Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance
Background: New long-acting HIV pre-exposure prophylaxis (LA-PrEP) methods may address adherence barriers during pregnant and postpartum periods, when HIV risk is elevated. Understanding their preferences for LA-PrEP is essential for person-centered HIV prevention in maternal and child health (MCH)...
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Elsevier
2025-05-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577825000553 |
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| author | Tessa Concepcion, PhD John Kinuthia, MMed Felix A. Otieno, BS Eunita Akim, BSN Brian P. Flaherty, PhD Laurén Gómez, MPH Grace John-Stewart, PhD Emmaculate M. Nzove, MBA Nancy Ngumbau, MPH Jerusha N. Mogaka, PhD Ben Odhiambo, MPH Anjuli D. Wagner, PhD Salphine Watoyi, MPH Jillian Pintye, PhD |
| author_facet | Tessa Concepcion, PhD John Kinuthia, MMed Felix A. Otieno, BS Eunita Akim, BSN Brian P. Flaherty, PhD Laurén Gómez, MPH Grace John-Stewart, PhD Emmaculate M. Nzove, MBA Nancy Ngumbau, MPH Jerusha N. Mogaka, PhD Ben Odhiambo, MPH Anjuli D. Wagner, PhD Salphine Watoyi, MPH Jillian Pintye, PhD |
| author_sort | Tessa Concepcion, PhD |
| collection | DOAJ |
| description | Background: New long-acting HIV pre-exposure prophylaxis (LA-PrEP) methods may address adherence barriers during pregnant and postpartum periods, when HIV risk is elevated. Understanding their preferences for LA-PrEP is essential for person-centered HIV prevention in maternal and child health (MCH) systems, yet evidence on preferred attributes is limited. Objective: To estimate pregnant and postpartum women’s preferred PrEP attributes using a discrete choice experiment (DCE) at important timepoints in the perinatal period Study design: From February 2023 to July 2024, we conducted a DCE among 513 HIV-negative pregnant and postpartum women taking daily oral PrEP in Kisumu and Siaya, Kenya, enrolled between 24–32 weeks gestation and a high HIV risk score. Participants completed the DCE with 12 choice sets at their third antepartum (median gestational age: 37.0 weeks) and/or 6-month postpartum visits. Attributes included effectiveness, form and dosing, safety data, side effects, collection place, cost, and multipurpose prevention (postpartum only). We fit effects-coded choice data to a conditional logit model, latent class analysis (LCA) for preference heterogeneity, and univariate multinomial logistic regressions to predict class membership by individual characteristics. Results: A total of 513 women completed the DCE at least once (151 at third antepartum, 509 at 6-month postpartum). Every 2-month injections were strongly preferred, showing the highest positive preference weight (pregnant: 1.22, 95% CI: 1.12–1.33; postpartum: 1.24, 95% CI: 1.18–1.30). Four latent classes emerged: “Flexible PrEP Adopters” (37.2%), “Safe and Effective Injection Preference” (16.5%), “Strong Injection Preference” (37.7%), and “Oral PrEP Preference” (8.6%). Higher parity was associated with lower odds of membership in “Flexible PrEP Adopters” (OR=0.6, 95% CI: 0.4–0.8, P=.001), “Safe and Effective Injection Preference” (OR=0.6, 95% CI: 0.4–0.8, P=.003), and “Strong Injection Preference” (OR=0.7, 95% CI: 0.5–1, P=.027) compared to “Oral PrEP preference.” Conclusions: Strong preferences for every 2-month injectables emphasize the need to prioritize LA-PrEP in this population. ANC settings can support diverse PrEP preference profiles with tailored counseling to account for individual preferences, PrEP experience, and obstetric history. |
| format | Article |
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| issn | 2666-5778 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | AJOG Global Reports |
| spelling | doaj-art-d7a4ccac1baf41f39fd9d4dbe5a7036a2025-06-28T05:31:21ZengElsevierAJOG Global Reports2666-57782025-05-0152100494Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a GlanceTessa Concepcion, PhD0John Kinuthia, MMed1Felix A. Otieno, BS2Eunita Akim, BSN3Brian P. Flaherty, PhD4Laurén Gómez, MPH5Grace John-Stewart, PhD6Emmaculate M. Nzove, MBA7Nancy Ngumbau, MPH8Jerusha N. Mogaka, PhD9Ben Odhiambo, MPH10Anjuli D. Wagner, PhD11Salphine Watoyi, MPH12Jillian Pintye, PhD13Department of Global Health, University of Washington, Seattle, (Concepcion, John-Stewart, Wagner and Pintye).; Corresponding author: Tessa ConcepcionResearch and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Department of Psychology, University of Washington, Seattle, (Flaherty).Department of Epidemiology, University of Washington, Seattle, (Gómez and John-Stewart).Department of Global Health, University of Washington, Seattle, (Concepcion, John-Stewart, Wagner and Pintye).; Department of Epidemiology, University of Washington, Seattle, (Gómez and John-Stewart).; Department of Medicine, University of Washington, Seattle, (John-Stewart).; Department of Pediatrics, University of Washington, Seattle, (John-Stewart).Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)School of Nursing, University of Washington, Seattle, (Mogaka).Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Department of Global Health, University of Washington, Seattle, (Concepcion, John-Stewart, Wagner and Pintye).Department of Global Health, University of Washington, Seattle, (Concepcion, John-Stewart, Wagner and Pintye).; Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya, (Kinuthia, Otieno, Akim, Nzove, Ngumbau, Odhiambo, Watoyi and Pintye)Department of Psychology, University of Washington, Seattle, (Flaherty).; Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, (Pintye).Background: New long-acting HIV pre-exposure prophylaxis (LA-PrEP) methods may address adherence barriers during pregnant and postpartum periods, when HIV risk is elevated. Understanding their preferences for LA-PrEP is essential for person-centered HIV prevention in maternal and child health (MCH) systems, yet evidence on preferred attributes is limited. Objective: To estimate pregnant and postpartum women’s preferred PrEP attributes using a discrete choice experiment (DCE) at important timepoints in the perinatal period Study design: From February 2023 to July 2024, we conducted a DCE among 513 HIV-negative pregnant and postpartum women taking daily oral PrEP in Kisumu and Siaya, Kenya, enrolled between 24–32 weeks gestation and a high HIV risk score. Participants completed the DCE with 12 choice sets at their third antepartum (median gestational age: 37.0 weeks) and/or 6-month postpartum visits. Attributes included effectiveness, form and dosing, safety data, side effects, collection place, cost, and multipurpose prevention (postpartum only). We fit effects-coded choice data to a conditional logit model, latent class analysis (LCA) for preference heterogeneity, and univariate multinomial logistic regressions to predict class membership by individual characteristics. Results: A total of 513 women completed the DCE at least once (151 at third antepartum, 509 at 6-month postpartum). Every 2-month injections were strongly preferred, showing the highest positive preference weight (pregnant: 1.22, 95% CI: 1.12–1.33; postpartum: 1.24, 95% CI: 1.18–1.30). Four latent classes emerged: “Flexible PrEP Adopters” (37.2%), “Safe and Effective Injection Preference” (16.5%), “Strong Injection Preference” (37.7%), and “Oral PrEP Preference” (8.6%). Higher parity was associated with lower odds of membership in “Flexible PrEP Adopters” (OR=0.6, 95% CI: 0.4–0.8, P=.001), “Safe and Effective Injection Preference” (OR=0.6, 95% CI: 0.4–0.8, P=.003), and “Strong Injection Preference” (OR=0.7, 95% CI: 0.5–1, P=.027) compared to “Oral PrEP preference.” Conclusions: Strong preferences for every 2-month injectables emphasize the need to prioritize LA-PrEP in this population. ANC settings can support diverse PrEP preference profiles with tailored counseling to account for individual preferences, PrEP experience, and obstetric history.http://www.sciencedirect.com/science/article/pii/S2666577825000553HIV preventionmaternal healthadherencelatent class analysispreference heterogeneityInjectable PrEP |
| spellingShingle | Tessa Concepcion, PhD John Kinuthia, MMed Felix A. Otieno, BS Eunita Akim, BSN Brian P. Flaherty, PhD Laurén Gómez, MPH Grace John-Stewart, PhD Emmaculate M. Nzove, MBA Nancy Ngumbau, MPH Jerusha N. Mogaka, PhD Ben Odhiambo, MPH Anjuli D. Wagner, PhD Salphine Watoyi, MPH Jillian Pintye, PhD Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance AJOG Global Reports HIV prevention maternal health adherence latent class analysis preference heterogeneity Injectable PrEP |
| title | Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance |
| title_full | Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance |
| title_fullStr | Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance |
| title_full_unstemmed | Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance |
| title_short | Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experimentAJOG Global Reports at a Glance |
| title_sort | long acting pre exposure prophylaxis preferences among pregnant and postpartum women in kenya results from a discrete choice experimentajog global reports at a glance |
| topic | HIV prevention maternal health adherence latent class analysis preference heterogeneity Injectable PrEP |
| url | http://www.sciencedirect.com/science/article/pii/S2666577825000553 |
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