Prevalance and factors associated with uptake of oral pre-exposure prophylaxis among pregnant women at high risk of HIV in Bugiri District

Abstract

Background: The World Health Organization (WHO) and The Ministry of Health Uganda (MOH) recommend Pre-Exposure prophylaxis (PrEP) for pregnant women at increased risk of HIV as a strategy for eliminating mother-to-child transmission of HIV (EMTCT). However, PrEP uptake among pregnant women remains a challenge and there is need to assess PrEP uptake and factors associated with its use among pregnant women at high risk of HIV infection. Objective: The aim of this study was to determine the prevalence and factors associated with uptake of oral pre-exposure prophylaxis among pregnant women at high risk of HIV in Bugiri district. Methods: This was a mixed-methods cross-sectional study to investigate oral PrEP uptake among 352 high-risk pregnant selected using probability proportionate to size and simple random sampling across four healthcare facilities in Bugiri district in May 2024. PrEP uptake was determined as the proportion (95% CI) of women that reported use of PrEP on the day prior to the interview. Bivariate followed by multivariable modified Poisson Regression was used to determine the associations between PrEP uptake and demographic characteristics, awareness levels, sexual behaviour, and health system factors. Key informant and in-depth interviews were conducted with health workers and pregnant women to explore facilitators and barriers to PrEP uptake. Qualitative data was analysed thematically. Results: The median age of the women was 25 years (Inter quartile range (IQR): 21-30). The majority (89.5%) were married. Many (57.4%) were unaware of PrEP and many (53.1%) of the participants did not know their partner’s HIV status. Overall, of the 352 pregnant women, 56 (15.9%) (95% CI 12.25-20.16) reported using PrEP at the time of the study. PrEP uptake was associated with being divorced (aPR 5.36, CI 2.10-13.69), being single (aPR 2.40, CI 1.06-5.41), and being in a sero discordant relationship (aPR 6.53, CI 3.40-12.55). Use of Injectable PrEP was mentioned as a less preferred option as compared to Oral PrEP (aPR 0.32, CI 0.14-0.76). Key informant and in-depth interviews highlighted side effects of PrEP and stigma as barriers to PrEP uptake while availability of PrEP, health education and perceived benefit were identified as facilitating factors. Conclusion: This study highlights a concerning low uptake of oral PrEP among pregnant women at high risk of HIV in Bugiri district, Uganda. Being single or divorced and being in a serodiscordant were associated with PrEP uptake. There is a need for integrated approaches to improve access and utilization in this population.