Pregnancy and breastfeeding are critical periods that put women at an increased risk of HIV acquisition. To prevent the transmission of the virus from mother to child, antenatal clinics often offer pre-exposure prophylaxis (PrEP) as a preventive measure. However, questions have remained about the most effective approach to delivering PrEP. A recent study conducted in Kenya compared two models of PrEP delivery: targeted (risk-guided) and universal counseling.
The study, which enrolled 4,447 pregnant women seeking routine maternal care, found that both the targeted and universal arms had similar rates of PrEP uptake. Furthermore, both approaches resulted in high PrEP continuation rates and comparable HIV incidence rates. This means that offering universal PrEP counseling, which is simpler and easier to provide, yielded similar outcomes to the risk-guided approach.
The targeted approach involved conducting an HIV risk assessment using a risk-scoring tool, and then providing PrEP counseling only to women assessed as being at high risk of HIV. On the other hand, the universal approach involved providing standardized PrEP counseling to all participants and allowing them to decide whether or not to take it.
The primary outcomes of the study were maternal HIV incidence and appropriate PrEP use. Secondary outcomes included PrEP acceptance, initiation, adherence, and partner HIV status. The results showed that most women made appropriate decisions regarding PrEP, and the overall PrEP acceptance and continuation rates were similar in both arms.
These findings suggest that incorporating HIV-risk screening to target high-risk women in antenatal clinics for PrEP offer does not significantly impact HIV incidence or PrEP uptake. Moreover, the risk-based screening process took up valuable time and sometimes led to challenging discussions for healthcare workers. Therefore, a universal approach to PrEP counseling may be the simplest and most effective option.
This study provides valuable insights into improving the delivery of PrEP to pregnant women. By adopting a universal counseling approach, healthcare providers can streamline the process and ensure that all women receive the necessary information and support to make informed decisions about PrEP.
1. What is PrEP?
PrEP stands for pre-exposure prophylaxis, which is a preventive measure to reduce the risk of acquiring HIV.
2. What is the difference between targeted and universal PrEP counseling?
Targeted PrEP counseling involves conducting an HIV risk assessment to identify high-risk individuals who are then offered PrEP. Universal PrEP counseling, on the other hand, provides standardized counseling to all individuals and allows them to decide whether or not to take PrEP.
3. What were the primary outcomes of the study?
The primary outcomes of the study were maternal HIV incidence and appropriate PrEP use.
4. What were the findings of the study?
The study found that both targeted and universal PrEP counseling resulted in similar rates of PrEP uptake, high continuation rates, and comparable HIV incidence rates.
5. What is the recommendation based on the study’s findings?
The researchers recommend adopting a universal approach to PrEP counseling for pregnant women, as it is simpler and just as effective as the targeted approach.