Understanding pregnant women’s risk perception and whether this correlates with their actual HIV risk is important to guide PrEP implementation in high HIV prevalence regions.
The PrEP Implementation for Mothers in Antenatal Care (PrIMA) study (NCT03070600) is a cluster-RCT in western Kenya that assesses strategies for delivering PrEP to pregnant women. At enrollment, HIV risk perception was assessed using two risk perception scales (Napper and Vargas). Intimate partner violence (IPV) was assessed using the Hurt, Insulted, Threatened with Harm and Screamed screening tool. HIV risk was assessed using a validated empiric risk score for predicting HIV acquisition designed for pregnant women which includes behavioral and partner characteristics: scores >6 indicate high-risk for HIV. Women self-reported their partner’s HIV status. Women’s perceived HIV risk was compared between women with a high (>6) and low (≤6) empiric risk scores.
Of the 2,280 women enrolled, median age was 24 years (IQR 20-29), median gestational age was 25 weeks (IQR 20-30), and 84% were married. Overall, 33% reported having partners of unknown HIV status and 40% had empiric HIV risk scores >6; 7% believed they had a ‘great chance’ of acquiring HIV in the next year. Compared to women with lower risk scores, women with scores >6 were more likely to believe they had a ‘great chance’ of acquiring HIV in the next year (15% vs 2%). Mean perceived HIV risk was 21 (SD, 4.5) and 1.8 (SD, 1.9) using the Napper and Vargas scales, respectively, signifying moderate perceived risk. Women with high-risk scores (>6) reported greater perceived risk in both scales compared to women with low risk scores (Napper, Mean [M]: 23.2 vs 19.5 and Vargas, M, 2.69 vs 1.19). Women who experienced IPV had greater perceived risk in both scales (Napper, M: 24 vs 21) and (Vargas, M: 2.7 vs 1.7). Compared to women with HIV-uninfected partners, women with partners of unknown or known positive status had higher perceived risk (positive partners, Napper, M: 26 vs 19; Vargas, M: 3.8 vs 1.2) and (unknown partner status, Napper, M: 23 vs 19; Vargas, 2.6 vs 1.2). All P values <0.001.
Women with high empiric HIV risk scores were more likely to report a higher perceived risk of acquiring HIV. This suggests that women may accurately assess their own risk for HIV and providers may be able to universally counsel women on PrEP rather than conducting a risk assessment to target PrEP.