HIV risk and pre‐exposure prophylaxis interest among women seeking post‐abortion care in Kenya: a cross‐sectional study

Introduction Post‐abortion clinics located in regions with high HIV burden may ideal locations to integrate counselling and delivery of HIV pre‐exposure prophylaxis (PrEP), aligning with normative goals for integrated delivery of HIV and reproductive health care. The objective of this study was to gauge the degree to which Kenyan women seeking care for a pregnancy loss, including induced abortion, are at risk for HIV and whether women would welcome an introduction to PrEP prior to discharge from post‐abortion care. Methods We conducted a mixed‐methods study from August 2019 to February 2020 with women ages 15 to 30 recruited sequentially as they were accessing post‐abortion care at public and private facilities in Thika and Kisumu, Kenya. Data collection was through a cross‐sectional survey and laboratory testing for common sexually transmitted infections (N = 200), and in‐depth interviews (N = 30). Descriptive statistics summarize PrEP knowledge and referrals and a multivariable log‐link binomial model estimated correlates of receiving a referral for PrEP. Qualitative data were analysed using inductive and deductive approaches. Results Among 200 HIV‐negative women (median age 21.0, interquartile range 19.0 to 22.0), the prevalence of Chlamydia trachomatis was 18.2% and Neisseria gonorrhoeae was 2.0%. Half of the women scored ≥5 on a validated tool that would correspond to an expected HIV incidence of 9.5% per year. Approximately half (55.8%) of women were familiar with PrEP prior to the study and 33.3% received a referral from study staff to a clinic offering PrEP. In qualitative interviews, women expressed interest in accessing PrEP from the gynaecology ward that provided post‐abortion care but they preferred alternative locations for PrEP refills. Conclusions Kenyan women accessing post‐abortion care have substantial HIV risk and were favourable about the idea of receiving support to initiate PrEP as part of care offered during post‐abortion care. These settings can be integrated into national PrEP programmes as locations providing PrEP referrals and initiation.