Awareness, acceptability, and intention to initiate HIV pre-exposure prophylaxis among pregnant women

ABSTRACT

HIV prevention is critically important during pregnancy, however, pre-exposure prophylaxis (PrEP) is underutilized. We conducted a survey of pregnant and non-pregnant women in a high HIV prevalence community in Washington D.C. to evaluate determinants of PrEP initiation during pregnancy. 201 pregnant women and a reference population of 1103 non-pregnant women completed the survey. Among pregnant women, mean age was 26.9 years; the majority were Black with household-incomes below the federal poverty level. Despite low perceived risk of HIV acquisition and low prior awareness of PrEP, 10.5% of respondents planned to initiate PrEP during pregnancy. Pregnant women identified safety, efficacy, and social network and medical provider support as key factors in PrEP uptake intention. The belief that PrEP will “protect (their) baby from HIV” was associated with PrEP uptake intention during pregnancy. Concerns regarding maternal/fetal side effects, and safety in pregnancy or while breastfeeding were not identified as deterrents to uptake intention. When compared to a nonpregnant sample, there were no significant differences in uptake intention between the two samples. These findings support the need for prenatal educational interventions to promote HIV prevention during pregnancy, as well as interventions that center on the role of providers in the provision of PrEP.

KEYWORDS:

• Behavioral intention
• Human Immunodeficiency Virus (HIV)
• HIV prevention
• pre-exposure prophylaxis (PrEP)
• pregnancy
• Integrated Model of Behavior Prediction
• psychosocial determinants
• women
• high prevalence
• reasoned action approach

Acknowledgements

The authors would like to thank Patricia Moriarty, Patricia Tanjutco, and Ron Migues for their administrative support, as well as MedStar Gradulate Medical Education.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Research support was provided by MedStar Washington Hospital Center Graduate Medical Education [grant number: N/A]. The non-pregnant comparison group referenced is from an investigator-sponsored research award from Gilead Sciences [grant number: ISR-17-10227]. Research reported in this publication was supported by National Institute on Drug Abuse of the National Institutes of Health under award number 1K01DA050496-01A1.