Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme
Pregnant women in settings with high HIV prevalence are at increased risk of HIV acquisition and subsequent vertical transmission. We implemented and evaluated a novel programme to provide pre-exposure prophylaxis (PrEP) in maternal and child health clinics in Kenya. In collaboration with Kisumu Cou...
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| Veröffentlicht in: | The lancet HIV 2020-01, Vol.7 (1), p.e38-e48 |
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| creator | Kinuthia, John Pintye, Jillian Abuna, Felix Mugwanya, Kenneth K Lagat, Harison Onyango, Dickens Begnel, Emily Dettinger, Julia Baeten, Jared M John-Stewart, Grace Aquino, Ajode C Ochieng, Steve J Lipesa, Alice M Naidu, Ambia L Kamau, Anastacia Njoroge, Anne W Okeah, Bernard O Makabwa, Cecilia B Atieno, Celestine C Ireri, Christine K Ojowi, Diana A Lubembe, Elizabeth S Mukenyi, Emma Kephas, Emma J A Bundi, Esther N Akim, Eunita I A Otieno, Fredrick O Owiti, George R Cherotich, Irene Ouma, Irene A Adhiambo, Jacqueline Q Otieno, Joel A Mwendwa, Joseph M Kemunto, Joyness B Rono, Magdalene C Ndung'u, Martin C Osama, Mary I A Odhiambo, Maurine A Kiche, Melvin A Mwania, Meridah M Bhatt, Neera Auma, Osama M Otieno, Paskal O Achieng, Pauline Muthoni, Peris W Chiira, Rose K Mmbukane, Serede M Mwania, Sila J Kipyegon, Titus Ochieng, Tonny O Kemunto, Valarie A Odede, Veronica A Obote, Vivian A Mituga, Winnie N Fondo, Yvonne F |
| description | Pregnant women in settings with high HIV prevalence are at increased risk of HIV acquisition and subsequent vertical transmission. We implemented and evaluated a novel programme to provide pre-exposure prophylaxis (PrEP) in maternal and child health clinics in Kenya.
In collaboration with Kisumu County Department of Health, we integrated PrEP delivery within 16 maternal and child health clinics in Kisumu County (Kenya). Women and girls older than 15 years seeking maternal and child health services who tested HIV negative at that visit or within a month and were willing to receive PrEP counselling were interviewed to assess for HIV behavioural risk factors and offered PrEP. Correlates of PrEP initiation and continuation were assessed using Poisson regression in univariate and multivariate analyses. Potential correlates included in our analyses were age, marital status, marriage type, whether pregnant or post partum, gestational age (if pregnant), and HIV risk factors in the previous 6 months. Reasons for the decision to discontinue after having decided to initiate PrEP were evaluated. Women who initiated PrEP were followed up 1 month, 3 months, and 6 months after initiation.
Between Nov 20, 2017, and June 13, 2018, 9376 pregnant and post-partum women were assessed for behavioural risk factors and willingness to initiate PrEP. Overall, 2030 (21·7%) initiated PrEP, and 2027 had the status of their partner captured (153 [79·3%] of 193 women with partners living with HIV, 1178 [37·2%] of 3165 women with partners of unknown HIV status, and 696 [11·6%] of 5997 women with HIV-negative partners). Predictors of PrEP initiation in the multivariate analysis were: being younger than 24 years (adjusted prevalence ratio 1·14, 95% CI 1·02–1·28); having a partner living with HIV (6·96, 5·46–8·89) or of unknown HIV status (3·08, 2·50–3·81); gestational age of less than 26 weeks (1·22, 1·02–1·47); having been diagnosed or treated for a sexually transmitted infection (1·57, 1·20–2·06); having been forced to have sex (1·82, 1·38–2·42); having experienced intimate partner violence during the previous 6 months (1·65, 1·10–2·48); having shared needles while engaging in injection drug use (2·43, 1·69–3·50); and recurrent use of post-exposure prophylaxis (1·96, 1·36–2·82). Overall, 786 (38·7%) of 2030 women who initiated PrEP continued use after the first month, with 104 (68·0%) of 153 women who had a partner living with HIV continuing use. Having a partner living with HIV was the |
| doi_str_mv | 10.1016/S2352-3018(19)30335-2 |
| format | Article |
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In collaboration with Kisumu County Department of Health, we integrated PrEP delivery within 16 maternal and child health clinics in Kisumu County (Kenya). Women and girls older than 15 years seeking maternal and child health services who tested HIV negative at that visit or within a month and were willing to receive PrEP counselling were interviewed to assess for HIV behavioural risk factors and offered PrEP. Correlates of PrEP initiation and continuation were assessed using Poisson regression in univariate and multivariate analyses. Potential correlates included in our analyses were age, marital status, marriage type, whether pregnant or post partum, gestational age (if pregnant), and HIV risk factors in the previous 6 months. Reasons for the decision to discontinue after having decided to initiate PrEP were evaluated. Women who initiated PrEP were followed up 1 month, 3 months, and 6 months after initiation.
