Institute for Communicable Diseases, American University, the University of Connecticut, HEARD at the University of KwaZulu-Natal, and Stellenbosch University

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