“Dream PrEP delivery package”: co-creating innovative PrEP delivery with pregnant or parenting young women in South Africa

We conducted a participatory workshop with pregnant or parenting young women to co-create innovative PrEP delivery strategies informed by their lived experiences. Nine pregnant or parenting young women (n = 6 aged 18-24; n = 3 aged 25-28) were recruited from the FastPrEP study, an implementation project in South Africa. Participants ranked barriers to PrEP access and use, with early clinic closures listed as the biggest challenge, followed by community PrEP-related stigma, pill burden, side effects, partner resistance, and missed appointments. Their proposed solutions included after-hours clinic opening times and alternative delivery models such as mobile clinics, home courier delivery, locker pick-up, and pharmacy access; community education led by providers and peers; long-acting PrEP (particularly injectables); side-effect remedies and lower-toxicity options like vaginal rings; co-packaging of PrEP and condoms with educational materials; and appointments reminders. Participants also designed their "dream PrEP delivery package." Participants wanted discreet packaging, convenient delivery platforms, and bundled access to sexual and reproductive health products, including PrEP, condoms, self-test kits, and menstrual hygiene items. Engaging pregnant or parenting young women as co-designers of PrEP delivery strategies is feasible and generates practical, user-driven solutions. Their insights underscore the importance of stigma-free, community-based, convenient, differentiated, and person-centred PrEP delivery.