Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme

Kinuthia, John; Pintye, Jillian; Abuna, Felix; Mugwanya, Kenneth; Lagat, Harison; Onyango, Dickens; Begnel, Emily R; Dettinger, Julia; Baeten, Jared M.; John‐Stewart, Grace; Aquino, Ajode C; Ochieng, Steve J; Lipesa, Alice M; Naidu, Ambia L; Kamau, Anastacia; Njoroge, Anne; Okeah, Bernard Ojiambo; Makabwa, Cecilia B; Atieno, Celestine C; Ireri, Christine K; Ojowi, Diana A; Lubembe, Elizabeth S; Mukenyi, Emma; Kephas, Emma J A; Bundi, Esther N; Akim, Eunita; Otieno, Fredrick; Owiti, George; Cherotich, Irene; Ouma, Irene A; Adhiambo, Jacqueline Q; Otieno, Joel A; Mwendwa, Joseph M; Kemunto, Joyness B; Rono, Magdalene C; Ndung'u, Martin C; Osama, Mary I A; Odhiambo, Maurine A; Kiche, Melvin A; Mwania, Meridah M; Bhatt, Neera; Auma, Osama M; Otieno, Paskal O; Achieng, Pauline; Muthoni, Peris W; Chiira, Rose K; Mmbukane, Serede M; Mwania, Sila J; Kipyegon, Titus; Ochieng, Tonny O; Kemunto, Valarie; Odede, Veronica A; Obote, Vivian A; Mituga, Winnie N; Fondo, Yvonne F

doi:10.1016/s2352-3018(19)30335-2

Cited by 115 publications

(168 citation statements)

References 26 publications

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“…FP, antenatal, and postpartum clinics). 14,15 This integration eliminates the need to provide separate referrals for either FP services or PrEP, removing a structural barrier to their uptake, 15 and has potential for decreased stigma (e.g., if PrEP is delivered in FP clinics). However, it is unclear whether use of contraception shows an inclination to a prevention mindset, hence contraception users are more likely to use PrEP.…”

Section: Introductionmentioning

confidence: 99%

Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships

et al. 2020

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Women who have a prevention mindset may opt for concurrent use of oral pre-exposure prophylaxis (PrEP) and all forms of contraception; we therefore assessed how contraception may influence PrEP use or vice versa. We analyzed data from Kenyan and Ugandan HIV-uninfected non-pregnant women in sero-discordant partnerships who were participating in the Partners Demonstration Project. Using multivariable generalized estimating equation models, we estimated the associations between effective contraceptive use and 1) PrEP dispensation 2) high effective PrEP use. Among the 311 women (93.1% of all those followed in the Partners Demonstration Project) median age was 29 years (interquartile range [IQR] 24.0–35.0) and 115 (37.0%) reported using effective contraception at baseline. All the women initiated PrEP during the study and moderately high PrEP adherence was recorded at 73.1% of visits over an average 7.5 months following PrEP dispensation. Women (14.8%) consistently used an effective contraceptive throughout study follow-up. PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk [aRR] = 1.19; 95% confidence interval [CI] = 1.08–1.32) and contraceptive use was more common among those on PrEP (aRR = 1.63; 95% CI = 1.18–2.25). Among East African women at high risk of HIV infection, PrEP dispensation was more frequent among women using effective contraception, indicating that family planning outlets may be efficient locations to deliver PrEP.

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Section: Introductionmentioning

confidence: 99%

Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships

et al. 2020

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“…Uptake was much lower among women with other risk factors (eg, 1178 [37•2%] of 3165 women with partners of unknown serostatus initiated PrEP). 4 It remains unclear whether PrEP uptake in 22% of women is adequate to achieve the population-level benefits of this intervention.…”

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confidence: 99%

“…Second, the authors note that 40 dedicated programme nurses implemented the PrEP intervention in the clinics. 4 This approach makes sense in preliminary demonstration studies. But issues of training, staffing, and infrastructure to provide screening, dispensing, and adherence counselling and monitoring require careful scrutiny, if countries are to scale-up maternal PrEP as part of routine public sector care.…”

