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Introduction: Pregnant and breastfeeding women at substantial risk for HIV infection in sub-Saharan Africa can benefit from biomedical interventions such as pre-exposure prophylaxis (PrEP). We estimated the benefit that pregnant and breastfeeding women may derive from PrEP service delivery in order to guide PrEP roll-out in the target population in Zambia. Methods: Between September and December 2021, we conducted a discrete choice experiment (DCE) among a convenient sample of 389 pregnant and breastfeeding women not living with HIV in Lusaka, Zambia. Women aged 18 years or older, with a documented negative HIV result in their antenatal card responded to a structured questionnaire containing 12 choice sets on service delivery attributes of PrEP: waiting time at the facility, travel time to the facility dispensing PrEP, location for PrEP pick-up, health care provider attitude and PrEP supply at each refill. Mixed logit regression analysis was used to determine the participant's willingness to trade off one attribute of PrEP for the other at a 5% significance level. Willingness to wait (WTW) was used to determine the relative utility derived from each attribute against waiting time. Results: Waiting time at the facility, travel time to the facility, health care provider attitude and amount of PrEP supply at each refill were important attributes of PrEP service delivery (all p < 0.01). Participants preferred less waiting time at the facility (β = −0.27, p < 0.01). Women demonstrated a strong preference for a 3-months' supply of PrEP (β = 1.69, p < 0.01). They were willing to wait for 5 h at the facility, walk for more than an hour to a facility dispensing PrEP, encounter a health care provider with a negative attitude in order to receive PrEP enough for 3 months. Conclusion: Patient-centered approaches can help to inform the design and implementation of PrEP services among pregnant and breastfeeding women. In this study, we found that a reduction in clinic visits—including through multi-month dispensing of PrEP—could improve uptake of services in antenatal and postnatal settings. [ABSTRACT FROM AUTHOR]

Background: There is persistent pressure on countries with a high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from the "one-size-fits-all" model to differentiated service delivery (DSD) models, which are meant to be more patient-centered and efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess the availability of HIV service indicators and the readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia., Methods: We conducted a nationwide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess the availability of HIV service indicators and the readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered latent constructs, and therefore, we used structural equation modeling (SEM) to determine the correlations between them and their respective indicators., Results: Of 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60), and readiness to provide the DSD models was 81.7% (48/60). However, only 48 and 39% of the facilities had all indicators of availability and readiness, respectively. Retention in care for HIV multidisciplinary teams was more likely to occur in urban areas than in rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated ( r  = 0.73, p  < 0.0001). In addition, both availability and readiness were significantly and positively correlated with most of their respective indicators., Conclusion: Although most facilities had available HIV service indicators and were ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban facilities in some indicators. There is a need for persistent and heightened efforts meant to implement DSD in HIV treatment, especially in rural areas to accelerate reaching the desired HIV treatment outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kaonga, Sampa, Musukuma, Mulawa, Mulavu, Sitali, Moonga, Mweemba, Matenga, Zyambo, Hamoonga, Phiri, Halwindi, Chavula, Zulu and Jacobs.)

Background: Daily oral pre-exposure prophylaxis (PrEP) can reduce HIV incidence in pregnant and breastfeeding women, but adherence is essential., Methods: We conducted a pilot randomized trial to evaluate an intervention package to enhance antenatal and postnatal PrEP use in Lilongwe, Malawi. The intervention was based on patient-centered counseling adapted from previous PrEP studies, with the option of a participant-selected adherence supporter. Participants were locally eligible for PrEP and randomized 1:1 to intervention or standard counseling (ie, control) and followed for 6 months. Participants received the intervention package or standard counseling at enrollment, 1, 3, and 6 months. Adherence was measured through plasma and intracellular tenofovir concentrations and scored using a published algorithm. Our primary outcome was retention in care with concentrations consistent with 4-7 doses/week., Results: From June to November 2020, we enrolled 200 pregnant women with the median gestational age of 26 (interquartile range: 19-33) weeks. Study retention was high at 3 months (89.5%) and 6 months (85.5%). By contrast, across the 2 time points, 32.8% of participants retained in the study had adherence scores consistent with 2-5 doses/week while 10.3% had scores consistent with daily dosing. For the composite primary end point, no substantial differences were observed between the intervention and control groups at 3 months (28.3% vs. 29.0%, probability difference: -0.7%, 95% confidence interval: -13.3%, 11.8%) or at 6 months (22.0% vs. 26.3%, probability difference: -4.3%, 95% confidence interval: -16.1%, 7.6%)., Conclusions: In this randomized trial of PrEP adherence support, retention was high, but less than one-third of participants had pharmacologically confirmed adherence of ≥4 doses/week. Future research should focus on antenatal and postnatal HIV prevention needs and their alignment across the PrEP continuum, including uptake, persistence, and adherence., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)