BACKGROUND: PrEP and HIV self-testing (HIVST) for male partners are being scaled up within antenatal clinics (ANC). Few data are available on how co-distribution influences acceptance of both interventions and the cofactors for PrEP, HIVST or combined PrEP/HIVST use among pregnant women at high risk for HIV.
METHODS: We utilized data from the PrIMA (NCT03070600) trial in Kenya. Women included in this analysis were determined to be at high HIV risk and offered PrEP and partner HIVST. Characteristics were compared between women who chose: 1) PrEP and HIVST, 2) HIVST-alone, 3) PrEP-alone, or 4) declined both (reference), excluding women with partners known to be living with HIV.
RESULTS: Among 911 women, the median age was 24 years, 87.3% were married, and 13.0% had history of intimate partner violence (IPV); 68.8% accepted HIVST and 18.4% accepted PrEP. Of women accepting HIVST, 84% offered them to partners; 94% of partners used HIVST; 1.2% had a reactive HIVST. Partner HIV testing increased from 20% to 82% and women’s knowledge of partner HIV status increased from 4.7% to 82.0% between pregnancy and 9-months postpartum (p<0.001). Overall, 54.7% accepted HIVST-alone, 4.1% PrEP-alone and 14.3% both HIVST and PrEP. Compared to women who accepted neither, choosing: 1) HIVST-alone was associated with being married, participant and partner higher level of education, and residing with partner; 2) PrEP-alone with lower social support, IPV, not residing with partner, longer time with partner, and suspicion of other sexual partners; and 3) PrEP and HIVST was associated with being married, IPV, and suspicion that partner had other partners.
CONCLUSIONS: Understanding factors associated with accepting HIVST, PrEP or both can inform HIV prevention programs for pregnant women. Strategies to improve women’s self-efficacy to take up HIV prevention interventions are important to reduce incident infections during pregnancy and postpartum.