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A pilot evaluation of integrating STI testing & expedited partner therapy into PrEP delivery within antenatal care for pregnant women in Kenya

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BACKGROUND: PrEP delivery integrated within antenatal care (ANC) is scaling up in Kenya, yet pregnant women may not accurately perceive their HIV acquisition risk. Incorporating testingfor sexually transmitted infections (STIs) into ANC could increase their HIV risk perception and motivation for PrEP initiation.
METHODS: From December 2020 to August 2021,we piloted integrating chlamydia and gonorrhea (CT/NG) testing and expedited partner therapy (EPT) at one ANC clinic in Siaya, Kenya. HIV-negative ANC clients '¥15 years were counseled on and offered Xpert CT/NG® testing with instructions on vaginal swab self-collection. If participants were uncomfortable with self-collection, nurses collected swabs. CT/NG results were returned to nurses who counseled participants on their results prior to offering PrEP. Women diagnosed with CT or NG were offered immediate supervised treatment per national guidelines and EPT with appropriate medication for their partner(s).
RESULTS: In total, 300 HIV-negative ANC clients were enrolled at a median gestational age of 24 weeks (IQR 16-24); 23% reported having any STI symptoms. The most frequent STI symptoms were vulvar burning/itching (22%) and abnormal vaginal discharge (14%). Overall, 82% of participants accepted CT/NG testing and 93% self-collected swabs. We did not detect differences between participants who accepted vs. declined testing, except in frequency of STI symptoms (28% vs. 2%%, p<0.001). Among participants who declined testing, the most frequent reasons for declining were not having time to wait 90-minutes for results (80%) and feeling like they did not have STIs (20%). Among those who accepted testing, 9% had CT detected; no cases of NG were detected. All participants received their CT/NG results at the same visit. PrEP acceptance was higher among women who accepted CT/NG testing compared to those who declined (25% vs. 11%, p=0.03). Among participants with CT detected (n=23), all were treated immediately and 61% accepted EPT; 35% accepted PrEP. Reasons for declining EPT included partners residing far away and fear of partner reactions. No adverse events occurred following EPT acceptance.
CONCLUSIONS: In this pilot, offering both CT/NG testing and PrEP integrated within ANC was feasible. HIV-negative pregnant women frequently accepted CT/NG testing and if CT was detected, frequently accepted EPT and PrEP.

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