HIV acquisition during pregnancy presents a serious threat to maternal and child health. WHO recommends pre-exposure prophylaxis (PrEP) for HIV prevention among pregnant women living in communities with high HIV incidence. 1,2 However, there are few studies of the implementation of PrEP during pregnancy and the post-partum period in settings with a high HIV burden. PrEP delivery to pregnant women under regular clinical conditions needs to be documented urgently. 3 In the Lancet HIV, John Kinuthia and colleagues 4 report important results of their PrEP Implementation for Young Women and Adolescents (PrIYA) programme in Kenya. The study is the first to provide evidence from the real-world implementation of PrEP in 16 maternal and child health clinics in a region with high HIV prevalence (antenatal HIV prevalence >20%). Among the key findings, 2030 (21•7%) of 9376 pregnant and post-partum women initiated PrEP, although only 786 (38•7%) of them returned for a refill prescription after 1 month. 104 (68•0%) of 153 women with partners living with HIV continued PrEP at least throughout the first month, but continuation was not as high for women with other risk factors for HIV. This study shows that maternal and child health clinics could potentially be an effective platform for PrEP delivery because of existing services for the prevention of mother-to-child transmission and integrated HIV testing and retesting of HIV-uninfected women; however, it also indicates that advising and dispensing PrEP are, alone, unlikely to be sufficient to protect all pregnant women at risk for HIV. We highlight two areas for future research to optimise maternal PrEP use. First, women who used PrEP reported increased behavioural risks of HIV acquisition, and initial uptake was