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

Title

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

Presenter

Lauren Gomez

Authors

A. Larsen (1), J. Kinuthia (2), M. Marwa (3), J. Dettinger (4), L. Gomez * (4), J. Stern (4), F. Abuna (3), B. Odhiambo (3), N. Mwongeli (2), P. Omondi (2), J. Baeten (1), J. Pintye (5), G. John-Stewart (4)

Institutions

(1) University of Washington, Department of Epidemiology, Seattle, United States, (2) Kenyatta National Hospital, Nairobi, Kenya, (3) University of Nairobi, Nairobi, Kenya, (4) University of Washington, Department of Global Health, Seattle, United States, (5) University of Washington, School of Nursing, Department of Biobehavioral Nursing and Health Informatics, Seattle, United States

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.

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