Abstract
Integrating pre-exposure prophylaxis delivery into family planning (FP) clinics may reach women at elevated HIV risk. We evaluated population characteristics, assessed and perceived HIV risk, and preferences of women accessing real-world FP clinics. Between July 26, 2021, and July 07, 2024, we conducted a cross-sectional study nested within a pragmatic trial of PrEP delivery integrated in twelve real-world FP clinics in Kisumu Kenya (Clinical Trials.Gov: NCT04666792). Quantitative exit surveys were administered to women on randomly selected days to characterize service satisfaction, preferences, behavioral and HIV risk. HIV risk and PrEP eligibility were assessed using Kenya PrEP guidelines. Overall, 1801 participants were interviewed, representing 9.9% of women without HIV accessing the twelve clinics during the 24-month study period. Median age (IQR) was 27.0 (23.2-32.0) years, 37.0% were ≤24 years, and 77.8% were married. Nearly all women (97.5%) visited clinics for FP services; 22.5% used injectable, 19.7% oral pills, and 20.4% implants. Most women (79.1%) reported condomless sex at last sex, but two-thirds were unaware of the HIV status of the person they last had sex with. One-third (30.6%, 551/1801) were assessed to have elevated HIV risk and PrEP eligible, but 72.2% (1300/1801) reported low self-perceived HIV risk and declined PrEP. Most women (78.5%) were not using any HIV prevention strategy, including 88% of those at elevated HIV risk. Knowledge about daily oral PrEP was high (69.5%) but low for injectable PrEP (8.2%). Most women preferred long-acting PrEP, with 70.9% interested in injectables and 39.8% in monthly oral PrEP. Trust in FP providers was high (98.6%), and FP clinics were the preferred access point for HIV prevention care (81.3%). Although women at elevated HIV risk frequently visited FP clinics, 55.3% (305/551) reported low self-perceived risk and low oral PrEP uptake; FP clinics were the preferred and trusted platform for HIV prevention care.