Clinics Encourage PrEP Use in Pregnant and Postpartum African Women

One of the most vulnerable populations in areas of sub-Saharan Africa that experience high rates of HIV is pregnant and postpartum women. Studies have shown an incidence rate in this group roughly equal to that of women who work in the sex trade, and the risk is not mitigated even if women have partners who currently are HIV negative or if women are having less frequent sex because of impending or recent childbirth.

Concerned about this elevated risk to both mothers and babies, a team of investigators from the University of Washington in Seattle teamed up with the Kenyan Kisumu County Department of Health to create a program known as PrIYA, for PrEP [pre-exposure prophylaxis] Implementation for Young Women and Adolescents. The goal was to allow women who visited any of 16 different maternal-child health centers to receive a behavioral assessment designed to provide information about HIV risk, learn about PrEP, and obtain a prescription for PrEP, if desired.

Between November 2017 and June 2018, more than 9300 women or adolescents from the age of 15 up who visited a clinic received a behavioral assessment and were asked if they wanted to start taking PrEP. Two thousand and thirty women, or 21.7% of the total, agreed to take PrEP. They were more likely to be younger (the median age was 24), with partners who had HIV or whose HIV status was unknown. Of those women who began PrEP, 38.7 continued using it after 1 month. However, in women who knew their partners were HIV positive, the continuation rate after 1 month shot up to 68%.

“Our results show that maternal and child health clinics can be an effective platform for PrEP delivery,” the authors wrote in the discussion section of their report. “Maternal and child health clinics currently deliver prevention of mother-to-child HIV transmission services including HIV testing and retesting, and can thus identify women at risk for HIV who could benefit from PrEP.” Retesting is an important part of HIV prevention, the authors noted, explaining that HIV risk can shift over time, making it imperative that women have access to PrEP “in periods of increased vulnerability.”

While women may be concerned about their HIV risk if their partners’ HIV status is positive or unknown, many African women feel disempowered to take preventive measures. According to the authors, condoms are not commonly used by women who are pregnant or have recently given birth, and male partners often are not willing to consider them. “PrEP offers protection while allowing time for women to encourage their partners to get tested and initiate treatment if HIV-infected,” according to the authors.

The authors noted that, in a different study, women mentioned being particularly concerned about HIV infection during pregnancy because they were having less sex with their male partners, who might then seek sex outside of the relationship. Other research suggests the possibility of biological changes that make pregnancy and the postpartum period particularly risky times for HIV transmission. Considering the difficulty some women have convincing their male partners to get tested for HIV or use condoms, the ability to take PrEP discreetly may give women the peace of mind they need during this time.