Between Nov 20, 2017, and June 13, 2018, 9376 pregnant and post-partum women were assessed for behavioural risk factors and willingness to initiate PrEP. Overall, 2030 (21·7%) initiated PrEP, and 2027 had the status of their partner captured (153 [79·3%] of 193 women with partners living with HIV, 1178 [37·2%] of 3165 women with partners of unknown HIV status, and 696 [11·6%] of 5997 women with HIV-negative partners). Predictors of PrEP initiation in the multivariate analysis were: being younger than 24 years (adjusted prevalence ratio 1·14, 95% CI 1·02–1·28); having a partner living with HIV (6·96, 5·46–8·89) or of unknown HIV status (3·08, 2·50–3·81); gestational age of less than 26 weeks (1·22, 1·02–1·47); having been diagnosed or treated for a sexually transmitted infection (1·57, 1·20–2·06); having been forced to have sex (1·82, 1·38–2·42); having experienced intimate partner violence during the previous 6 months (1·65, 1·10–2·48); having shared needles while engaging in injection drug use (2·43, 1·69–3·50); and recurrent use of post-exposure prophylaxis (1·96, 1·36–2·82). Overall, 786 (38·7%) of 2030 women who initiated PrEP continued use after the first month, with 104 (68·0%) of 153 women who had a partner living with HIV continuing use. Having a partner living with HIV was the only predictor of PrEP continuation at 1 month in the multivariable model (1·98, 1·54–2·55). Frequent reasons for discontinuation were side effects and low HIV risk perception. No incident HIV infection was reported among women on PrEP.
Many women attending maternal and child health clinics had risk factors for HIV and elected to use PrEP, indicating that routinely accessed maternal and child health clinics can be an effective platform for PrEP delivery for young women. As PrEP awareness rises, PrEP provision in routine clinical settings such as maternal and child health facilities might contribute to decreased HIV incidence among young women.
US Department of State.</description><identifier>ISSN: 2352-3018</identifier><identifier>EISSN: 2352-3018</identifier><identifier>DOI: 10.1016/S2352-3018(19)30335-2</identifier><identifier>PMID: 31813837</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adolescent ; Ambulatory Care ; Anti-HIV Agents - therapeutic use ; Child Health ; Female ; HIV Infections - prevention & control ; HIV Infections - transmission ; Humans ; Infectious Disease Transmission, Vertical - prevention & control ; Infectious Disease Transmission, Vertical - statistics & numerical data ; Kenya ; Male ; Postpartum Period ; Pre-Exposure Prophylaxis ; Pregnancy ; Pregnant Women ; Young Adult</subject><ispartof>The lancet HIV, 2020-01, Vol.7 (1), p.e38-e48</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-2a024a8523702697dc1b3b719adc4d936ae2f8dd13039ba21ef94e2da1f8c1033</citedby><cites>FETCH-LOGICAL-c417t-2a024a8523702697dc1b3b719adc4d936ae2f8dd13039ba21ef94e2da1f8c1033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31813837$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kinuthia, John</creatorcontrib><creatorcontrib>Pintye, Jillian</creatorcontrib><creatorcontrib>Abuna, Felix</creatorcontrib><creatorcontrib>Mugwanya, Kenneth K</creatorcontrib><creatorcontrib>Lagat, Harison</creatorcontrib><creatorcontrib>Onyango, Dickens</creatorcontrib><creatorcontrib>Begnel, Emily</creatorcontrib><creatorcontrib>Dettinger, Julia</creatorcontrib><creatorcontrib>Baeten, Jared M</creatorcontrib><creatorcontrib>John-Stewart, Grace</creatorcontrib><creatorcontrib>Aquino, Ajode C</creatorcontrib><creatorcontrib>Ochieng, Steve