Prevalence and Incidence of Chlamydia trachomatis and Neisseria gonorrhoeae Among Women Who Initiated HIV PrEP During Pregnancy in Kenya.

BACKGROUND

We evaluated the prevalence, incidence, and correlates of sexually transmitted infections among pregnant women initiating preexposure prophylaxis.

METHODS

We analyzed data from an ongoing randomized control trial that enrolled pregnant women in Kenya (NCT04472884) who were ≥18 years, between 24 and 32 weeks' gestation, had high HIV risk scores, and initiated oral preexposure prophylaxis within routine antenatal care. A subset of women were sequentially offered Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing in pregnancy and at 6 and 9 months after delivery. Directly observed treatment and expedited partner therapy (EPT) were offered to women diagnosed with CT/NG.

RESULTS

All pregnant women offered CT and NG testing accepted (n = 221). The median age of women was 26 years (interquartile range 22-30); median gestational age was 27 weeks (interquartile range 25-29). Prevalence of CT and/or NG during pregnancy was 19/221 (8.6%): 4.1% CT, 3.6% NG, and 1% CT and NG coinfection. Women <24 years were 3 times more likely to have prevalent CT/NG infection as older women (adjusted prevalence ratio: 3.12; 95% confidence interval [CI]: 1.24 to 7.85 P = 0.016). Overall, 21 CT/NG infections occurred in 181.2 total person-years of follow-up (incidence 11.6 per 100 person-years, 95% CI: 7.6 to 17.8). Incident CT and/or NG was 7-fold higher among women <24 years compared with older women (adjusted incidence rate ratio = 6.69, 95% CI: 2.55 to 17.54, P < 0.001). Same-day directly observed treatment and EPT acceptance was 95%; at subsequent visits, 79% reported partners accepted EPT, of whom 95% confirmed treatment completion.

CONCLUSIONS

CT/NG incidence was high among women who initiated preexposure prophylaxis in pregnancy, indicating that CT/NG testing would be high yield in this population.