Background: Very few examples of PrEP delivery to pregnant and postpartum women have been reported. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program provides real-world evidence on delivering PrEP to pregnant and postpartum women in Kenya.
Methods: PrIYA is part of the DREAMS Innovation Challenge funded by PEPFAR managed by JSI Research & Training Institute, Inc. We approached HIV-uninfected pregnant women seeking routine antenatal (ANC) and postnatal (PNC) services at 16 maternal and child health clinics in Kisumu, Kenya from June to December 2017. At each patient encounter, screening for behavioral risk factors and willingness to consider PrEP was conducted per national PrEP guidelines. Those who were willing to consider PrEP were assessed for medical eligibility and those eligible were offered PrEP at the same visit. Logistic regression models determined correlates of PrEP initiation.
Results: In total, we conducted 9,704 assessments among pregnant/postpartum clients for behavioral risk factors and willingness to consider PrEP. The median age was 24 years (IQR 21-28); 31% did not know their male partner''s HIV status and 84% were married. Overall, 1,856 (19%) of encounters led to PrEP initiation; only 6 women (< 0.01%) were medically ineligible (creatinine clearance < 50 min/mL). Frequency of PrEP initiation differed by male partner HIV status (HIV-negative 7%, unknown 43%, HIV-positive 79%, p< 0.001). PrEP initiation was more common in the postpartum period than during pregnancy (23% vs 16%, p< 0.001). Women younger than 24 years of age were more likely than older women to initiate PrEP (OR=1.18, 95% CI 1.08-1.28, p=< 0.001). Initiating PrEP was also associated with having an STI (OR=2.66, 95% CI 1.48-4.77, p=0.001) and being forced to have sex in the last 6 months (OR=3.69, 95% CI 1.69-8.06, p=0.001). The most frequently reported reasons for declining PrEP were the perception that HIV risk was low (46%) and the partner was HIV-negative (43%); few women accepting PrEP feared intimate partner violence as a result (2%).
Conclusions: In this pregnant and postpartum population, a substantial number of women desired and started PrEP. PrEP initiators were younger and more likely to have HIV risk factors than those who declined PrEP.