ArticleBMC global and public health2024
Integration of HIV pre-exposure prophylaxis (PrEP) services for pregnant and breastfeeding women in eight primary care clinics: results of an implementation science study.
Article in BMC global and public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis.BMC public health · 2024Pooled it
- Fidelity of Implementation of Oral Pre-Exposure Prophylaxis for HIV in Public Family Planning Clinics in Kenya: Results From a Stepped-Wedge Cluster Randomized Trial.Journal of the International AIDS Society · 2026Trial
- Behavioral and Structural Interventions for PrEP Adherence Among Young Female Sex Workers from Western Kenya.AIDS and behavior · 2026Trial
- Exploring Preferences for Long-Acting Injectable PrEP Among Postpartum Women in South Africa Using the Consolidated Framework for Implementation Research: The Siphila Sonke Study.AIDS and behavior · 2026Article
- Determinants of PrEP Delivery Platform Choice in Adolescents and Young People: The Fast-PrEP Project in Cape Town, South Africa.International journal of environmental research and public health · 2026Article
- Long-Acting HIV Pre-exposure Prophylaxis Preferences Through Pregnancy and the Postpartum Period Among Women in Kenya: A Latent Transition Analysis.AIDS and behavior · 2026Article
- Oral PrEP use among pregnant or parenting young women in South Africa: evidence from a large community-based implementation study.BMC public health · 2026Article
- A rapid qualitative analysis of health care worker and community focus groups on determinants and implementation strategies for long-acting PrEP in antenatal and postpartum settings in Kenya.Discover health systems · 2026Article
- I needed somebody to encourage me to take it [PrEP], maybe it would have protected me and the baby: a qualitative study to understand prenatal oral PrEP use among pregnant adolescent girls and young women in Tshwane, South Africa.Reproductive health · 2025Article
- Implementation science derived from low- and middle-income countries is essential for advancing global health.BMC global and public health · 2025Article
- Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experiment.AJOG global reports · 2025Article
- Exploring resource availability for nurses implementing HIV prevention guidelines in primary healthcare facilities.Health SA = SA Gesondheid · 2025Article
- Health System Factors Influencing the Integration of Pre-Exposure Prophylaxis into Antenatal and Postnatal Clinic Services in Cape Town, South Africa.Global health, science and practice · 2024Article
- Oral pre-exposure prophylaxis implementation in South Africa: a case study of USAID-supported programs.Frontiers in reproductive health · 2024Article
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Abstract
backgroundAlthough HIV vertical transmission has declined significantly in sub-Saharan Africa, incident HIV infection in pregnant and postpartum women is estimated to account for over one-third of HIV vertical transmission. Oral pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women (PBFW) is included in South African PrEP guidelines since 2021; however, integration of PrEP services within ante- and postnatal care remains limited.
methodsBetween March 2022 and September 2023, we evaluated the integration of PrEP for PBFW in eight antenatal clinics in Cape Town, South Africa, following training and mentorship of providers. We applied an adapted Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the integration of PrEP services for pregnant and breastfeeding women. Before the study, PrEP was not routinely offered. We implemented a staff didactic/practice-based training and mentorship on PrEP provision targeting PBFW. We evaluated the following: (1) Reach as the proportion of women initiating PrEP among women counselled and tested for HIV, (2) effectiveness as PrEP continuation up to 3 months by pregnant vs. breastfeeding women, (3) adoption of PrEP integration via pre- and post-training assessments and ongoing mentorship assessments, (4) implementation through clinic trends of PrEP offer over time, and (5) maintenance: continued PrEP offer 3 months following the intervention.
resultsIn 8 facilities providing ante- and postnatal care, we trained 224 healthcare providers (127 nurses and 37 counsellors). Of those, we mentored 60 nurses, midwives, and HIV counsellors working with pregnant and breastfeeding women, with 80% of nurse/midwives and 65% of counsellors scoring ≥ 80% on the final mentoring assessment. Overall, 12% of HIV-negative pregnant women started PrEP, and 41% of those continued PrEP up to 3 months. Among HIV-negative breastfeeding women, 14% initiated PrEP, and 25% continued PrEP up to 3 months. All eight facilities continued providing PrEP 3 months post intervention.
conclusionsIn these high HIV prevalence clinics, the proportion of pregnant and breastfeeding women initiating and continuing PrEP rapidly increased but was limited among breastfeeding women. Staff training, mentorship, and PrEP integration were well-adopted by nurses and counsellors, and services continued following the intervention. Barriers included limited HIV testing of breastfeeding mothers and need for additional PrEP-trained nurses.
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