Postpartum women's prospective acceptability of long-acting HIV prevention approaches in Kenya: a qualitative study

New long-acting pre-exposure prophylaxis (LA-PrEP) options offer an alternative to daily oral PrEP, which poses difficulties for adherence, especially during pregnancy and postpartum. Yet, limited data exist on LA-PrEP acceptability among pregnant and postpartum women. We aimed to evaluate its acceptability and identify strategies to enhance it.

We conducted an exploratory qualitative study with postpartum women in five public health facilities in Kisumu and Siaya Counties, Kenya. We conducted 70 in-depth interviews (IDIs) with postpartum women between August 2023 and March 2024. IDIs were conducted with women expressing high, low, and mixed LA-PrEP interest throughout pregnancy and postpartum. Inductive and deductive content analysis was used, and themes of acceptability were explored using the Theoretical Framework of Acceptability (TFA).

Most participants viewed LA-PrEP, especially every two-month injectables, as highly acceptable due to reduced pill burden, side effects, and dosing frequency. Concerns were raised regarding injectable PrEP safety for the baby during pregnancy and suitability of using the vaginal ring during birth. Participants emphasized the importance of education on the safety of these methods during pregnancy and breastfeeding, and strategies for improving adherence, such as mobile text message reminders. Overall, women preferred LA-PrEP options over daily oral PrEP for convenience, effectiveness, and privacy, with healthcare provider education seen as crucial.

We found high acceptability of LA-PrEP options among postpartum women with experience taking PrEP during pregnancy. The findings reveal diverse preferences and key factors influencing acceptability, including safety, discretion, and convenience.