Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships

Abstract

Women who have a prevention mindset may opt for concurrent use of oral pre-exposure prophylaxis (PrEP) and all forms of contraception; we therefore assessed how contraception may influence PrEP use or vice versa. We analyzed data from Kenyan and Ugandan HIV-uninfected non-pregnant women in sero-discordant partnerships who were participating in the Partners Demonstration Project. Using multivariable generalized estimating equation models, we estimated the associations between effective contraceptive use and 1) PrEP dispensation 2) high effective PrEP use. Among the 311 women (93.1% of all those followed in the Partners Demonstration Project) median age was 29 years (interquartile range [IQR] 24.0–35.0) and 115 (37.0%) reported using effective contraception at baseline. All the women initiated PrEP during the study and moderately high PrEP adherence was recorded at 73.1% of visits over an average 7.5 months following PrEP dispensation. Women (14.8%) consistently used an effective contraceptive throughout study follow-up. PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk [aRR] = 1.19; 95% confidence interval [CI] = 1.08–1.32) and contraceptive use was more common among those on PrEP (aRR = 1.63; 95% CI = 1.18–2.25). Among East African women at high risk of HIV infection, PrEP dispensation was more frequent among women using effective contraception, indicating that family planning outlets may be efficient locations to deliver PrEP.

High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda

“…Emerging studies of PrEP use among adolescent girls, and young women have mixed results, although most note high PrEP initiation and declining use over time (66)(67)(68)(69)(70). The high uptake and sustained adherence observed in this study are consistent with a recent periconception study conducted among HIV-negative Kenyan women within a serodifferent partnership and desire to have a child (27).…”

High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda: A cohort study

“…Emerging studies of PrEP use among adolescent girls, and young women have mixed results, although most note high PrEP initiation and declining use over time [79][80][81][82][83]. The high uptake and sustained adherence observed in this study are consistent with a recent periconception study conducted among HIV-negative Kenyan women within a serodifferent partnership and desire to have a child [27].…”

Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review

“…A study by Ngure et al which integrated PrEP with FP services found that PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk (aRR)=1.19; 95% CI =1.08 to 1.32) and contraceptive use was more common among those on PrEP (aRR 1.63; 95% CI 1.18 to 2.25), highlighting the importance of SDMs that integrate PrEP with FP services. 32 Pintye et al found that participants who initiated PrEP at MCH clinics took an additional 18 min for PrEP related activities over and above the time spent at the clinic to receive routine MCH services. The additional time could deter AGYW from initiating and continuing PrEP and depending on healthcare facility size and patient volume integrating PrEP into these routine services could result in several additional hours of work for nurses.…”

“…These studies used nurses dedicated to providing PrEP services only, which may limit applicability in a sub-Saharan setting where facilities have a limited clinical workforce. A study by Ngure et al which integrated PrEP with FP services found that PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk (aRR)=1.19; 95% CI =1.08 to 1.32) and contraceptive use was more common among those on PrEP (aRR 1.63; 95% CI 1.18 to 2.25), highlighting the importance of SDMs that integrate PrEP with FP services 32. Pintye et al found that participants who initiated PrEP at MCH clinics took an additional 18 min for PrEP related activities over and above the time spent at the clinic to receive routine MCH services.…”