Long-Acting HIV Pre-exposure Prophylaxis Preferences Through Pregnancy and the Postpartum Period Among Women in Kenya: A Latent Transition Analysis

Adherence to daily oral HIV PrEP wanes over pregnancy and postpartum and new long-acting injectable HIV PrEP (LAI-PrEP) methods may address barriers to effective use. Understanding changing LAI-PrEP preferences during the perinatal period could inform the integration into maternal healthcare. We used data from a randomized trial of pregnant women initiating daily oral HIV PrEP at five public maternal child health facilities in western Kenya, followed through 9 months postpartum (NCT04472884). Participants completed surveys on LAI-PrEP interest from the third trimester through postpartum. Latent Transition Analysis (LTA) examined underlying patterns of LAI-PrEP interest. Predictors of transitions between statuses were assessed using univariate logistic regression. Overall, 598 pregnant women were enrolled (median age: 25 years). We identified three preferences statuses: "No interest in LAI-PrEP", "Willing to pay (WTP) for LAI-PrEP", and "Prefers free LAI-PrEP". About 10% comprised the "No interest in LAI-PrEP" at each time point. In pregnancy, 36.8% belonged to the "Prefers free LAI-PrEP" status, with participants increasingly transitioning to "WTP for LAI-PrEP" through the postpartum period. The "WTP for LAI-PrEP" status grew from 53.2% in third trimester to 76.6% at nine months postpartum, however women who were primigravida had 5-fold higher odds of transitioning out of "WTP for LAI-PrEP" to "Prefers free LAI-PrEP" (95% CI: 5.29-5.39, p < 0.001). Most women remained interested in LAI-PrEP across pregnancy and postpartum, with willingness to pay for LAI-PrEP growing over time. Expanding cost-free LAI-PrEP within MCH systems, especially for postpartum and primigravida women, could improve PrEP use during this critical period.ClinicalTrials.gov registration number: NCT04472884.