J</creatorcontrib><creatorcontrib>Lipesa, Alice M</creatorcontrib><creatorcontrib>Naidu, Ambia L</creatorcontrib><creatorcontrib>Kamau, Anastacia</creatorcontrib><creatorcontrib>Njoroge, Anne W</creatorcontrib><creatorcontrib>Okeah, Bernard O</creatorcontrib><creatorcontrib>Makabwa, Cecilia B</creatorcontrib><creatorcontrib>Atieno, Celestine C</creatorcontrib><creatorcontrib>Ireri, Christine K</creatorcontrib><creatorcontrib>Ojowi, Diana A</creatorcontrib><creatorcontrib>Lubembe, Elizabeth S</creatorcontrib><creatorcontrib>Mukenyi, Emma</creatorcontrib><creatorcontrib>Kephas, Emma J A</creatorcontrib><creatorcontrib>Bundi, Esther N</creatorcontrib><creatorcontrib>Akim, Eunita I A</creatorcontrib><creatorcontrib>Otieno, Fredrick O</creatorcontrib><creatorcontrib>Owiti, George R</creatorcontrib><creatorcontrib>Cherotich, Irene</creatorcontrib><creatorcontrib>Ouma, Irene A</creatorcontrib><creatorcontrib>Adhiambo, Jacqueline Q</creatorcontrib><creatorcontrib>Otieno, Joel A</creatorcontrib><creatorcontrib>Mwendwa, Joseph M</creatorcontrib><creatorcontrib>Kemunto, Joyness B</creatorcontrib><creatorcontrib>Rono, Magdalene C</creatorcontrib><creatorcontrib>Ndung'u, Martin C</creatorcontrib><creatorcontrib>Osama, Mary I A</creatorcontrib><creatorcontrib>Odhiambo, Maurine A</creatorcontrib><creatorcontrib>Kiche, Melvin A</creatorcontrib><creatorcontrib>Mwania, Meridah M</creatorcontrib><creatorcontrib>Bhatt, Neera</creatorcontrib><creatorcontrib>Auma, Osama M</creatorcontrib><creatorcontrib>Otieno, Paskal O</creatorcontrib><creatorcontrib>Achieng, Pauline</creatorcontrib><creatorcontrib>Muthoni, Peris W</creatorcontrib><creatorcontrib>Chiira, Rose K</creatorcontrib><creatorcontrib>Mmbukane, Serede M</creatorcontrib><creatorcontrib>Mwania, Sila J</creatorcontrib><creatorcontrib>Kipyegon, Titus</creatorcontrib><creatorcontrib>Ochieng, Tonny O</creatorcontrib><creatorcontrib>Kemunto, Valarie A</creatorcontrib><creatorcontrib>Odede, Veronica A</creatorcontrib><creatorcontrib>Obote, Vivian A</creatorcontrib><creatorcontrib>Mituga, Winnie N</creatorcontrib><creatorcontrib>Fondo, Yvonne F</creatorcontrib><creatorcontrib>PrEP Implementation for Young Women and Adolescents (PrIYA) programme</creatorcontrib><title>Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme</title><title>The lancet HIV</title><addtitle>Lancet HIV</addtitle><description>Pregnant women in settings with high HIV prevalence are at increased risk of HIV acquisition and subsequent vertical transmission. We implemented and evaluated a novel programme to provide pre-exposure prophylaxis (PrEP) in maternal and child health clinics in Kenya.
In collaboration with Kisumu County Department of Health, we integrated PrEP delivery within 16 maternal and child health clinics in Kisumu County (Kenya). Women and girls older than 15 years seeking maternal and child health services who tested HIV negative at that visit or within a month and were willing to receive PrEP counselling were interviewed to assess for HIV behavioural risk factors and offered PrEP. Correlates of PrEP initiation and continuation were assessed using Poisson regression in univariate and multivariate analyses. Potential correlates included in our analyses were age, marital status, marriage type, whether pregnant or post partum, gestational age (if pregnant), and HIV risk factors in the previous 6 months. Reasons for the decision to discontinue after having decided to initiate PrEP were evaluated. Women who initiated PrEP were followed up 1 month, 3 months, and 6 months after initiation.
