A prospective analysis of PrEP adherence and depressive symptoms among Kenyan women who initiated PrEP during pregnancy and postpartum


BACKGROUND: Prior studies report suboptimal adherence among depressed PrEP users, yet few data exist on psychosocial factors associated with PrEP adherence among pregnant and postpartum women.
METHODS: We prospectively analyzed data from the PrIMA Study (NCT03070600) among participants who initiated PrEP during pregnancy or postpartum to identify psychosocial correlates of adherence. Depressive symptoms were assessed serially (pregnancy, 6 weeks, 9 months postpartum) using the Center for Epidemiologic Studies Depression scale (moderate-to-severe depressive symptoms [MSD]=scores'¥10). Optimal PrEP adherence (self-reporting no missed PrEP pills in the last 30 days) was evaluated monthly in pregnancy; 6 weeks, 14 weeks, 6 months, 9 months postpartum. Correlates of PrEP adherence were identified using generalized estimating equation models, clustered by participant, adjusted for age, parity, education, partner HIV status, pregnancy status.
RESULTS: Among 715 women who initiated PrEP, median age was 25 years (IQR:21-30), median gestational age at PrEP initiation was 29 weeks (IQR:24-33), 88% were married, and 19% had a partner living with HIV. Over a third (36%) of women reported MSD during pregnancy; of those 36% reported MSD in postpartum. Perinatal MSD was associated with having a partner of unknown HIV status, '¥4 lifetime sexual partners, intimate partner violence (IPV), and low social support (p<0.05). Among 3856 PrEP follow-up visits, 47% had optimal PrEP adherence which was 60% higher during pregnancy compared to postpartum (adjusted relative risk[aRR]:1.5, 95%CI:1.4-1.6, p<0.001). Women >24 years were more likely to adhere to PrEP compared to younger women (aRR:1.2, 95%CI:1.0-1.3, p=0.008). PrEP adherence was 60% higher among women with partners living with HIV compared to women with partners of unknown HIV status or presumed HIV-negative (aRR:1.6, 95%CI:1.4-1.7, p<0.001). MSD in the past 6 months was not associated with PrEP adherence (aRR:1.02, 95%CI:0.93-1.14, p=0.643). Marital status, IPV, and social support were not associated with PrEP adherence.
CONCLUSIONS: Among perinatal women who initiated PrEP, self-reported adherence was higher in pregnancy than postpartum, among older women, and those with partners living with HIV. In contrast to studies of non-pregnant women, PrEP adherence was not associated with depression. Our findings suggest that the impact of psychosocial barriers to PrEP adherence may be attenuated among perinatal populations.

Download the e-Poster (PDF)