PrEP Acceptability among Pregnant Women and Implications for HIV Prevention in Clinical Practice

Florence Momplaisir, PhD
University of Pennsylvania

ABSTRACT:
RATIONALE:

Of the 1,008,929 people in the U.S. who are diagnosed with HIV, 240,306 are women.1 In 2017, 7,401 women were diagnosed with HIV and more than 80% were women of color. Young women, including those of reproductive age, are significantly affected: nearly one-third of new infections (29%) among women occur among those aged 25-44, and 22% among women aged 13-24.1 Pregnancy and the postpartum period present a time period when women are vulnerable to HIV infection and HIV infection during this time is associated with an elevated risk for perinatal transmission. During pregnancy and the postpartum period, women experience physiologic changes including hormonal changes that induce systemic and genital mucosal changes that may increase susceptibility to HIV infection.2,3 In addition, associated with efforts to conceive, women are having condomless sex, which also increases the risk of acquiring sexual transmitted infections and acquiring HIV.

Oral pre-exposure prophylaxis (PrEP) containing tenofovir/emtricitabine (TDF/FTC) is safe and efficacious in preventing HIV infection among pregnant and lactating women.4,5 A recent systematic review showed no statistically significant differences between TDF and non-TDF regimens in pregnancy incidence, stillbirth, preterm delivery, low birth weight, small for gestational age, birth defects, or maternal mortality.6 Additionally, studies report that women at risk for HIV desire to use PrEP for HIV prevention.7 Long acting injectable PrEP have been shown to be safe, well-tolerated and acceptable in HPTN 077 (66% of enrollees were female). The use of long acting formulation during the postpartum period has great potential because it is a time when women struggle with adherence to medications.8 Currently, there are limited data on acceptability of oral PrEP in pregnancy and no data on acceptability of long acting injectable PrEP for women in the postpartum period.

STUDY AIM: In this study, we aim to assess knowledge, interest, beliefs and outcome expectancy about oral PrEP use in pregnancy and the use of long-acting injectable PrEP in the postpartum period. We also aim to assess acceptability and preference for oral PrEP versus long-acting injectable PrEP in the postpartum period. Our findings provide insight of how to best integrate PrEP in routine antenatal and postpartum care.

STUDY DESIGN: To accomplish our aims, we sampled and conducted in-depth interviews with 20 at risk participants (indicated by a recent sexually transmitted infection (STI)), from an urban obstetrics clinic. Interview questions focused on pregnant women's perceived HIV risk, their knowledge and perceptions of PrEP, and their preferences for different PrEP formulations. We used deductive and inductive codes to code the data, created matrices to explore patterns in findings based on participant's perceptions of their HIV risk, and wrote memos to interpret emergent themes.