Between Nov 20, 2017, and June 13, 2018, 9376 pregnant and post-partum women were assessed for behavioural risk factors and willingness to initiate PrEP. Overall, 2030 (21·7%) initiated PrEP, and 2027 had the status of their partner captured (153 [79·3%] of 193 women with partners living with HIV, 1178 [37·2%] of 3165 women with partners of unknown HIV status, and 696 [11·6%] of 5997 women with HIV-negative partners). Predictors of PrEP initiation in the multivariate analysis were: being younger than 24 years (adjusted prevalence ratio 1·14, 95% CI 1·02–1·28); having a partner living with HIV (6·96, 5·46–8·89) or of unknown HIV status (3·08, 2·50–3·81); gestational age of less than 26 weeks (1·22, 1·02–1·47); having been diagnosed or treated for a sexually transmitted infection (1·57, 1·20–2·06); having been forced to have sex (1·82, 1·38–2·42); having experienced intimate partner violence during the previous 6 months (1·65, 1·10–2·48); having shared needles while engaging in injection drug use (2·43, 1·69–3·50); and recurrent use of post-exposure prophylaxis (1·96, 1·36–2·82). Overall, 786 (38·7%) of 2030 women who initiated PrEP continued use after the first month, with 104 (68·0%) of 153 women who had a partner living with HIV continuing use. Having a partner living with HIV was the only predictor of PrEP continuation at 1 month in the multivariable model (1·98, 1·54–2·55). Frequent reasons for discontinuation were side effects and low HIV risk perception. No incident HIV infection was reported among women on PrEP.
Many women attending maternal and child health clinics had risk factors for HIV and elected to use PrEP, indicating that routinely accessed maternal and child health clinics can be an effective platform for PrEP delivery for young women. As PrEP awareness rises, PrEP provision in routine clinical settings such as maternal and child health facilities might contribute to decreased HIV incidence among young women.
US Department of State.</description><subject>Adolescent</subject><subject>Ambulatory Care</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Child Health</subject><subject>Female</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - transmission</subject><subject>Humans</subject><subject>Infectious Disease Transmission, Vertical - prevention & control</subject><subject>Infectious Disease Transmission, Vertical - statistics & numerical data</subject><subject>Kenya</subject><subject>Male</subject><subject>Postpartum Period</subject><subject>Pre-Exposure Prophylaxis</subject><subject>Pregnancy</subject><subject>Pregnant Women</subject><subject>Young 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Adhiambo, Jacqueline Q ; Otieno, Joel A ; Mwendwa, Joseph M ; Kemunto, Joyness B ; Rono, Magdalene C ; Ndung'u, Martin C ; Osama, Mary I A ; Odhiambo, Maurine A ; Kiche, Melvin A ; Mwania, Meridah M ; Bhatt, Neera ; Auma, Osama M ; Otieno, Paskal O ; Achieng, Pauline ; Muthoni, Peris W ; Chiira, Rose K ; Mmbukane, Serede M ; Mwania, Sila J ; Kipyegon, Titus ; Ochieng, Tonny O ; Kemunto, Valarie A ; Odede, Veronica A ; Obote, Vivian A ; Mituga, Winnie N ; Fondo, Yvonne F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-2a024a8523702697dc1b3b719adc4d936ae2f8dd13039ba21ef94e2da1f8c1033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Ambulatory Care</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Child Health</topic><topic>Female</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Infections - transmission</topic><topic>Humans</topic><topic>Infectious Disease Transmission, Vertical - prevention & control</topic><topic>Infectious Disease Transmission, Vertical - statistics & numerical data</topic><topic>Kenya</topic><topic>Male</topic><topic>Postpartum Period</topic><topic>Pre-Exposure Prophylaxis</topic><topic>Pregnancy</topic><topic>Pregnant Women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kinuthia, John</creatorcontrib><creatorcontrib>Pintye, Jillian</creatorcontrib><creatorcontrib>Abuna, Felix</creatorcontrib><creatorcontrib>Mugwanya, Kenneth K</creatorcontrib><creatorcontrib>Lagat, Harison</creatorcontrib><creatorcontrib>Onyango, Dickens</creatorcontrib><creatorcontrib>Begnel, Emily</creatorcontrib><creatorcontrib>Dettinger, Julia</creatorcontrib><creatorcontrib>Baeten, Jared M</creatorcontrib><creatorcontrib>John-Stewart, Grace</creatorcontrib><creatorcontrib>Aquino, Ajode