Association of self-reported HIV infection with oral pre-exposure prophylaxis use among women of reproductive age in Lesotho: evidence from mixed-effects estimates of nationally representative data.

OBJECTIVES

This study examined the association of self-reported HIV status with history of oral pre-exposure prophylaxis (PrEP) use among reproductive-age women from Lesotho.

METHODS

This study analysed a sample of 6413 women from the 2023-24 Lesotho Demographic and Health Survey (LDHS) data. The data were collected between November 2023 and February 2024. Categorical data were analysed with percentages and χ tests. In addition, ever use of oral PrEP and covariates of self-reported HIV infection were investigated using binary multivariable multilevel logistic regression. HIV infection data were self-reported by the women based on their most recent HIV test.

RESULTS

The weighted prevalence of self-reported HIV infection among women was 22.1% (95% CI 20.6% to 23.7%). Among women who ever used oral PrEP, the prevalence of self-reported HIV infection was 13.4% (95% CI 9.9% to 17.9%), but was 24.0% (22.0% to 26.1%) among women who have never used. History of oral PrEP use was associated with 62.0% reduction in the odds of self-reported HIV infection (adjusted OR (aOR) 0.38; 95% CI 0.28 to 0.51). Respondents who have heard of a sexually transmitted infection (STI) have 27.0% reduction in the odds of self-reported HIV infection when compared with those who have not heard of an STI (aOR 0.73; 95% CI 0.59 to 0.90). Women aged 25+ years at first sex had 60.0% reduction in the odds of self-reported HIV infection, when compared with those <18 years at first sex (aOR 0.40; 95% CI 0.19 to 0.84). Women with multiple total lifetime number of sexual partners had higher odds of self-reported HIV infection, when compared with those with single lifetime number of sexual partner.

CONCLUSIONS

HIV infection among women in Lesotho remains high. Having a history of oral PrEP use was associated with lower odds of self-reported HIV infection. Stakeholders in healthcare should promote oral PrEP interventions and design programmes for HIV prevention among women.