Abstract
Pregnant women have a high HIV incidence in South Africa (SA), increasing the risk of mother-to-child transmission (MTCT) of HIV. Strengthening coverage of HIV prevention strategies such as pre-exposure prophylaxis (PrEP) is essential to ending the epidemic in SA. We estimated awareness and coverage of PrEP among pregnant women attending antenatal clinics. Using the national cross-sectional antenatal HIV sentinel survey SA, that was conducted from February to April 2022, we performed descriptive and survey logistic regression analyses. Women were deemed as aware about PrEP if they reported ever having heard of PrEP. Women were eligible for PrEP if they were HIV-negative and had either: (1) an HIV-positive/status-unknown partner; (2) multiple sexual partners in the past twelve months; (3) a sexually transmitted infection in the preceding six months; or (4) sex under the influence of alcohol/drugs in the past six months. 31.18% (n = 7 271) of HIV-negative women were eligible for PrEP. Among eligible women, 33.65% (n = 2 403) were aware about PrEP, 3.58% (n = 271) took PrEP before pregnancy, and 6.50% (n = 507) were currently on PrEP. Compared to follow-up visit attendees, first ANC visit attendees were less likely to be: (1) aware about PrEP (adjusted odds ratio (aOR) = 0.65; 95% confidence interval (CI): 0.59-0.72), and (2) to currently be on PrEP (aOR = 0.69; 95% CI: 0.57-0.84). Women who had never tested for HIV before pregnancy were less likely to: (1) be aware about PrEP (aOR = 0.51; 95% CI: 0.45-0.59), and (2) currently be on PrEP (aOR = 0.56; 95% CI: 0.43-0.74) compared to those who had tested for HIV before pregnancy. Women who reported having an HIV-positive partner compared to those with an HIV-negative partner had higher: (1) PrEP awareness (aOR = 2.21; 95% CI: 1.80-2.71), and (2) PrEP coverage during pregnancy (aOR = 8.51; 95% CI: 6.43-11.25). Overall PrEP awareness and coverage were low. PrEP is being integrated into safe conception programs as an HIV prevention strategy. Entry into ANC presents an important opportunity to prevent new HIV infections among new mothers, accelerating the elimination of MTCT of HIV in the country.