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Perceptions of PrEP Use Among Pregnant Individuals and Implications for HIV Prevention

person holding PrEP oral medication

March 17, 2022

Ali Groves, PhD, MHS, Assistant Professor in the Department of Community Health and Prevention at the Dornsife School of Public Health (DSPH), led research on preexposure prophylaxis (PrEP) perceptions among pregnant individuals and its implications for human immunodeficiency virus (HIV) prevention.

This qualitative research, Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention, aimed to build a greater understanding of opinions towards PrEP use among this population. PrEP is medicine taken to prevent getting HIV, and it is highly effective according to the Centers for Disease Control and Prevention.

“There has been limited research on acceptability of PrEP during pregnancy in the U.S. among folks at high risk of HIV,” shared Groves. “Yet the perinatal period is a unique time of HIV risk, given the biologic and social changes that accompany pregnancy. Increasing pregnant individuals’ access to and awareness of PrEP during this time can play an important role in preventing HIV not only for pregnant individuals but also their children.”

"Increasing pregnant individuals’ access to and awareness of PrEP during [the perinatal period] can play an important role in preventing HIV not only for pregnant individuals but also for their children." - Ali Groves, PhD, MHS

The study found that participants had little to no knowledge of PrEP and most saw themselves at low risk of HIV acquisition, even though they were eligible for PrEP because they had recently been diagnosed with a sexually transmitted infection (STI). Additionally, participants’ low HIV risk perception and medication safety concerns reduced their willingness to consider using PrEP during pregnancy.

Despite their vulnerability to HIV, very few obstetrician-gynecologists (OB/GYNs) had discussed PrEP with participants during antenatal care. This was another barrier in considering its use. Those who did discuss the medication with their OB/GYNs had favorable perceptions of it.

Researchers also explored participants’ hypothetical preferences for various PrEP formulations, i.e. a daily oral pill versus a bimonthly injectable. Participants indicated that they would choose a formulation based on individual preferences, which were largely shaped by perceived ease of use, acceptability, and prior experience with other medication regimens.

This research shines a light on the critical role OB/GYNs may play in introducing PrEP to high-risk pregnant individuals and the importance of individual consideration when selecting a PrEP formulation which can increase adherence. In 2019, the U.S. government announced the goal to end the HIV epidemic in the states by 2030. PrEP is an essential tool in reaching this goal.

“Barriers to PrEP uptake in pregnancy could easily be addressed through conversations between OB/GYNS and those patients at risk of HIV during antenatal care visits,” shared Groves. “Given the racial disparities in HIV infection in the United States, improving individual’s access to PrEP during and after pregnancy has important implications for health equity and for ending the HIV epidemic in the U.S.”

Valerie Raziano, MPH, DrPH Candidate at DSPH, Jessica Vadaketh, an MD candidate at Drexel School of Medicine, and colleagues from the Perelman School of Medicine at the University of Pennsylvania also contributed to this publication.

This research was published in the Journal of Obstetrics & Gynecology on March 10, 2022.

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