Community PrEP delivery preferences among pregnant and breastfeeding women using oral PrEP in south africa and kenya

OBJECTIVE: We evaluated preferences for differentiated service delivery of oral pre-exposure prophylaxis (PrEP) versus clinic pick-up among oral PrEP-experienced pregnant and breastfeeding women (PBFW) in South Africa and Kenya. DESIGN AND METHODS: From September 2021 to February 2022, we surveyed PBFW in oral PrEP studies in South Africa and Kenya. We asked participants about their PrEP delivery preferences and used logistic regression models adjusted for age and country to identify predictors of preferring community over clinic-based PrEP delivery. RESULTS: We surveyed 394 South African and Kenyan PBFW (73% postpartum, median age 28 years). Overall, 59.5% of South African participants (n = 113) and 24.5% of Kenyan participants (n = 50, p < 0.01) were interested in community PrEP delivery, most frequently due to convenience (n = 80, 49.1%) and lower transportation costs (n = 78, 47.9%). Participants preferred clinic PrEP pick-up due to privacy (n = 174, 75.3%) and desire to see a healthcare provider (n = 83, 35.9%). Preference for community PrEP delivery was positively associated with South African participants (aOR = 4.32, 95% CI = 2.80-6.67), PrEP stigma (aOR = 2.59, 95% CI = 1.58-4.23), completing secondary school or higher (aOR = 1.84, 95% CI = 1.17-2.92), and transportation cost to clinic (aOR = 1.39, 95% CI = 1.10-1.75). Preference of community PrEP delivery was negatively associated with age (aOR = 0.68 per 10-year increase, 95% CI = 0.49-0.95) and having one or more sexual partners versus no sexual partners (aOR = 0.34, 95% CI = 0.12-0.95). CONCLUSIONS: Oral PrEP-experienced PBFW in South Africa and Kenya described varied preferences for community PrEP delivery. Associations with community-based PrEP delivery preference identified in this analysis may be useful in the development of context-specific DSD interventions targeting PBFW.