icon-    folder.gif   Conference Reports for NATAP  
  Conference on Retroviruses
and Opportunistic Infections
Will be Virtual
Boston USA
March 6-10, 2021
Back grey_arrow_rt.gif
  CROI 2021 March 6-10 reported by Jules Levin
Dvora L . Joseph Davey1, Rufaro Mvududu1, Nyiko Mashele1, Maia Lesosky1, Linda-Gail Bekker2, Pamina M. Gorbach3, Thomas J. Coates3, Landon Myer1, for PrEP-PP Study Team 1University of Cape Town, Cape Town, South Africa, 2Desmond Tutu HIV Foundation, Cape Town, South Africa, 3University of California Los Angeles, Los Angeles, CA, USA
Background: Oral pre-exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP requires daily PrEP adherence, but little is known about how minor symptoms, which may be more common during pregnancy, overlap with PrEP side effects (SE) and could impact on PrEP persistence.
Methods: The PrEP in pregnancy and postpartum (PrEP-PP) study is an ongoing prospective cohort that enrolls consenting pregnant, HIV-uninfected women (>15-years) at first antenatal care (ANC) visit, followed through 12-months postpartum. Interviewers collected data on socio-demographics, SE, and PrEP use. We analyzed the reporting of SE and their association with PrEP persistence (defined as staying on PrEP at 3-months) and PrEP adherence (defined as taking PrEP >5 of last 7 days at 3-month visit) with multivariable logistic regression adjusting for baseline maternal, gestational age and time in study.
Results: Between August 2019 and November 2020 we enrolled 759 pregnant women (median gestation=21 weeks; median age=26 years). Following PrEP counseling, 91% of pregnant women initiated PrEP at their first antenatal visit (n=690), including 21 women <18 years old (84%); 20% were married. Overall 73% of women on PrEP returned for a repeat prescription at 1-month, and 62% returned at 3-months. Among those returning at 3-months, 85% reported adhering to PrEP. Adherence was poorer with women who came in later in their pregnancy (>20 weeks) for their first ANC visit, or had lower education (completed primary vs. secondary school) (p<0.05). Over 31% of women on PrEP reported side effects at 1-month, mostly nausea/vomiting (22%), dizziness (25%), and headache (8%). Women on PrEP in the 1st or 2nd trimester had highest odds of reporting side effects (aOR=2.61; 95%CI=1.17, 5.84) compared to postpartum women adjusting for age, gestation and time in study. Women who reported SE at 1m had lower persistence and adherence at 3m compared to women who did not report SE (aOR=0.50; 95% CI=0.31, 0.81) adjusting for age, gestational age, and time in study (Table 1).
Conclusion: PrEP initiation was high in antenatal care in this setting but reporting of side effects that may be overlap with pregnancy symptoms was associated with poor PrEP persistence and adherence. This presents an opportunity for improved clinical management and counseling during pregnancy of nausea/vomiting to normalize early, transient side effects to improve PrEP adherence in pregnant women.