Preference for Service Delivery for Long-Acting Pre-exposure Prophylaxis for HIV Infection Among Pregnant and Breastfeeding Women in South Africa and Botswana.

HIV particularly affects women during pregnancy and postpartum, where they face a two-fold or more increased risk of HIV acquisition. We explored preferences for long-acting PrEP and multipurpose prevention technologies among pregnant and breastfeeding women (PBFW) without HIV. From April to December 2023, we conducted a discrete choice experiment at maternal healthcare clinics in Cape Town, East London (South Africa), and Gaborone (Botswana) including PrEP-experienced and PrEP-naive women. Analysis included site stratification, mixed-effects logistic regression, and latent class modeling. Among 450 pregnant and breastfeeding women (52% pregnant, 47% breastfeeding), vaginally inserted and implanted PrEP was least preferred compared to oral. East London and Gaborone preferred clinic PrEP pick-up and effectiveness, while Cape Town showed indifference for community delivery. Three latent classes emerged: 'comprehensive delivery seekers' (43%), 'physical and physiological prioritisers' (25%), and 'vaginal insertion avoiders' (32%). Future PrEP programs should prioritize user-centered approaches, aligning with user preferences for effective use.