Missed HIV prevention opportunities: the PrEP cascade among pregnant or parenting adolescent girls and young women in South Africa

Jenny Chen-Charles^1,2*Linda-Gail Bekker²Janina Jochim¹Camille Wittesaele^1,3,4Lucie Cluver^1,5Elona Toska⁴

• ¹Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
• ²University of Cape Town Desmond Tutu HIV Centre, Observatory, South Africa
• ³MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
• ⁴Centre for Social Science Research, Department of Sociology, University of Cape Town, Rondebosch, South Africa
• ⁵University of Cape Town Department of Psychiatry and Mental Health, Observatory, South Africa

Introduction: Pregnant or parenting adolescent girls and young women (PPYW) are at greater risk of sexual exposure to HIV than their peers, yet tailored HIV prevention efforts for PPYW remain limited. Methods: We analysed cross-sectional data (2020-2023) from a sample of PPYW (median age 21.5, IQR = 20.3–22.5) in the Eastern Cape, South Africa. Results: Approximately 88% of PPYW who were HIV-negative (n=646) had a HIV test in the last few years. Of these – 58% knew about PrEP (n=328). Of those who knew about PrEP, 31% had ever been offered PrEP (n=100; 15% of HIV-negative PPYW), and 62% of those who were offered PrEP had ever taken PrEP (n=62; 10% of HIV-negative PPYW). Compared to PPYW who have not had a HIV test in the last few years, PPYW who had accessed HIV testing were more likely to be aware of PrEP (aOR=2.39, 95% CI:1.44–3.97, p=0.001), have been offered PrEP (aOR=2.96, 95% CI:1.16– 7.55, p=0.023), and taken PrEP (aOR = 4.57, 95% CI:1.09–19.16, p=0.038). Conclusions: This study highlights missed opportunities in PrEP delivery and offers recommendations to enhance PrEP awareness and uptake among PPYW. Despite high HIV testing rates in this key population, awareness of PrEP, its offer, and uptake remain low.