Online Poster Portal

  • Author
    Nafisa Wara
  • Discovery PI

    Nafisa Wara

  • Project Co-Author

    Carey Pike, Elzette Rousseau, Rufaro Mvududu, Kalisha Bheemraj, Sumaya Dadan, Lara Court, Pippa Macdonald, Pakama Mapukata, Bryan Leonard, Keitumetse Lebelo, Ringie Gulwa, Chwayita Ntwasa, Kungeka Ndzondzo, Beryl Samukelisiwe Sibanda, Catherine Orrell, Risa Hoffman, Linda-Gail Bekker, Dvora Joseph Davey

  • Abstract Title

    Implementation of Injectable Cabotegravir PrEP during Pregnancy and Postpartum in Cape Town, South Africa: Lessons from PrEPared to Choose and SCOPE-PP

  • Discovery AOC Petal or Dual Degree Program

    Global Health

  • Abstract

    Background and Objective: Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences among PLP offered CAB-LA versus oral PrEP in South Africa, and developed a decision support tool (DST) to support PLP in choosing between PrEP methods.

    Methods: We report baseline CAB-LA and oral PrEP initiations and acceptability among PLP enrolled in PrEPared to Choose, an ongoing implementation study offering CAB-LA and oral PrEP in Cape Town, South Africa. Further, we conducted in-depth interviews (IDIs) with PLP enrolled in SCOPE-PP, an ongoing oral PrEP implementation study in Cape Town, and healthcare workers at Cape Town clinics to explore perspectives on antenatal PrEP decision-making. We report descriptive statistics and utilized thematic analysis to identify key themes in qualitative interviews.

    Results: From February to August 2024, the PrEPared to Choose study enrolled 58 PLP (n=30 pregnant, n=28 breastfeeding). Median age was 23 years (IQR=19.5-26). Of these participants, 83% (n=48) initiated CAB-LA and 17% (n=10) oral PrEP, with no difference by pregnancy status. PLP who initiated CAB-LA liked its ease of use (69%; n=22/32) and long-acting protection (44%; n=14/32), while disliking experienced injection site pain (50%, n=16/32). 97% (n=31/32) of surveyed PLP using CAB-LA were interested in continuing, and all PLP using oral PrEP reported interest in trying CAB-LA. From IDIs with 30 SCOPE-PP participants and 25 healthcare workers, an ideal PrEP DST should utilize task-shifting of PrEP counseling (e.g, before/after encounter with prescribing provider) and a wider variety of client-facing materials (e.g., pamphlets, SMS/WhatsApp-based education, videos).

    Conclusions: PLP in South Africa had a strong preference for CAB-LA over oral PrEP. Based on these findings, we are pre-testing a novel DST among PLP in South Africa choosing between oral PrEP and CAB-LA.

    Key words: HIV, PrEP, oral, injectable, pregnancy, breastfeeding, South Africa

    Specialty: HIV implementation science

Back