C</creatorcontrib><creatorcontrib>Ochieng, Steve J</creatorcontrib><creatorcontrib>Lipesa, Alice M</creatorcontrib><creatorcontrib>Naidu, Ambia L</creatorcontrib><creatorcontrib>Kamau, Anastacia</creatorcontrib><creatorcontrib>Njoroge, Anne W</creatorcontrib><creatorcontrib>Okeah, Bernard O</creatorcontrib><creatorcontrib>Makabwa, Cecilia B</creatorcontrib><creatorcontrib>Atieno, Celestine C</creatorcontrib><creatorcontrib>Ireri, Christine K</creatorcontrib><creatorcontrib>Ojowi, Diana A</creatorcontrib><creatorcontrib>Lubembe, Elizabeth S</creatorcontrib><creatorcontrib>Mukenyi, Emma</creatorcontrib><creatorcontrib>Kephas, Emma J A</creatorcontrib><creatorcontrib>Bundi, Esther N</creatorcontrib><creatorcontrib>Akim, Eunita I A</creatorcontrib><creatorcontrib>Otieno, Fredrick O</creatorcontrib><creatorcontrib>Owiti, George R</creatorcontrib><creatorcontrib>Cherotich, Irene</creatorcontrib><creatorcontrib>Ouma, Irene A</creatorcontrib><creatorcontrib>Adhiambo, Jacqueline Q</creatorcontrib><creatorcontrib>Otieno, Joel A</creatorcontrib><creatorcontrib>Mwendwa, Joseph M</creatorcontrib><creatorcontrib>Kemunto, Joyness B</creatorcontrib><creatorcontrib>Rono, Magdalene C</creatorcontrib><creatorcontrib>Ndung'u, Martin C</creatorcontrib><creatorcontrib>Osama, Mary I A</creatorcontrib><creatorcontrib>Odhiambo, Maurine A</creatorcontrib><creatorcontrib>Kiche, Melvin A</creatorcontrib><creatorcontrib>Mwania, Meridah M</creatorcontrib><creatorcontrib>Bhatt, Neera</creatorcontrib><creatorcontrib>Auma, Osama M</creatorcontrib><creatorcontrib>Otieno, Paskal O</creatorcontrib><creatorcontrib>Achieng, Pauline</creatorcontrib><creatorcontrib>Muthoni, Peris W</creatorcontrib><creatorcontrib>Chiira, Rose K</creatorcontrib><creatorcontrib>Mmbukane, Serede M</creatorcontrib><creatorcontrib>Mwania, Sila J</creatorcontrib><creatorcontrib>Kipyegon, Titus</creatorcontrib><creatorcontrib>Ochieng, Tonny O</creatorcontrib><creatorcontrib>Kemunto, Valarie A</creatorcontrib><creatorcontrib>Odede, Veronica A</creatorcontrib><creatorcontrib>Obote, Vivian A</creatorcontrib><creatorcontrib>Mituga, Winnie N</creatorcontrib><creatorcontrib>Fondo, Yvonne F</creatorcontrib><creatorcontrib>PrEP Implementation for Young Women and Adolescents (PrIYA) programme</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The lancet HIV</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kinuthia, John</au><au>Pintye, Jillian</au><au>Abuna, Felix</au><au>Mugwanya, Kenneth K</au><au>Lagat, Harison</au><au>Onyango, Dickens</au><au>Begnel, Emily</au><au>Dettinger, Julia</au><au>Baeten, Jared M</au><au>John-Stewart, Grace</au><au>Aquino, Ajode C</au><au>Ochieng, Steve J</au><au>Lipesa, Alice M</au><au>Naidu, Ambia L</au><au>Kamau, Anastacia</au><au>Njoroge, Anne W</au><au>Okeah, Bernard O</au><au>Makabwa, Cecilia B</au><au>Atieno, Celestine C</au><au>Ireri, Christine K</au><au>Ojowi, Diana A</au><au>Lubembe, Elizabeth S</au><au>Mukenyi, Emma</au><au>Kephas, Emma J A</au><au>Bundi, Esther N</au><au>Akim, Eunita I A</au><au>Otieno, Fredrick O</au><au>Owiti, George R</au><au>Cherotich, Irene</au><au>Ouma, Irene A</au><au>Adhiambo, Jacqueline Q</au><au>Otieno, Joel A</au><au>Mwendwa, Joseph M</au><au>Kemunto, Joyness B</au><au>Rono, Magdalene C</au><au>Ndung'u, Martin C</au><au>Osama, Mary I A</au><au>Odhiambo, Maurine A</au><au>Kiche, Melvin A</au><au>Mwania, Meridah M</au><au>Bhatt, Neera</au><au>Auma, Osama M</au><au>Otieno, Paskal O</au><au>Achieng, Pauline</au><au>Muthoni, Peris W</au><au>Chiira, Rose K</au><au>Mmbukane, Serede M</au><au>Mwania, Sila J</au><au>Kipyegon, Titus</au><au>Ochieng, Tonny O</au><au>Kemunto, Valarie A</au><au>Odede, Veronica A</au><au>Obote, Vivian A</au><au>Mituga, Winnie N</au><au>Fondo, Yvonne F</au><aucorp>PrEP Implementation for Young Women and Adolescents (PrIYA) programme</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme</atitle><jtitle>The lancet HIV</jtitle><addtitle>Lancet HIV</addtitle><date>2020-01</date><risdate>2020</risdate><volume>7</volume><issue>1</issue><spage>e38</spage><epage>e48</epage><pages>e38-e48</pages><issn>2352-3018</issn><eissn>2352-3018</eissn><abstract>Pregnant women in settings with high HIV prevalence are at increased risk of HIV acquisition and subsequent vertical transmission. We implemented and evaluated a novel programme to provide pre-exposure prophylaxis (PrEP) in maternal and child health clinics in Kenya.
