PrEP preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-07-02 DOI:10.1002/jia2.26492

Nafisa Wara, Carey Pike, Elzette Rousseau, Pippa Macdonald, Pakama Mapukata, Bryan Leonard, Keitumetse Lebelo, Risa Hoffman, Catherine Orrell, Linda-Gail Bekker, Dvora Joseph Davey

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引用次数: 0

Abstract

Introduction

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 and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.

Methods

The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15–29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.

Results

From February to August 2024, we enrolled 58 PLP (n = 30 pregnant, n = 28 breastfeeding). Median age 23 years (IQR 19.5−26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, n = 13 pregnant, n = 23 breastfeeding) completed the acceptability survey. Of these, 83% (n = 12/13 pregnant, n = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (n = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; n = 22/32) and long-acting protection (44%; n = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (n = 13/32) described no CAB-LA dislikes. Almost all (97%; n = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (n = 31/36) did not want to try the dapivirine vaginal ring.

Conclusions

PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.

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南非开普敦孕妇和哺乳期人群对注射卡波特韦的PrEP偏好和早期可接受性：来自“准备选择”研究的结果

为孕妇和哺乳期人群提供艾滋病毒暴露前预防（PrEP）方法的选择，包括长效注射卡波特韦（CAB-LA），可能会减轻有效使用PrEP的障碍。我们评估了南非提供CAB-LA和口服PrEP的PLP对PrEP的偏好和可接受性。方法“准备选择”研究在南非开普敦的一家公立诊所和一家社区流动诊所招募了15-29岁的年轻人。使用知情选择咨询，参与者被提供口服PrEP或CAB-LA，并在18个月的随访中选择切换方法。我们报告了研究中PLP的基线CAB-LA和口服PrEP开始，他们在入组3个月内的初始选择的可接受性以及关于可能适用于PLP的PrEP方法的理论偏好。我们报告了描述性统计数据，并使用卡方和Fisher精确值来比较初始PrEP方法和妊娠状态的反应。结果从2024年2月至8月，我们招募了58名PLP （n = 30名孕妇，n = 28名母乳喂养）。中位年龄23岁（IQR 19.5−26）。在30名怀孕参与者中，23名（77%）开始使用CAB-LA， 7名（23%）口服PrEP；在28名母乳喂养的参与者中，25名（89%）开始使用caba - la， 3名（11%）开始口服PrEP。在纳入的PLP中，36名（62%,n = 13名孕妇，n = 23名母乳喂养）完成了可接受性调查。其中，83% （n = 12/13孕妇，n = 20/23母乳喂养）选择并接受caba - la，其余（n = 4）选择并接受口服PrEP。接受caba - la的PLP报告喜欢其易于使用(69%；N = 22/32)和长效保护(44%；N = 14/32)。一半的CAB-LA使用者不喜欢副作用（例如注射部位疼痛），尽管41%的PLP （n = 13/32）没有描述CAB-LA不喜欢。几乎所有(97%；n = 31/32)目前使用CAB-LA的PLP有兴趣继续使用CAB-LA，所有使用口服PrEP的PLP报告有兴趣在未来尝试CAB-LA。86%的受访PLP （n = 31/36）不想尝试达匹维林阴道环。结论南非PLP患者对CAB-LA的偏好高于口服PrEP， CAB-LA可接受度高。提供PrEP方法选择（包括CAB-LA）对PLP患者持续PrEP的影响有待进一步研究。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.