Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention

Groves, Allison K.; Vadaketh, Jessica; Raziano, Valerie T.; Nkwihoreze, Hervette; Short, William R.; Momplaisir, Florence

doi:10.1097/aog.0000000000004709

Cited by 5 publications

(5 citation statements)

References 37 publications

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“…This is an indication of gaps in health education, particularly within health facilities, which is where the women were recruited for the study. Whilst this study shows slightly higher proportions of PPW aware and also having correct knowledge about PrEP, several studies in similar populations in different settings in Sub-Saharan Africa and the United States of America have reported relatively low awareness and knowledge about PrEP ( 12 , 26 – 32 ). In South Africa, in a study among pregnant women from Cape Town knowledge about PrEP was only 33% ( 12 ) and in a study among young pregnant women aged 18–24 years old in KwaZulu Natal, none of the women had ever heard about PrEP before the survey ( 32 ).…”

Section: Discussioncontrasting

confidence: 72%

“…In Zambia, knowledge about PrEP among pregnant and breastfeeding was only 36% ( 28 ). In the United States approximately two thirds of pregnant women had never heard of PrEP before participating in the study ( 26 ). Of note is that even if the women were aware about PrEP, a majority tended to have incorrect knowledge about PrEP as an option for HIV prevention and also tended to have concerns about potential effects to their babies during pregnancy or breast feeding ( 27 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

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Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey

Khumalo,

Mkhonta,

Kindandi

et al. 2023

Front. Reprod. Health

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IntroductionIn Eswatini, HIV incidence among women of childbearing age is 1.45%. Eswatini introduced oral pre-exposure prophylaxis (PrEP) for HIV prevention in 2016 and requires that all HIV-negative pregnant and post-natal women (PPW) visiting health care facilities be offered PrEP.MethodsBetween September-November 2021, we conducted a survey among HIV-negative PPW from 16 purposively selected healthcare facilities in the Hhohho and Shiselweni regions in Eswatini. We interviewed consenting HIV-negative PPW using a structured questionnaire to collect data on PrEP knowledge, attitudes, intentions, and practices, as well as information on partner HIV status and stigma. Multivariate logistic regression was used to determine predictors of PrEP use and intention, adjusted for significant covariates.ResultsOf 1,484 PPW women approached, 1,149 consented and were interviewed, of whom 704 (61.3%) were post-partum and 445 (38.7%) pregnant. The median age was 25 years [Interquartile Range (IQR) = 21–30 years], with 533 (46.4%) 18–24 years old. Among the 1,149 women, 930 (80.7%) had ever heard about PrEP; 635 (55.3%) had knowledge about PrEP; 183 (15.9%) were currently using PrEP; and 285 (24.8%) had ever used PrEP. Increased odds of PrEP use were associated having HIV-positive male partner (aOR:7.76, 95%CI 3.53- 17.04); positive attitudes to PrEP (aOR:1.56, 95%CI: 1.02–2.40); and high self-efficacy (aOR:1.49, 95%CI:1.13–1.98). Among 864 women who never used PrEP, 569 (65.3%) intended to use PrEP in the future. Odds of intention to use PrEP were higher among women with low levels of education (aOR:2.23, 95% CI: 1.32–3.77); who ever heard about PrEP (aOR:1.69, 95%CI: 1.12–2.56); and had high self-efficacy (aOR:1.57, 95%CI: 1.31–1.87). Regarding stigma, among all women, 759 (66%) either agreed or strongly agreed that people would think they have HIV if they were to use PrEP; 658 (57.3%) reported they would be labelled as having multiple sex partners; 468 (40.7%) reported that their partner would think they are having risky sex with other people. Of 102 women who had discontinued PrEP, a majority stopped due to side effects 32 (35.2%).ConclusionOnly about 50% of women had knowledge of PrEP, and PrEP uptake among PPW was low, though intention to use appeared high. More efforts to reduce stigma and promote PrEP use, including adequate information on side effects, are needed.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey

Khumalo,

Mkhonta,

Kindandi

et al. 2023

Front. Reprod. Health

View full text Add to dashboard Cite

show abstract

“…Pregnant and postpartum women faced the challenge of distinguishing between normal pregnancy symptoms and oral PrEP-related side effects. They were concerned that the observed side effects might be a danger sign for oral PrEP-exposed infants, which greatly reduced the willingness to use oral PrEP [46,47].Therefore, to alleviate maternal concerns about the side effects and safety of oral PrEP, medical providers should prioritize initiating early and frequent discussions with pregnant and postpartum women at high risk of HIV exposure, thoroughly explaining its safety profile, potential side effects, and providing informational support to enhance their awareness [48]. Furthermore, this review identified stigma against oral PrEP as a barrier to maternal oral PrEP implementation.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 12 papers were included in the review [16][17][18][25][26][27][28][29][30][31][32][33]. Of these 12 papers, four were described as descriptive qualitative studies, one was a mixed method study with thematic analysis of qualitative results, and the remaining seven qualitative research articles did not explicitly report the research methods.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis

Liu,

Zhang,

Chen

2024

BMC Public Health

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Background Acute HIV infection during pregnancy and in the postpartum period increases the risk of vertical transmission. The World Health Organization (WHO) has recommended preexposure prophylaxis for pregnant and postpartum women at risk of acquiring HIV. However, there are significant gaps between the actual practice and the ideal goal of preexposure prophylaxis implementation among pregnant and postpartum women. Therefore, it is important to determine what influences women’s implementation of preexposure prophylaxis during pregnancy and in the postpartum period. This review aims to aggregate barriers and facilitators to preexposure prophylaxis implementation among pregnant and postpartum women. Methods A range of electronic databases, including PubMed, CINAHL Plus with Full Text, Embase, and Web of Science, were searched for potentially relevant qualitative studies. The search period extended from the establishment of the databases to March 16, 2023. This review used the ENTREQ (Enhancing transparency in reporting of qualitative research synthesis) statement to guide the design and reporting of qualitative synthesis. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The JBI meta-aggregation method was applied for guiding the data extraction, and the JBI ConQual method was applied for guiding the evaluation of the level of evidence for the synthesis. Results Of retrieved 2042 studies, 12 met the inclusion criteria. The total population sample included 447 participants, including 231 pregnant and postpartum women, 21 male partners, 75 healthcare providers (HCPs)/healthcare workers (HCWs), 18 policymakers, 37 mothers, and 65 women of childbearing age. A total of 149 findings with credibility ratings of “unequivocal” or “equivocal” were included in this meta-synthesis. Barriers and facilitators to preexposure prophylaxis implementation were coded into seven categories, including three facilitator categories: perceived benefits, maintaining relationships with partners, and external support, and four barriers: medication-related barriers, stigma, barriers at the level of providers and facilities, and biases in risk perception. Conclusion This systematic review and meta-synthesis aggregated the barriers and facilitators of preexposure prophylaxis implementation among pregnant and postpartum women. We aggregated several barriers to maternal preexposure prophylaxis implementation, including medication-related factors, stigma, barriers at the level of providers and facilities, and risk perception biases. Therefore, intervention measures for improving preexposure prophylaxis services can be developed based on these points. PROSPERO Number CRD42023412631.

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The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission

2023

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Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention

Abstract: The authors thank the study participants for taking the time to share their experiences with us so that we can better understand how to increase access to and uptake of PrEP during pregnancy.

Cited by 5 publications

References 37 publications

Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey

Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey

Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis

The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission

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