Antenatal clinics in Kenya can effectively provide PrEP to at-risk women
The first ‘real world’ programme to provide PrEP through maternal and child health clinics in a high prevalence setting finds one in five women offered PrEP will take it up.
The initiative made pre-exposure prophylaxis (PrEP) available for women attending maternal and child health clinics in Kisumu County, Kenya. The area has the second highest HIV incidence in the country, and HIV prevalence is around 3.5 times higher than the national average at 21% among women and 18% among men.
Between November 2017 and June 2018 around 9,300 HIV-negative women aged 15 and over attending the clinics were assessed for HIV risk and offered PrEP. Around half were aged 18 to 24, 85% were married or cohabitating and 50% were pregnant. The vast majority (95%) reported having sex without a condom in the past six months.
Around 22% of those offered PrEP accepted it, of whom almost 40% used it for at least one month.
A total of 193 women reported having an HIV-positive partner, and 79% of this group started PrEP. Around 3,165 women reported having partners of unknown HIV status and 37% of this group opted to take PrEP, while around 6,000 women reported having an HIV-negative partner, of whom 12% began taking PrEP. Overall, women’s awareness of their partner’s HIV status was low, highlighting the need for strategies to increase partner testing.
Younger women (aged 15 to 24) were more likely to take up PrEP than older women. The most common reasons given for accepting PrEP were having a partner living with HIV or of unknown status and feeling at risk for acquiring HIV. Interestingly, among those starting PrEP, more women with HIV-negative partners reported that they felt at risk of acquiring HIV than did those with partners living with HIV or of unknown HIV status.
Being less than 26 weeks pregnant, having been diagnosed or treated for a sexually transmitted infection, having been forced to have sex, having experienced intimate partner violence during the previous 6 months, having shared needles while injecting drugs, and recurrent use of post-exposure prophylaxis (PEP) were also associated with accepting PrEP.
The most common reasons for declining PrEP were the need to consult a partner and a low perceived HIV risk.
Among those women who started PrEP, 68% of those with an HIV-positive partner continued taking it after one month. In comparison, just 38% of women on PrEP with a partner of unknown HIV status, and 34% of those with an HIV-negative partner continued use. After three months, around half of those with an HIV-positive partner were still taking PrEP, as were 20% of those with a partner of unknown HIV status, and 18% with an HIV-negative partner.
Reasons most cited for stopping PrEP were side effects and not feeling like they were at risk of HIV. Among women on PrEP, no new HIV infections were reported.
The fact that many women accessing antenatal and child health services were found to be vulnerable to HIV, and a relatively high proportion elected to use PrEP, suggests antenatal clinics could be effective routes for reaching at-risk women, preventing new infections among both pregnant women and their infants.