Wara Nafisa, Pike Carey, Rousseau Elzette, Macdonald Pippa, Mapukata Pakama, Leonard Bryan, Lebelo Keitumetse, Hoffman Risa, Orrell Catherine, Bekker Linda-Gail, Davey Dvora Joseph
Los Angeles David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2025 Jul;28 Suppl 2(Suppl 2):e26492. doi: 10.1002/jia2.26492.
Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.
The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15-29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.
From February to August 2024, we enrolled 58 PLP (n = 30 pregnant, n = 28 breastfeeding). Median age 23 years (IQR 19.5-26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, n = 13 pregnant, n = 23 breastfeeding) completed the acceptability survey. Of these, 83% (n = 12/13 pregnant, n = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (n = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; n = 22/32) and long-acting protection (44%; n = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (n = 13/32) described no CAB-LA dislikes. Almost all (97%; n = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (n = 31/36) did not want to try the dapivirine vaginal ring.
PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.
为怀孕和哺乳期女性（PLP）提供包括长效注射用卡博特韦（CAB-LA）在内的HIV暴露前预防（PrEP）方法的选择，可能会减少有效使用PrEP的障碍。我们评估了在南非提供CAB-LA与口服PrEP的情况下，PLP对PrEP的偏好和可接受性。
在南非开普敦进行的“准备好选择”研究，在一家公共诊所和一家社区移动诊所招募了15至29岁的年轻人。通过知情选择咨询，为参与者提供口服PrEP或CAB-LA，并可在18个月的随访中选择更换方法。我们报告了研究中PLP开始使用CAB-LA和口服PrEP的基线情况、入组后3个月内对其初始选择的可接受性以及对PLP可能获得的PrEP方法的理论偏好。我们报告描述性统计数据，并使用卡方检验和费舍尔精确检验按开始使用的PrEP方法和怀孕状态比较反应。
2024年2月至8月，我们招募了58名PLP（n = 30名孕妇，n = 28名哺乳期女性）。中位年龄23岁（四分位间距19.5 - 26）。在30名孕妇中，23名（77%）开始使用CAB-LA，7名（23%）开始使用口服PrEP；在28名哺乳期女性中，25名（89%）开始使用CAB-LA，3名（11%）开始使用口服PrEP。在入组的PLP中，36名（62%，n = 13名孕妇，n = 23名哺乳期女性）完成了可接受性调查。其中，83%（n = 12/13名孕妇，n = 20/23名哺乳期女性）选择并接受了CAB-LA，其余（n = 4）选择并接受了口服PrEP。接受CAB-LA的PLP报告喜欢其使用方便（69%；n = 22/32）和长效保护（44%；n = 14/32）。一半的CAB-LA使用者不喜欢副作用（如注射部位疼痛），尽管41%的PLP（n = 13/32）表示没有不喜欢CAB-LA的地方。几乎所有（97%；n = 31/32）目前使用CAB-LA的PLP都有兴趣继续使用CAB-LA，所有使用口服PrEP的PLP都表示有兴趣在未来尝试CAB-LA。86%的接受调查的PLP（n = 31/36）不想尝试达匹韦林阴道环。
南非的PLP对CAB-LA的偏好明显高于口服PrEP，且CAB-LA被发现具有很高的可接受性。需要进一步研究来评估提供包括CAB-LA在内的PrEP方法选择对PLP持续使用PrEP的影响。
