Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya
Abstract Introduction 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 hi...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-05-01
|
| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26088 |
| _version_ | 1827939175707443200 |
|---|---|
| author | Nafisa J. Wara Rufaro Mvududu Mary M. Marwa Laurén Gómez Nyiko Mashele Catherine Orrell Corrina Moucheraud John Kinuthia Grace John‐Stewart Landon Myer Risa Hoffman Jillian Pintye Dvora L. Joseph Davey |
| author_facet | Nafisa J. Wara Rufaro Mvududu Mary M. Marwa Laurén Gómez Nyiko Mashele Catherine Orrell Corrina Moucheraud John Kinuthia Grace John‐Stewart Landon Myer Risa Hoffman Jillian Pintye Dvora L. Joseph Davey |
| author_sort | Nafisa J. Wara |
| collection | DOAJ |
| description | Abstract Introduction 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). Methods 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. Results 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). Conclusions 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. |
| first_indexed | 2024-03-13T08:49:36Z |
| format | Article |
| id | doaj.art-ed5eee03cb3a46209819255e36207d11 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-13T08:49:36Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-ed5eee03cb3a46209819255e36207d112023-05-29T18:30:38ZengWileyJournal of the International AIDS Society1758-26522023-05-01265n/an/a10.1002/jia2.26088Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and KenyaNafisa J. Wara0Rufaro Mvududu1Mary M. Marwa2Laurén Gómez3Nyiko Mashele4Catherine Orrell5Corrina Moucheraud6John Kinuthia7Grace John‐Stewart8Landon Myer9Risa Hoffman10Jillian Pintye11Dvora L. Joseph Davey12David Geffen School of Medicine at the University of California Los Angeles California USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaDepartment of Research and Programs Kenyatta National Hospital Nairobi KenyaDepartment of Global Health University of Washington Seattle Washington USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaDesmond Tutu HIV Centre Institute of Infectious Disease and Molecular Medicine and the Department of Medicine University of Cape Town Cape Town South AfricaDepartment of Health Policy and Management Fielding School of Public Health University of California Los Angeles Los Angeles California USADepartment of Research and Programs Kenyatta National Hospital Nairobi KenyaDepartment of Global Health University of Washington Seattle Washington USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaDivision of Infectious Diseases David Geffen School of Medicine at the University of California Los Angeles California USADepartment of Global Health University of Washington Seattle Washington USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaAbstract Introduction 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). Methods 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. Results 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). Conclusions 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.https://doi.org/10.1002/jia2.26088breastfeedinglong‐actingPrEPpregnancyKenyaSouth Africa |
| spellingShingle | Nafisa J. Wara Rufaro Mvududu Mary M. Marwa Laurén Gómez Nyiko Mashele Catherine Orrell Corrina Moucheraud John Kinuthia Grace John‐Stewart Landon Myer Risa Hoffman Jillian Pintye Dvora L. Joseph Davey Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya Journal of the International AIDS Society breastfeeding long‐acting PrEP pregnancy Kenya South Africa |
| title | Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya |
| title_full | Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya |
| title_fullStr | Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya |
| title_full_unstemmed | Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya |
| title_short | Preferences and acceptability for long‐acting PrEP agents among pregnant and postpartum women with experience using daily oral PrEP in South Africa and Kenya |
| title_sort | preferences and acceptability for long acting prep agents among pregnant and postpartum women with experience using daily oral prep in south africa and kenya |
| topic | breastfeeding long‐acting PrEP pregnancy Kenya South Africa |
| url | https://doi.org/10.1002/jia2.26088 |
| work_keys_str_mv | AT nafisajwara preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT rufaromvududu preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT marymmarwa preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT laurengomez preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT nyikomashele preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT catherineorrell preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT corrinamoucheraud preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT johnkinuthia preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT gracejohnstewart preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT landonmyer preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT risahoffman preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT jillianpintye preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya AT dvoraljosephdavey preferencesandacceptabilityforlongactingprepagentsamongpregnantandpostpartumwomenwithexperienceusingdailyoralprepinsouthafricaandkenya |