Oluwaseyi Isehunwa, PhD, MPH

Exploring preferences for long-acting injectable PrEP among postpartum women living in KwaZulu-Natal Province, South Africa.

Oluwaseyi O. Isehunwa 1, Shannon Bosman2, Thandanani Madonsela2, Thembelihle P. Pita2, Lindani Msimango2, Londeka Mbewe2, Ayanda Tshazi2, Patricia M. Smith 1, Alastair Van Heerden 2,3, Lynn T. Matthews 1

1. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
2. Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
3. MRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, South Africa

 

Women in South Africa are disproportionately affected by HIV, with increased incidence during pregnancy and postpartum. While daily oral TDF/FTC PrEP is safe, effective, and recommended for pregnant and PP women exposed to HIV, daily pill adherence is challenging. Long-acting injectable (LAI) PrEP may be more desirable for postpartum women. Using the Consolidated Framework for Implementation Research (CFIR), we explored acceptability and factors that might influence LAI-CAB delivery for postpartum women in South Africa.

Between March and April 2023, 4 focus group discussions (FGDs) were conducted among a one-year postpartum women in rural KwaZulu-Natal, South Africa. Enrolled women were not living with HIV and reported a male partner living with HIV or of unknown serostatus. Transcripts were analyzed using content analysis.

The median age of 27 participants was 27 (range 19 -36) years. Five (19%) reported that their main pregnancy partner was living with HIV, 8 (30%) ever-used PrEP, and 25 (92%) had ever-breastfed. Preliminary emergent themes were observed in the innovation, inner setting, outer setting, and individual CFIR domains. 1) Need: Women expressed the need for HIV prevention interventions to protect themselves and their babies during the postpartum period. Discussion highlighted the tendency of men to seek other partners during postpartum abstinent periods, putting women at increased risk for HIV-exposure. Women were aware of oral PrEP and voiced concerns with postpartum use including frequent clinic visits, side-effects, forgetting to take pills, and antiretroviral use stigma. 2) High interest and preference for long-acting injectable: Women expressed that they would prefer LAI over oral PrEP due to perceived ease of use (less frequent visits, stigma), similarities to injectable contraception, especially if offered in a community setting. 3) Opportunities to promote LAI: Women suggested that mobile clinics, incentives, and integrating the delivery of LAI with child immunization could facilitate use. 4) Barriers to LAI: Women mentioned the anticipated cost of LAI, lack of transportation, and some concerns about safety while breastfeeding.

These findings highlight the need for HIV prevention modality choice among postpartum women, and opportunities to promote access in community settings to reduce the risk of HIV acquisition and perinatal transmission.