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


Autoři: Chifundo Zimba aff001;  Suzanne Maman aff002;  Nora E. Rosenberg aff002;  Wilbroad Mutale aff003;  Oliver Mweemba aff004;  Wezzie Dunda aff001;  Twambilile Phanga aff001;  Kasapo F. Chibwe aff004;  Tulani Matenga aff004;  Kellie Freeborn aff005;  Leah Schrubbe aff005;  Bellington Vwalika aff006;  Benjamin H. Chi aff005
Působiště autorů: UNC Project-Malawi, Tidziwe Center, Lilongwe, Malawi aff001;  Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff002;  Department of Health Policy, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia aff003;  Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia aff004;  Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff005;  Department of Obstetrics and Gynecology, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223487

Souhrn

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.

Klíčová slova:

Breast feeding – HIV – HIV epidemiology – HIV prevention – Malawi – Pre-exposure prophylaxis – Pregnancy – Zambia


Zdroje

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