DISCUSSION
youth‐friendly
This study sought to assess whether a multilevel, community‐based intervention comprised of support clubs, male partner sensitization and a couples’ education session showed promise to increase PrEP uptake and adherence among AGYW in Kenya without concomitant risks to their safety. Results indicate that intervention participants had approximately two‐fold higher PrEP uptake and adherence than control arm participants, and no evidence of increased IPV or social harms. We also observed significantly lower rates of IPV in the intervention arm among participants with a prior history of IPV, suggesting that the intervention might also be an effective IPV reduction strategy. However, PrEP adherence remained low among intervention arm participants, suggesting that they faced additional barriers not addressed by Tu'Washindi, and that the intervention may need to be delivered alongside other PrEP promotion programmes.To our knowledge, this is the first intervention to show preliminary evidence of increasing PrEP uptake and adherence in a controlled trial. Several scoping/systematic reviews have noted the failure of interventions to achieve HIV and IPV prevention among young women in the sub‐Saharan African region, and the lack of proven successful PrEP adherence interventions [The strengths described above may also help explain how the intervention could have reduced IPV. Our primary goal in measuring IPV was to ensure that the intervention did not increase risk by encouraging AGYW to disclose PrEP use, gain partner support and use PrEP even without partner support. The trend towards reduced IPV reported in the intervention arm was an unexpected finding. In our qualitative analyses reported elsewhere, participants attributed reductions in violence to the communication skills they learned from Tu'Washindi, which helped them prevent and de‐escalate conflict, and to the PrEP education that men received through the study, which reduced their male partners’ misperceptions about PrEP and facilitated partner support for PrEP use upon disclosure [The Tu'Washindi intervention primarily sought to address This study has several limitations. First, because it was designed as a pilot, it had a small sample size and short follow‐up duration, limiting our ability to draw strong conclusions about effectiveness. Second, electronic adherence monitoring may not have accurately reflected participant's PrEP use, if they chose to store their pills in a separate container, removed several pills at once to facilitate covert use or opened the pillbox without taking the pills. Third, we did not enrol any AGYW ages 15–16 and thus cannot draw conclusions about intervention effectiveness in this age range. This was because the PrEP rollout in DREAMS focused on AGYW ages 18 and above, so few younger adolescents were using PrEP or considered themselves eligible. Finally, the intervention was developed to be delivered within DREAMS and to build upon, rather than replicate, other DREAMS interventions targeting barriers to PrEP use, such as community mobilization and norms change, youth‐friendly services and school‐based IPV and HIV education [