Background
Sexually transmitted infections (STIs) in pregnancy contribute to adverse birth outcomes and increased HIV acquisition during pregnancy and the postpartum period. Yet, few studies evaluate how STI testing influences HIV PrEP use among pregnant women who initiate HIV PrEP.
Methods
We analyzed data from a randomized trial conducted between February 2022-July 2023 among pregnant women who newly initiated daily oral HIV PrEP during routine antenatal care and were followed through 9 months postpartum in western Kenya (NCT04472884). Women were tested for syphilis per national guidelines. At two of the five study sites, women were offered Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing at enrollment using Xpert® CT/NG assays starting September 2022. Women tested received same-day results, and directly observed treatment (DOT) was offered to women diagnosed with CT/NG. We evaluated the association between CT/NG testing and time to HIV PrEP discontinuation using Cox proportional hazards models.
Results
Overall, 260 pregnant women initiating HIV PrEP enrolled in the two study sites at a median gestational age of 26 weeks (IQR 24-29). The median age was 26 years (IQR 22-30), most women (80%) were married, and 92% had partners of unknown HIV status; 2% tested positive for syphilis. Overall, 39 (15%) enrolled before commencement of CT/NG testing procedures; 221 (85%) women were offered CT/NG testing in pregnancy — all of whom accepted. Only 19 (7%) reported STI symptoms (e.g., abnormal vaginal discharge and/or vulvar burning/itching). Prevalence of CT and/or NG was 19/260 (7.3%): 4% CT, 3% NG, and 1% CT/NG co-infection. The median time to HIV PrEP discontinuation for all women was 331 days from initiation in pregnancy (IQR 144-366). By 9 months postpartum, women who tested for CT/NG in pregnancy were less likely to discontinue HIV PrEP compared to those not tested in pregnancy (51% vs. 77%, p=0.003). Testing for CT/NG in pregnancy was associated with a 45% longer time to HIV PrEP discontinuation (hazard ratio[HR] 0.55, 95%CI: 0.38-0.80, p=0.002). Having STI symptoms or testing positive for CT/NG was not associated with HIV PrEP discontinuation (HR 0.98, 95% CI 0.38-2.52, p=0.975) and (HR 1.01, 95% CI 0.64-1.58, p=0.978) respectively.
Conclusions
Co-offering CT/NG testing to women initiating HIV PrEP in pregnancy could increase HIV PrEP continuation through postpartum, regardless of test results and represents an opportunity for addressing HIV/STI in this priority population
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