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

Abstract

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 indepth 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.

A Scoping Review of Oral Pre-exposure Prophylaxis for Cisgender and Transgender Adolescent Girls and Young Women: What Works and Where Do We Go from Here?

“… Electronically monitored adherence, using Wisepill RT2000, was defined as openings of the adherence monitoring device recorded among days with functional monitoring 37 (C) 40 (I) 27 (C, I) 9. Heffron et al, 2021 Ages 15–30; n = 200; Kenya [ 47 ] No control Intervention : Women receiving post-abortion care were counselled about PrEP and offered referrals. Said they would like to use PrEP 46 Accepted an off-site PrEP referral 33 10.…”

“…Among these studies (n = 15), three interventions addressed PrEP willingness/interest. Studies focused on interest/willingness to use PrEP assessed both interventions outside of clinical settings, such as the impact of general marketing materials on PrEP interest [ 46 ], as well as PrEP interventions integrated within clinical settings [ 47 , 48 ]. Within these studies, Morton et al demonstrated that video advertisements could generate interest in learning more about oral PrEP in more than half of viewers [ 46 ].…”

“…Within clinic settings, studies utilised both family planning (FP) clinics and post-abortion care facilities as referral points for oral PrEP. In the FP setting, 18% accepted off-site oral PrEP referrals [ 48 ], whereas 33% of AGYW aged 15–30 years receiving post-abortion care accepted a PrEP referral [ 47 ].…”

“…Results from included studies found that it is feasible to integrate oral PrEP into a range of settings serving AGYW. For cisgender AGYW, these include settings involving other sexual and reproductive health services such as FP [ 22 , 46 , 48 , 53 , 54 ], MCH clinics [ 28 ], and post-abortion care [ 47 ], DREAMS programming [ 8 , 49 ], and FSW-friendly services [ 51 ]. For transgender AGYW, integration occurred in existing LGBTQ-focused spaces [ 11 , 43 ], public facilities [ 44 , 45 ], and new PrEP-focused comprehensive services designed for and implemented by key populations [ 29 ].…”

Provision of HIV preexposure prophylaxis to female patients seeking family planning services in the United States

“…Prior research has demonstrated that women expect HIV prevention counseling during family planning visits, and 40% of women exclusively access healthcare through sexual and reproductive care visits [13]. A significant proportion of patients seeking abortion are also interested in PrEP [14]. Integration of PrEP care into the family planning setting has the potential to increase awareness and uptake of the medication.…”