Exploring Adolescent Girls' and Young Women's Perceptions of HIV Prevention Pre-exposure Prophylaxis Use: A Qualitative Synthesis of Evidence from Sub-Saharan Africa.

Adolescent girls' and young women's (AGYW) perceptions of HIV prevention Pre-Exposure Prophylaxis (PrEP) shape interest in use, uptake and sexual decisions. Although PrEP and its choices are increasingly available in Sub-Saharan Africa (SSA), evidence on how AGYW perceive its use in their daily lives remains fragmented. This qualitative evidence synthesis reviewed existing studies on AGYW's perception of PrEP in SSA. Embase, MEDLINE, CINAHL, CABI, and ProQuest were searched for studies published between January 2012 and December 2024 that reported AGYW's views on PrEP use in SSA. Two reviewers independently screened titles, abstracts, and full texts, with disagreements resolved by a third reviewer. Data were synthesised using thematic synthesis and managed in NVivo. The methodological quality was appraised using the appropriate Critical Appraisal Skills Program checklist. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A total of 3,104 studies were identified; 24 studies from seven countries in SSA met the inclusion criteria. Three themes were developed regarding AGYW's perceptions of PrEP use: the protective role of PrEP, confidence, and its effectiveness; empowerment, agency, and hope for future health and sexuality; and behaviour change concerns while on PrEP. This systematic review highlights the complex and paradoxical perceptions of PrEP among AGYW, emphasising the need for comprehensive sexual health education, risk reduction counselling, and promotion of dual prevention interventions. These interventions are crucial to balancing and maximising PrEP's benefits while mitigating potential risks.