Prevalence and Incidence of Chlamydia trachomatis and Neisseria gonorrhoeae Among Women Who Initiated HIV PrEP During Pregnancy in Kenya

BACKGROUND: We evaluated the prevalence, incidence, and correlates of sexually transmitted infections among pregnant women initiating preexposure prophylaxis. METHODS: We analyzed data from an ongoing randomized control trial that enrolled pregnant women in Kenya (NCT04472884) who were ≥18 years, between 24 and 32 weeks' gestation, had high HIV risk scores, and initiated oral preexposure prophylaxis within routine antenatal care. A subset of women were sequentially offered Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing in pregnancy and at 6 and 9 months after delivery. Directly observed treatment and expedited partner therapy (EPT) were offered to women diagnosed with CT/NG. RESULTS: All pregnant women offered CT and NG testing accepted (n = 221). The median age of women was 26 years (interquartile range 22-30); median gestational age was 27 weeks (interquartile range 25-29). Prevalence of CT and/or NG during pregnancy was 19/221 (8.6%): 4.1% CT, 3.6% NG, and 1% CT and NG coinfection. Women <24 years were 3 times more likely to have prevalent CT/NG infection as older women (adjusted prevalence ratio: 3.12; 95% confidence interval [CI]: 1.24 to 7.85 P = 0.016). Overall, 21 CT/NG infections occurred in 181.2 total person-years of follow-up (incidence 11.6 per 100 person-years, 95% CI: 7.6 to 17.8). Incident CT and/or NG was 7-fold higher among women <24 years compared with older women (adjusted incidence rate ratio = 6.69, 95% CI: 2.55 to 17.54, P < 0.001). Same-day directly observed treatment and EPT acceptance was 95%; at subsequent visits, 79% reported partners accepted EPT, of whom 95% confirmed treatment completion. CONCLUSIONS: CT/NG incidence was high among women who initiated preexposure prophylaxis in pregnancy, indicating that CT/NG testing would be high yield in this population.