The landscape for HIV pre-exposure prophylaxis during pregnancy and breastfeeding in Malawi and Zambia: A qualitative study

High HIV incidence rates have been observed among pregnant and breastfeeding women in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) can effectively reduce HIV acquisition in women during these periods; however, understanding of its acceptability and feasibility in antenatal and postpartum...

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Bibliographic Details
Published in:PloS one 2019-10, Vol.14 (10), p.e0223487-e0223487
Main Authors: Zimba, Chifundo, Maman, Suzanne, Rosenberg, Nora E, Mutale, Wilbroad, Mweemba, Oliver, Dunda, Wezzie, Phanga, Twambilile, Chibwe, Kasapo F, Matenga, Tulani, Freeborn, Kellie, Schrubbe, Leah, Vwalika, Bellington, Chi, Benjamin H
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Anti-HIV Agents - therapeutic use
Biology and Life Sciences
Breast Feeding
Breastfeeding & lactation
Emtricitabine
Exposure
Feasibility
Female
Health aspects
Health care
Health promotion
HIV
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV patients
Human immunodeficiency virus
Humans
Malawi - epidemiology
Medical personnel
Medicine and Health Sciences
People and Places
Populations
Postpartum
Pre-Exposure Prophylaxis
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Pregnancy Complications, Infectious - prevention & control
Pregnant women
Prophylaxis
Public health
Qualitative Research
Studies
Women
Womens health
Workers
Young Adult
Zambia - epidemiology
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Summary:High HIV incidence rates have been observed among pregnant and breastfeeding women in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) can effectively reduce HIV acquisition in women during these periods; however, understanding of its acceptability and feasibility in antenatal and postpartum populations remains limited. To address this gap, we conducted in-depth interviews with 90 study participants in Malawi and Zambia: 39 HIV-negative pregnant/breastfeeding women, 14 male partners, 19 healthcare workers, and 18 policymakers. Inductive and deductive approaches were used to identify themes related to PrEP. As a public health intervention, PrEP was not well-known among patients and healthcare workers; however, when it was described to participants, most expressed positive views. Concerns about safety and adherence were raised, highlighting two critical areas for community outreach. The feasibility of introducing PrEP into antenatal services was also a concern, especially if introduced within already strained health systems. Support for PrEP varied among policymakers in Malawi and Zambia, reflecting the ongoing policy discussions in their respective countries. Implementing PrEP during the pregnancy and breastfeeding periods will require addressing barriers at the individual, facility, and policy levels. Multi- level approaches should be considered in the design of new PrEP programs for antenatal and postpartum populations.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0223487