Advancing HIV prevention: understanding and enhancing PrEP use in pregnant and postpartum women

Pregnant and postpartum women (PPW) experience a heightened risk of acquiring HIV, which threatens maternal health and increases the risk of vertical transmission. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention tool and integrating it into antenatal and postnatal care (ANC/PNC) is a promising approach to reach PPW. However, limited data exist on how PPW engage with these integrated services and which strategies enhance PrEP use. This mixed-method study will examine PrEP uptake, continuation (i.e. continued use at each visit over 6 months) and adherence (e.g., self-reported use during last 30 days) in Zambia by analysing cross-sectional population-based survey data from ever pregnant adolescent girls and young women and DHIS-2 data and medical records from PPW attending ANC/PNC. In-depth interviews and focus group discussions with stakeholders, including PPW, male partners and healthcare providers, will provide essential insights into multi-level factors influencing PrEP use. Based on these findings and a discrete choice experiment, a community-based PrEP delivery model, co-developed with and for postpartum women, will be pilot-tested to provide critical evidence on how to enhance PrEP use in the postpartum period. Overall, findings will inform broader scale-up and optimisation of PrEP integration into ANC/PNC, aiming to reduce new HIV infections among PPW and their infants.