Table 3.

Illustrative quotations from Low TFV-DP participants describing what they did with their PrEP

Stockpiling PrEP

“I think they were 6 [unopened PrEP bottles at home] then, now I am left with 3. […] Cause maybe I am not going to make after 5 years … like I am also growing like my time is running out I will also get to 25 [maximum age for study eligibility.]” (Low, peri-urban, age 16) “Maybe she has side effects and she don’t care, as people we not the same. There are people that can’t tell the nurses that they have side effects when they take [PrEP]. So they think they should go and collect it and stockpile it.” (Low, rural, age 16) “Maybe a person want this R30 [$2 USD] [reimbursement] or they lack support from home […] They do continue to collect the pills and just keep them or their boyfriend don’t want them to take PrEP.” (Low, rural, age 23)

Discarding PrEP

“I flush [PrEP pills down the toilet]. […] [I] am avoiding maybe people who like dumps, dogs. Or others will think [I] am taking ARVs even though [I] am not taking them. They will not understand maybe when I throw it in the bin maybe dogs can come and spill and tear the dump bin.” (Low, peri-urban, age 21) “I have witnessed that, I was walking with this person I don’t want to mention their name and she threw it away at the road. She opened it and threw it away. I asked her why, and she said she has side effects and I said to her when you feel that way you should tell the nurses [you] feel sick when you taking PrEP. And she said she won’t do that.” (Low, rural, age 16) “People are embarrassed to take them and they don’t take the pills. […] Maybe it is because people are unfamiliar with the pills, it was also my first time seeing them. And as we keep getting informed about them, some don’t come and end up not getting information on what PrEP is exactly. So the person end up messing up and saying ‘no you are lying, these pills are for something else.’” (Low, peri-urban, age 16) “I asked myself that why do I take this [PrEP] but I don’t have a boyfriend?” Said she threw pills “in the dust bin because I had no boyfriend at that time.” (Low, peri-urban, age 22)

Sharing PrEP

“I have shared it with someone. It was the whole box, I did not use it, and it was my cousin who was living at the rural areas. While I was telling her about it she was like ‘I want this but where I stay there is no one that teaches us about these things’. I had to that share that box. In fact she does not have one partner and she is not using condoms, so I was like you know what let me to introduce you to this so that every time you come here I will take you to the container.” (Low, peri-urban, age 22) “When my PrEP is finished I take from my sister before I come and collect mine here. Let’s say I’m supposed to come the site on the 15th and I forget my date on the 15th and I don’t come, then my PrEP gets finished, I take from S. [her sister] then the following day I go to the site to collect my pills. That’s how we share.” (Low, rural, age 24) “The ones that are curious… maybe those are the ones that like to come [for PrEP]. And then there are those friends of theirs then that are not curious […] because they are shy for going there to that PrEP container. Because they know everyone here in the community that PrEP container what it does. […] doesn’t want to be seen by her boyfriend… maybe her boyfriend has criticized the container.” (Low, peri-urban, age 22)

Selling PrEP

“So then I don’t want to tell on others but there’s one of our participants that has been selling PrEP, selling to this one guy. […] There was a guy that came to me and he asked me how can he get these pills and so forth, and I said to him it’s only young girls that can get them and he said there is a participant that comes and collects her PrEP, and he’s staying this side, so he asked me about her.” (Low, rural, age 24) “They could sell PrEP at a faraway places maybe […] they want to make money out of them, they think if they have this much they will charge R120 or R140 [$8–9 USD] when they are three [bottles of PrEP].” (Low, peri-urban, age 16)

^*Participant quotations are labeled with adherence level based on DBS, study site, and age at baseline