Motivation
anxiety
The support strategies motivated adherence by increasing risk perception and salience of HIV, helping participants set and strive for adherence goals, providing direct encouragement to build confidence, and making participants feel supported and invested in. Examples are illustrated by the quotes below:



DLF played an important role in motivating product use, and some participants admitted that they would not use the study products without it. Most often, this motivation was driven by the desire to avoid negative reactions from counsellors, whose approval AGYW were eager to gain. Many reported using the products so that they would not have to admit to poor adherence.


DLF also created friendly competition among peers, motivating them to match or beat each other's results, and some study sites encouraged this by rewarding those with consistently green results with treats like cake or lipstick, or with invitations to speak as role models during support clubs. For a smaller number of AGYW, receipt of red or yellow DLF results motivated higher adherence to get more protection for its own sake. This reflected widespread trust among most participants that the results accurately reflected their level of HIV protection, which stemmed from a clear understanding of how to interpret the results and overwhelming agreement that the results accurately represented their adherence behaviour.In rare cases, however, receiving yellow or red results led to high levels of stress, anxiety or shame, and became a barrier to using PrEP products or accessing additional support. One AGYW quit the support club because she felt she had nothing to offer if she was not getting green results, and another chose to use neither product during period 3 because she did not believe either would protect her.