Busiswa Pearl Peter* and Dominic Targema Abaver
Background: South Africa bears the highest global burden of HIV, disproportionately affecting Black African women and young adults due to socio-economic disparities and structural inequalities. Pre-exposure Prophylaxis (PrEP) has demonstrated high efficacy in preventing HIV when adhered to consistently. However, adherence challenges among pregnant women limit its effectiveness, increasing the risk of breakthrough infections. Methods: This study reviewed 150 medical records of HIV-negative pregnant women on PrEP attending antenatal care at Stanford Terrace Clinic, Mthatha. Socio-demographic characteristics, lifestyle risk factors and adherence-related behaviors were analyzed to assess their impact on breakthrough HIV infections. Results: Participants ranged from 15-42 years, with 44% aged 22-28 years and 68% identifying as single. While 80% had secondary education, 66% were unemployed. Adherence challenges included inconsistent follow-up visits (24%), missed PrEP doses (6%) and discontinuation of PrEP (7%). Risk behaviors, such as inconsistent condom use (16%) and multiple sexual partners (5%), compounded vulnerability to HIV. A 29.3% incidence of breakthrough infections was observed, highlighting significant gaps in adherence and PrEP effectiveness. Discussion: The findings reveal that socio-demographic and behavioral barriers, including low health literacy, unemployment and stigma, hinder effective PrEP use. Comparison with other studies highlights regional disparities in adherence, emphasizing the need for tailored interventions. Conclusions: Addressing adherence barriers through community-based education, integration of PrEP into antenatal care and innovative service delivery models is critical to reducing breakthrough infections. These measures are essential to improving PrEP outcomes and reducing HIV transmission among high-risk pregnant women in resource-limited settings.
Published Date: 2024-12-31; Received Date: 2024-12-02
