Oral PrEP use among pregnant or parenting young women in South Africa: evidence from a large community-based implementation study

Chen-Charles, Jenny Davey, Dvora J. Rousseau, Elzette Little, Francesca Toska, Elona Mathola, Ntombovuyo Macdonald, Pippa Vanto, Onesimo Wallace, Melissa Bekker, Linda-Gail; Davey, Dvora J; Rousseau, Elzette; Little, Francesca; Toska, Elona; Mathola, Ntombovuyo; Macdonald, Pippa; Vanto, Onesimo; Wallace, Melissa; Bekker, Linda-Gail, Melissa

Oral PrEP use among pregnant or parenting young women in South Africa: evidence from a large community-based implementation study

Journal Article

2026

Journal Title

BMC Public Health

Department

Department of Medicine

Faculty

Faculty of Health Sciences

License

http://creativecommons.org/licenses/by/4.0/

Abstract

Abstract Background The risk of HIV acquisition is heightened during pregnancy and early parenthood with the additional risk of vertical HIV transmission. While recent studies have improved our understanding of PrEP use among pregnant and breastfeeding women, further evidence is needed to inform the design of interventions that support sustained use, especially among young women who are pregnant or parenting. Methods We analysed data from young women aged 15–29 years who initiated PrEP in an implementation study (FastPrEP) in Cape Town, South Africa. Logistic regression was used to examine the association between pregnancy or parenting status (≥ 1 living child) and PrEP discontinuation at 1- and 4-months post-initiation, based on pharmacy refill data. The primary exposure was currently pregnant or having a child (vs. not); secondary analyses stratified by age (15–24 vs. 25–29 years) among women who were pregnant/parenting. Models were adjusted for age and hypothesised explanatory factors were included in sensitivity analysis: service delivery location, contraceptive use, HIV risk perception, and relationship status. Results Between August 2022 and June 2024 n = 4,876 young women initiated PrEP; 44% were pregnant/parenting (of which 10% were pregnant), and the median age was 21.6 years (IQR:18–25). At 1-month, women who were pregnant/parenting had higher odds of PrEP discontinuation (aOR:1.30, 95% CI:1.14–1.49). At 4-months this relationship persisted (aOR:1.41, 95% CI:1.12–1.78) compared with non-pregnant/parenting women. Among those pregnant/parenting, younger women (15–24 years) had higher odds of discontinuation at 1-month (aOR:1.31, 95% CI:1.08–1.58) and 4-months (aOR:1.41, 95%CI:1.02–1.96) compared to women aged 25–29. In the fully adjusted multivariable model, receiving PrEP in mobile clinics (aOR:0.71, 95% CI:0.61–0.82) vs. government clinics was associated with lower odds of early discontinuation. Conclusion Young women who are pregnant/parenting face elevated risk of early PrEP discontinuation. Differentiated, life-stage and youth-responsive interventions, such as counselling, partner involvement, and integration with maternal and child health, or sexual and reproductive health services, are critical to improving PrEP persistence among this priority population. This population should be prioritised in the rollout of long-acting PrEP formulations, which may better align with their needs and reduce the burden of daily adherence.