PrEP Acceptable to Pregnant, Post-Partum Women at High HIV Risk

By Reuters Staff

December 17, 2019

NEW YORK (Reuters Health) - Pregnant and post-partum women who are at increased risk of HIV often opt for pre-exposure prophylaxis (PrEP) when it is offered, according to a new study in maternal and child health clinics in Kenya.

"In this first real-world implementation programme of PrEP within maternal and child health clinics in a setting with high HIV prevalence, we showed that pregnant and post-partum women accept PrEP when offered and that PrEP uptake aligns with behavioral risk factors," Dr. John Kinuthia of the University of Washington in Seattle and colleagues write in The Lancet HIV.

Working with the Kisumu County Department of Health, the authors integrated PrEP delivery at 16 maternal and child health clinics in the county. Among more than 9,000 pregnant and postpartum women assessed for PrEP, 21.7% (2,030) began PrEP.

Factors associated with starting PreP included being under 24 years old (adjusted prevalence ratio, 1.14) and having a partner with HIV (aPR, 6.96) or unknown HIV status (aPR 3.08).

Pregnant women with a gestation of less than 26 weeks (aPR, 1.22) and those diagnosed with or treated for sexually transmitted infection (aPR, 1.57) were more likely to begin PrEP.

Women who had been forced to have sex (aPR, 1.82), experienced intimate partner violence in the past six months (aPR, 1.65), shared needles when using injection drugs (aPR, 2.43), or used PrEP in the past (aPR, 1.96) were also more likely to initiate PrEP.

A total of 38.7% of the women who started PrEP continued after one month, including 68% of women with HIV-positive partners. None of the women on PrEP contracted HIV during the study.

"Importantly, our data show that it is feasible to integrate PrEP delivery in maternal and child health clinics, making this a one-stop location for maternal and child health services and PrEP, which saves women time, increases accessibility, and supports efforts to eliminate mother-to-child transmission," the authors write. "Maternal and child health clinics have in-built staffing, supply chain, and serial HIV testing, which facilitates integrated PrEP delivery."

In an editorial accompanying the study, Dr. Thomas Coates of the University of California, Los Angeles, and colleagues write: "This study shows that maternal and child health clinics could potentially be an effective platform for PrEP delivery because of existing services for the prevention of mother-to-child transmission and integrated HIV testing and retesting of HIV-uninfected women; however, it also indicates that advising and dispensing PrEP are, alone, unlikely to be sufficient to protect all pregnant women at risk for HIV."

The study was funded by the U.S. Department of State. SOURCE: and The Lancet HIV, online December 5, 2019