Evaluation of Pre-Exposure Prophylaxis (PrEP) in Pregnant and Breastfeeding Women

The objectives of the study are to:

• Determine the distribution of women across the PrEP cascade:

• Evaluate the proportion of pregnant and breastfeeding women who initiate PrEP out of all women offered PrEP
• Evaluate the proportion of pregnant and breastfeeding women who are retained in the PrEP cohort
• Evaluate the proportion of pregnant and breastfeeding women who initiate PrEP who adhere to PrEP using objective dried blood spot measures and subjective measures of self-reported pill count and adherence
• Evaluate the proportion of pregnant and breastfeeding women on PrEP (and not on PrEP) who acquire HIV, who transmit HIV to their infant, and who report adverse events 2. Evaluate patient and provider-level factors associated with the PrEP cascade using quantitative and qualitative approaches (including in-depth interviews) 3. Apply an established mathematical model to simulate the impact of improvement in the PrEP cascade on HIV infections averted (maternal and perinatal)

Inclusion criteria

• >16 years of age,
• confirmed HIV-negative (using 2 rapid tests,
• confirmed with a 4th generation antigen HIV test;
• lives within 20 km. of the clinic;
• confirmed to be pregnant;
• without psychiatric or medical contraindications to PrEP

Exclusion criteria

• Concurrent enrollment in another HIV-1 vaccine or prevention trial;
• medical hospitalization in the past year for any reason;
• receipt of TB treatment in the past 30 days; history of renal disease;
• exhibiting psychotic symptoms (including hallucinations, suicidal or homicidal ideation, or violent behavior),
• currently or history of taking anti-psychotic medications;
• positive Hepatitis B surface antigen test on screening;
• history of bone fracture not related to trauma;
• any other medical, psychiatric, or social condition which in the opinion of the investigators would affect the ability to consent and/or participate in the study.