A Cross-Sectional Study of Differences in Pre-Exposure Prophylaxis Uptake in Kenya

Research Article

Abstract

Sub-Saharan Africa bears a disproportionate burden of human immunodeficiency virus acquisition, with young people facing acute exposure risks. Pre-exposure prophylaxis represents a cornerstone of biomedical prevention; however, population-level disparities across demographic and geographic subgroups remain inadequately characterized. A cross-sectional secondary analysis of the Kenya National AIDS and STI Control Programme National Data Warehouse evaluated pre-exposure prophylaxis utilization among 675,277 HIV-negative individuals aged 15 years and older seeking clinical prevention services during 2021. The cohort comprised 31,764 active pre-exposure prophylaxis users and 643,513 non-users. Multivariable logistic regression quantified crude odds ratios, adjusted odds ratios, and multiplicative interaction terms across age, gender, and geographic classifications. Overall prophylaxis utilization reached 4.70% (31,764/675,277). Individuals aged 15–29 years exhibited significantly reduced odds of uptake compared to adults aged 30 years and older (4.38% vs. 5.15%; adjusted odds ratio: 0.84, 95% confidence interval: 0.82–0.85). Male individuals showed lower utilization than females (4.40% vs. 4.88%; adjusted odds ratio: 0.88, 95% confidence interval: 0.86–0.90). Prophylaxis uptake across broad urban versus rural designations appeared identical in main-effect modeling (adjusted odds ratio: 1.00, 95% confidence interval: 0.97–1.03); however, geographic classification modified the association between age and utilization (Wald test statistic: 79.64, p < 0.0001). The age-related deficit was markedly amplified in urban areas (adjusted odds ratio: 0.71, 95% confidence interval: 0.68–0.74) compared to rural environments (adjusted odds ratio: 0.89, 95% confidence interval: 0.87–0.91). Targeted biomedical prevention initiatives must address the persistent deficits affecting young urban individuals and men through dedicated, differentiated, youth-centered delivery mechanisms