Background
Providing pregnant and lactating people (PLP) with choice in PrEP methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to PrEP continuation. We evaluated PrEP preferences and acceptability of their chosen method among PLP offered CAB-LA versus oral PrEP in South Africa.
Methods
The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15-29 at one clinic and one community-based mobile van offering sexual health services. Using informed choice counseling, participants were offered oral tenofovir disoproxil fumarate/emtricitabine or CAB-LA, with the option to switch modalities at follow-up visits over 18 months. We report baseline PrEP choices among PLP enrolled in the study, acceptability of their initial choice within 3 months of enrollment, and theoretical preferences regarding the dapivirine vaginal ring (expected to be approved for use by PLP pending safety review). We used Fisher’s Exact to compare responses by pregnancy status.
Results
From February to August 2024, we enrolled 58 PLP (n=30 pregnant, n=28 breastfeeding). Mean age was 22.5 years (SD=4.0). 23 pregnant participants (77%) initiated CAB-LA and 7 (23%) oral PrEP, while among breastfeeding participants, 25 (89%) initiated CAB-LA and 3 (11%) oral PrEP (Table). Reasons for CAB-LA selection included convenience and perceived side effects of oral PrEP (e.g., nausea and vomiting). Of enrolled PLP, 36 (n=14 pregnant, n=22 breastfeeding) completed the acceptability survey. Of these, 83% (n=12/14 pregnant, n=19/22 breastfeeding) chose and received CAB-LA, and the remaining (n=5) chose and received oral PrEP. PLP who received CAB-LA liked its ease of use (65%; n=20/31) and long-acting protection (45%; n=14/31). More breastfeeding CAB-LA users disliked side effects (e.g., injection site pain) than pregnant women (68% vs 17%, p=0.009), although 39% of PLP (n=12/30) described no CAB-LA dislikes. Almost all (97%; n=29/30) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. 86% of all surveyed PLP (n=31/36) did not want to try the dapivirine vaginal ring.
Conclusions
Our population of PLP had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable among PLP. Further study is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among pregnant and lactating people.