Poster - #UCLAFSPH-24 - Keywords: Oral PrEP HIV Adolescent Girls and Young Women pregnancy

Oral PrEP (TDF/FTC) Integration into Antenatal Care for HIV-negative and pregnant Adolescent Girls & Young Women in Cape Town, South Africa

Nehaa Khadka (1), Dorothy Nyemba (2), Rufaro Mvududu (2), Nyiko Mashele (2), Linda-Gail Bekker (3), Thomas Coates (4), Landon Myer(2) , Pamina Gorbach(1), Dvora Joseph Davey (1,2,4)
(1) Department of Epidemiology, School of Public Health, University of California Los Angeles, USA; (2) Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, South Africa; (3) Desmond Tutu HIV Centre, Cape Town, South Africa; (4) Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, USA

ABSTRACT:
Background: Adolescent girls and young women(AGYW) have elevated risk of incident HIV in South Africa. Despite growing availability of daily oral pre-exposure prophylaxis(PrEP) for HIV prevention, little is known about PrEP use during pregnancy and postpartum serviced at antenatal care (ANC) facility. Methods: We used data from HIV-uninfected pregnant women aged 16-24 in Cape Town, South Africa enrolled in the PrEP in pregnancy and postpartum(PrEP-PP) cohort study at 1st ANC visit. Outcomes were PrEP initiation(prescribed TDF-FTC at baseline),continuation(returned for prescription) and persistence(quantifiable tenofovir diphosphate [TDF-DP] in dried blood). Exposure was baseline HIV risk(0-5): condomless sex, >1 sexual partner, partner living with HIV/ unknown serostatus, laboratory-diagnosed STIs, hazardous alcohol use before pregnancy(AUDIT≥3). We used logistic regression to examine associations between HIV risk and PrEP adjusting for apriori confounders. Results: Of 489 pregnant women, 16% were “adolescents”(16-18 years) and 84% were “young women” (19-24). ANC initiation was later for adolescents than young women(28 weeks[20-35] vs 23 weeks[16-34], P=0.03). Almost half (48%) had STI diagnosis at baseline. Overall, 83% of AGYW initiated PrEP at 1st ANC; PrEP continuation was 63% at 1 month, 53% at 3 months and 34% at 6 months. About 24% consistently continued PrEP through 6 months and 11% stopped and restarted. AGYW with a higher HIV risk (score≥2 vs ≤1) had increased odds of continuing PrEP (aOR, 1.91 [95% CI, 1.15-3.16]) through 6 months.TDF-DP was detected among 56% of AGYW reporting PrEP use and 7% had high adherence to PrEP (~7 doses/week) at 6 months. Conclusions: AGYW had high oral PrEP initiation, but only one-third were retained in the study by 6 months. Higher baseline HIV risk was associated with PrEP continuation. Low persistence of TFV-DP suggests oral PrEP coverage remained inadequate for ample HIV protection. Key barriers persist in HIV prevention efforts for AGYW during pregnancy and postpartum.