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confidence: 99%

PrEP implementation in pregnant and post-partum women

2020

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HIV acquisition during pregnancy presents a serious threat to maternal and child health. WHO recommends pre-exposure prophylaxis (PrEP) for HIV prevention among pregnant women living in communities with high HIV incidence. 1,2 However, there are few studies of the implementation of PrEP during pregnancy and the post-partum period in settings with a high HIV burden. PrEP delivery to pregnant women under regular clinical conditions needs to be documented urgently. 3 In the Lancet HIV, John Kinuthia and colleagues 4 report important results of their PrEP Implementation for Young Women and Adolescents (PrIYA) programme in Kenya. The study is the first to provide evidence from the real-world implementation of PrEP in 16 maternal and child health clinics in a region with high HIV prevalence (antenatal HIV prevalence >20%). Among the key findings, 2030 (21•7%) of 9376 pregnant and post-partum women initiated PrEP, although only 786 (38•7%) of them returned for a refill prescription after 1 month. 104 (68•0%) of 153 women with partners living with HIV continued PrEP at least throughout the first month, but continuation was not as high for women with other risk factors for HIV. 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. We highlight two areas for future research to optimise maternal PrEP use. First, women who used PrEP reported increased behavioural risks of HIV acquisition, and initial uptake was

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“…Complications of STIs in pregnancy include spontaneous abortion, stillbirth, preterm birth, and low birth weight . In PrIYA, researchers found that only 1% of pregnant women screened for PrEP recently had an STI diagnosed with syndromic algorithms, which have poor sensitivity and specificity for detection of STIs . This contrasts to the >30% prevalence of laboratory‐confirmed STIs (35% CT, 15% NG) detected among women screened for PrEP in PrEP demonstration projects among young women from the same region These data suggest that an appreciable proportion of women who initiate PrEP in programmatic settings may have undiagnosed STIs.…”

Section: Resultsmentioning

confidence: 99%

Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?

et al. 2020

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Introduction HIV incidence is high during pregnancy and breastfeeding with HIV acquisition risk more than doubling during pregnancy and the postpartum period compared to when women are not pregnant. The World Health Organization recommends offering pre‐exposure prophylaxis (PrEP) to pregnant and postpartum women at substantial risk of HIV infection. However, maternal PrEP national guidelines differ and most countries with high maternal HIV incidence are not offering PrEP. We conducted a systematic review of recent research on PrEP safety in pregnancy to inform national policy and rollout. Methods We used a standard Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) approach to conduct a systematic review by searching for completed, ongoing, or planned PrEP in pregnancy projects or studies from http://www.clinicaltrials.gov, PubMed and NIH RePORTER from 2014 to March 2019. We performed a systematic review of studies that assess tenofovir disoproxil fumarate (TDF)‐based oral PrEP safety in pregnant and breastfeeding HIV‐uninfected women. Results and discussion We identified 14 completed (n = 5) and ongoing/planned (n = 9) studies that evaluate maternal and/or infant outcomes following PrEP exposure during pregnancy or breastfeeding. None of the completed studies found differences in pregnancy or perinatal outcomes associated with PrEP exposure. Nine ongoing studies, to be completed by 2022, will provide data on >6200 additional PrEP‐exposed pregnancies and assess perinatal, infant growth and bone health outcomes, expanding by sixfold the data on PrEP safety in pregnancy. Research gaps include limited data on (1) accurately measured PrEP exposure within maternal and infant populations including drug levels needed for maternal protection; (2) uncommon perinatal outcomes (e.g. congenital anomalies); (3) infant outcomes such as bone growth beyond one year following PrEP exposure; (4) outcomes in HIV‐uninfected women who use PrEP during pregnancy and/or lactation. Conclusions Expanding delivery of PrEP is an essential strategy to reduce HIV incidence in pregnancy and breastfeeding women. Early safety studies of PrEP among pregnant women without HIV infection are reassuring and ongoing/planned studies will contribute extensive new data to bolster the safety profile of PrEP use in pregnancy. However, addressing research gaps is essential to expanding PrEP delivery for women in the context of pregnancy.

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Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme

Cited by 115 publications

References 26 publications

Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships

Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships

PrEP implementation in pregnant and post-partum women

Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?

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