David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2023 May;26(5):e26088. doi: 10.1002/jia2.26088.
Long-acting pre-exposure prophylaxis (PrEP) options could overcome barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, countries with high PrEP coverage with pending regulatory approvals for long-acting injectable cabotegravir and the dapivirine vaginal ring (approved in South Africa, under review in Kenya).
From September 2021 to February 2022, we surveyed pregnant and postpartum women enrolled in oral PrEP studies in South Africa and Kenya. We evaluated oral PrEP attitudes and preferences for long-acting PrEP methods in multivariable logistic regression models adjusting for maternal age and country.
We surveyed 190 women in South Africa (67% postpartum; median age 27 years [IQR = 22-32]) and 204 women in Kenya (79% postpartum; median age 29 years [IQR = 25-33]). Seventy-five percent of participants reported oral PrEP use within the last 30 days. Overall, forty-nine percent of participants reported negative oral PrEP attributes, including side effects (21% South Africa, 30% Kenya) and pill burden (20% South Africa, 25% Kenya). Preferred PrEP attributes included long-acting method, effectiveness, safety while pregnant and breastfeeding, and free medication. Most participants (75%, South Africa and Kenya) preferred a potential long-acting injectable over oral PrEP, most frequently for a longer duration of effectiveness in South Africa (87% South Africa, 42% Kenya) versus discretion in Kenya (5% South Africa, 49% Kenya). Eighty-seven percent of participants preferred oral PrEP over a potential long-acting vaginal ring, mostly due to concern about possible discomfort with vaginal insertion (82% South Africa, 48% Kenya). Significant predictors of long-acting PrEP preference included past use of injectable contraceptive (aOR = 2.48, 95% CI: 1.34, 4.57), disliking at least one oral PrEP attribute (aOR = 1.72, 95% CI: 1.05, 2.80) and preferring infrequent PrEP use (aOR = 1.58, 95% CI: 0.94, 2.65).
Oral PrEP-experienced pregnant and postpartum women expressed a theoretical preference for long-acting injectable PrEP over other modalities, demonstrating potential acceptability among a key population who must be at the forefront of injectable PrEP rollout. Reasons for PrEP preferences differed by country, emphasizing the importance of increasing context-specific options and choice of PrEP modalities for pregnant and postpartum women.
长效暴露前预防 (PrEP) 方案可能克服口服 PrEP 在妊娠和产后期间持续使用的障碍。我们评估了南非和肯尼亚接受过口服 PrEP 且正在等待长效注射型卡替拉韦和地喹氯铵阴道环（在南非获批，在肯尼亚正在审查）监管批准的有妊娠和产后经历的女性对长效 PrEP 的偏好。
从 2021 年 9 月至 2022 年 2 月，我们对南非和肯尼亚的口服 PrEP 研究中纳入的孕妇和产后女性进行了调查。我们在调整了母亲年龄和国家的多变量逻辑回归模型中评估了对长效 PrEP 方法的口服 PrEP 态度和偏好。
我们调查了 190 名来自南非的参与者（67%为产后；中位年龄 27 岁 [IQR = 22-32]）和 204 名来自肯尼亚的参与者（79%为产后；中位年龄 29 岁 [IQR = 25-33]）。75%的参与者报告在过去 30 天内使用过口服 PrEP。总体而言，49%的参与者报告了口服 PrEP 的负面属性，包括副作用（南非 21%，肯尼亚 30%）和药丸负担（南非 20%，肯尼亚 25%）。首选的 PrEP 属性包括长效方法、有效性、对妊娠和哺乳期的安全性以及免费药物。大多数参与者（南非和肯尼亚均为 75%）更喜欢潜在的长效注射剂而不是口服 PrEP，最常因为南非的有效性持续时间更长（南非 87%，肯尼亚 42%），而肯尼亚则更注重便利性（南非 5%，肯尼亚 49%）。87%的参与者更喜欢口服 PrEP 而不是潜在的长效阴道环，主要是因为担心阴道插入可能会引起不适（南非 82%，肯尼亚 48%）。长效 PrEP 偏好的显著预测因素包括过去使用注射避孕（aOR = 2.48，95%CI：1.34，4.57）、不喜欢至少一种口服 PrEP 属性（aOR = 1.72，95%CI：1.05，2.80）和更喜欢不频繁使用 PrEP（aOR = 1.58，95%CI：0.94，2.65）。
有妊娠和产后经历的口服 PrEP 经验的女性表示理论上更喜欢长效注射 PrEP 而不是其他方式，这表明在必须处于注射 PrEP 推出前沿的关键人群中，这种方法具有潜在的可接受性。PrEP 偏好的原因因国家而异，强调了增加针对妊娠和产后女性的特定国情的选择和 PrEP 模式的重要性。
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