In the Journals

Program in Kenyan family planning clinics connects at-risk women to PrEP

Kenneth K. Mugwanya, PhD
Kenneth K. Mugwanya

Almost a quarter of at-risk women screened at family planning clinics in Kenya initiated pre-exposure prophylaxis, or PrEP, for HIV prevention, and more than 40% of them returned for at least one refill, suggesting that integrating universal screening and counseling for PrEP in family planning clinics is feasible, researchers said.

Writing in PLOS Medicine, the researchers noted that such a program could serve as a “one-stop” location for family planning and PrEP.

“It is possible to integrate provision of PrEP in public health family planning systems to efficiently reach young African women who may benefit from this highly effective HIV prevention method,” Kenneth K. Mugwanya, PhD, assistant professor of global health and physician-epidemiologist in the Department of Global Health at the University of Washington, told Infectious Disease News. “Women frequently initiated and continued PrEP use if they knew or [were] perceived to be at high risk of HIV infection.”

The Kenya Ministry of Health recommended in 2016 that all HIV-uninfected persons with substantial ongoing risk for infection receive PrEP, Mugwanya and colleagues noted, echoing a recommendation published by WHO a year earlier.

To demonstrate the feasibility of integrating PrEP delivery within routine family planning clinics to reach at-risk women aged 15 to 45 years, Mugwanya and colleagues created the PrEP Implementation in Young Women and Adolescents program in Kenya, which has a high burden of HIV. They screened 1,271 women for PrEP and counseled them about behavioral risks for HIV infection. Most (82%) women were married, and 94% reported recent condom-less sex.

Of the 278 women (22%) who initiated PrEP, 41% returned at 1 month for a refill, Mugwanya and colleagues reported. At 3 months, continuation dropped to 24%, and at 6 months, it was 15%. The likelihood for return for at least one PrEP refill within 45 days after initiation was strongly associated with reported male-partner HIV status (HIV-positive = 67%; negative = 39%; unknown = 31%; overall effect P = 0.001), according to the researchers. Further, women aged 24 years or older were more likely to continue PrEP at 1 month than women aged younger than 24 years (P = 0.002).

The researchers noted that women’s perceived risk for HIV, including having an HIV-positive partner, was an important driver of initiation and continuation on PrEP.

“Women want HIV prevention and family planning services in the same room, by the same provider and at the same moment,” Mugwanya said. “Health providers need to initiate conversations about sexual history during consultations as an entry point to identify women with elevated risk for HIV.”

Mugwanya also said that although the provision of PrEP in places where women routinely access care has tremendous potential to open up PrEP access for at-risk African women, more work is needed to improve PrEP awareness to help normalize pill taking for prevention in communities where at-risk women live. – by Joe Gramigna

Disclosure: Mugwanya reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Kenneth K. Mugwanya, PhD
Kenneth K. Mugwanya

Almost a quarter of at-risk women screened at family planning clinics in Kenya initiated pre-exposure prophylaxis, or PrEP, for HIV prevention, and more than 40% of them returned for at least one refill, suggesting that integrating universal screening and counseling for PrEP in family planning clinics is feasible, researchers said.

Writing in PLOS Medicine, the researchers noted that such a program could serve as a “one-stop” location for family planning and PrEP.

“It is possible to integrate provision of PrEP in public health family planning systems to efficiently reach young African women who may benefit from this highly effective HIV prevention method,” Kenneth K. Mugwanya, PhD, assistant professor of global health and physician-epidemiologist in the Department of Global Health at the University of Washington, told Infectious Disease News. “Women frequently initiated and continued PrEP use if they knew or [were] perceived to be at high risk of HIV infection.”

The Kenya Ministry of Health recommended in 2016 that all HIV-uninfected persons with substantial ongoing risk for infection receive PrEP, Mugwanya and colleagues noted, echoing a recommendation published by WHO a year earlier.

To demonstrate the feasibility of integrating PrEP delivery within routine family planning clinics to reach at-risk women aged 15 to 45 years, Mugwanya and colleagues created the PrEP Implementation in Young Women and Adolescents program in Kenya, which has a high burden of HIV. They screened 1,271 women for PrEP and counseled them about behavioral risks for HIV infection. Most (82%) women were married, and 94% reported recent condom-less sex.

Of the 278 women (22%) who initiated PrEP, 41% returned at 1 month for a refill, Mugwanya and colleagues reported. At 3 months, continuation dropped to 24%, and at 6 months, it was 15%. The likelihood for return for at least one PrEP refill within 45 days after initiation was strongly associated with reported male-partner HIV status (HIV-positive = 67%; negative = 39%; unknown = 31%; overall effect P = 0.001), according to the researchers. Further, women aged 24 years or older were more likely to continue PrEP at 1 month than women aged younger than 24 years (P = 0.002).

The researchers noted that women’s perceived risk for HIV, including having an HIV-positive partner, was an important driver of initiation and continuation on PrEP.

“Women want HIV prevention and family planning services in the same room, by the same provider and at the same moment,” Mugwanya said. “Health providers need to initiate conversations about sexual history during consultations as an entry point to identify women with elevated risk for HIV.”

Mugwanya also said that although the provision of PrEP in places where women routinely access care has tremendous potential to open up PrEP access for at-risk African women, more work is needed to improve PrEP awareness to help normalize pill taking for prevention in communities where at-risk women live. – by Joe Gramigna

Disclosure: Mugwanya reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.