In collaboration with Kisumu County Department of Health, we integrated PrEP delivery within 16 maternal and child health clinics in Kisumu County (Kenya). Women and girls older than 15 years seeking maternal and child health services who tested HIV negative at that visit or within a month and were willing to receive PrEP counselling were interviewed to assess for HIV behavioural risk factors and offered PrEP. Correlates of PrEP initiation and continuation were assessed using Poisson regression in univariate and multivariate analyses. Potential correlates included in our analyses were age, marital status, marriage type, whether pregnant or post partum, gestational age (if pregnant), and HIV risk factors in the previous 6 months. Reasons for the decision to discontinue after having decided to initiate PrEP were evaluated. Women who initiated PrEP were followed up 1 month, 3 months, and 6 months after initiation.
Between Nov 20, 2017, and June 13, 2018, 9376 pregnant and post-partum women were assessed for behavioural risk factors and willingness to initiate PrEP. Overall, 2030 (21·7%) initiated PrEP, and 2027 had the status of their partner captured (153 [79·3%] of 193 women with partners living with HIV, 1178 [37·2%] of 3165 women with partners of unknown HIV status, and 696 [11·6%] of 5997 women with HIV-negative partners). Predictors of PrEP initiation in the multivariate analysis were: being younger than 24 years (adjusted prevalence ratio 1·14, 95% CI 1·02–1·28); having a partner living with HIV (6·96, 5·46–8·89) or of unknown HIV status (3·08, 2·50–3·81); gestational age of less than 26 weeks (1·22, 1·02–1·47); having been diagnosed or treated for a sexually transmitted infection (1·57, 1·20–2·06); having been forced to have sex (1·82, 1·38–2·42); having experienced intimate partner violence during the previous 6 months (1·65, 1·10–2·48); having shared needles while engaging in injection drug use (2·43, 1·69–3·50); and recurrent use of post-exposure prophylaxis (1·96, 1·36–2·82). Overall, 786 (38·7%) of 2030 women who initiated PrEP continued use after the first month, with 104 (68·0%) of 153 women who had a partner living with HIV continuing use. Having a partner living with HIV was the only predictor of PrEP continuation at 1 month in the multivariable model (1·98, 1·54–2·55). Frequent reasons for discontinuation were side effects and low HIV risk perception. No incident HIV infection was reported among women on PrEP.
Many women attending maternal and child health clinics had risk factors for HIV and elected to use PrEP, indicating that routinely accessed maternal and child health clinics can be an effective platform for PrEP delivery for young women. As PrEP awareness rises, PrEP provision in routine clinical settings such as maternal and child health facilities might contribute to decreased HIV incidence among young women.
US Department of State.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>31813837</pmid><doi>10.1016/S2352-3018(19)30335-2</doi></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2352-3018 |
| ispartof | The lancet HIV, 2020-01, Vol.7 (1), p.e38-e48 |
| issn | 2352-3018 2352-3018 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2322808428 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Ambulatory Care Anti-HIV Agents - therapeutic use Child Health Female HIV Infections - prevention & control HIV Infections - transmission Humans Infectious Disease Transmission, Vertical - prevention & control Infectious Disease Transmission, Vertical - statistics & numerical data Kenya Male Postpartum Period Pre-Exposure Prophylaxis Pregnancy Pregnant Women Young Adult |
| title | Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: results from an implementation programme |
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