Abstract Body

Background:

HIV incidence is high during pregnancy and postpartum. Oral PrEP was introduced in South Africa in 2016 and guidelines were updated in 2021 to include PrEP for pregnant and postpartum women.

Methods:

The PrEP in pregnancy and postpartum (PrEP-PP) study is an observational cohort in one public health clinic in Cape Town, South Africa. We recruited pregnant women not living with HIV attending their first antenatal care (ANC) visit between August 2019 and October 2021. Study criteria included pregnant women: = >16 years old; confirmed HIV-negative; intending on giving birth in Cape Town; without contraindications to PrEP. We enrolled consecutive eligible, consenting women (N&#3f1200) and followed up through 12-months postpartum. HIV counselling and testing was offered, followed by HIV prevention counseling, including on safety/effectiveness of PrEP and offered PrEP. We evaluate PrEP initiation, continuation and risk factors of discontinuation with multivariate logistic regression.

Results:

We screened 2448 pregnant women without HIV at their first ANC visit, 2039 (61%) were interested in study participation, 409 (12%) declined participation. Of those interested and screened (n=2039), 839 (41%) were ineligible and 1200 (59%) were eligible and enrolled. Of those enrolled, 1013 (84%) accepted a PrEP prescription at first ANC visit and 187 (16%) did not. Among women who accepted a PrEP prescription at enrolment, 829 (82%) returned at 1 month and confirmed they had initiated PrEP. Of 829 women who initiated PrEP, 76% returned and received a repeat prescription at 1 month, 58% at 3 months, 44% at 6 months, and 35% at 9 months (Table 1). Of the 187 women who did not accept a PrEP prescription at enrolment, 104 (56%) returned and initiated PrEP sometime during their follow-up visits and 83 (7%) never started PrEP by the 9-month visit. Risk factors associated with PrEP discontinuation compared to PrEP persistence at 9 months included perceived low risk of HIV at baseline (aOR=1.56; 95% CI=1.03, 2.36) and earlier gestational age at baseline (aOR=0.55; 95% CI=0.41, 0.72) adjusted for age.

Conclusions:

Despite high PrEP initiation at first ANC visit, almost one-fifth did not return for the 1-month refill visit, and < 50% continued after 6 months when all were in postpartum period. A subset of women started PrEP in postpartum period, or restarted PrEP in postpartum. There is an urgent need for PrEP integration into antenatal and postpartum care including interventions to improve PrEP continuation.