<p><strong>PURPOSE: </strong>HIV pre-exposure prophylaxis (PrEP) reduces HIV transmission and is approved for adolescents aged 12-17 years. Adolescent girls and young women (AGYW) have modest PrEP uptake rates, while many receive reproductive health counseling. We sought to identify opportunities for incorporating PrEP education in contraceptive counseling delivered to AGYW.</p>

<p><strong>METHODS: </strong>We performed a secondary analysis of data from the Health Coaching for Contraceptive Continuation pilot study, which supported contraceptive use among AGYW. Participants were 14-22 years old, sexually active with males, and not desiring pregnancy within 12 months. Coaches were sexual health educators with ≥5&nbsp;years' experience providing contraceptive and PrEP counseling to youth. Participants completed a baseline visit within 30 days of contraceptive initiation and completed up to five monthly coaching sessions. Of 33 enrollees, this analysis includes the 21 who completed ≥4 sessions. Two coders deductively coded session transcripts for five themes: opportunities to discuss PrEP; HIV knowledge, risk perception, and testing attitudes; changes in HIV risk status; condom use knowledge and skills; and sexually transmitted infection knowledge and risk perception.</p>

<p><strong>RESULTS: </strong>Of the 111 transcripts coded, 24 contained opportunities to discuss PrEP and were inductively analyzed. Thematic analysis demonstrated three types of opportunities for PrEP discussions: failure to introduce information, and provision of incomplete information or misinformation. Analysis also revealed four opportunity contexts: sexually transmitted infection prevention strategies, HIV risk reduction, avoidance of adverse sexual health outcomes, and disclosures of condom nonprotected sexual behaviors. Only one transcript mentioned PrEP.</p>

<p><strong>CONCLUSIONS: </strong>Multiple opportunities to introduce PrEP counseling exist within contraceptive counseling provided to AGYW.</p>

<p><strong>STUDY OBJECTIVE: </strong>Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.</p>

<p><strong>DESIGN: </strong>Cross-sectional mixed methods.</p>

<p><strong>SETTING: </strong>Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>20 sexually active AGYW ages 18-24; 20 health system stakeholders.</p>

<p><strong>INTERVENTIONS: </strong>Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Themes reflecting barriers and facilitators of LARC implementation.</p>

<p><strong>RESULTS: </strong>The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.</p>

<p><strong>CONCLUSIONS: </strong>We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.</p>

<p><strong>OBJECTIVE: </strong>Nonadherence in sexual risk reduction interventions may be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a prior pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.</p>

<p><strong>DESIGN: </strong>Secondary data analysis from a feasibility study of a health coaching intervention to improve contraceptive continuation.</p>

<p><strong>SETTING: </strong>Three urban pediatric clinics in Philadelphia.</p>

<p><strong>PARTICIPANTS: </strong>Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.</p>

<p><strong>INTERVENTIONS: </strong>At baseline, participants completed a sociodemographic questionnaire and semi-structured interview, followed by five monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Intervention completion was defined as the number of completed coaching sessions.</p>

<p><strong>SECONDARY OUTCOMES: </strong>Qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.</p>

<p><strong>RESULTS: </strong>Participants with a prior adverse outcome (a prior STI and/or a prior pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs. 4, p=0.03). Both groups had low HIV/STI knowledge, negative attitudes towards pregnancy, and low HIV/STI risk perception. Those with a prior adverse reproductive outcome held more negative attitudes towards condoms.</p>

<p><strong>CONCLUSION: </strong>Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome may be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize interventions reach for vulnerable youth.</p>