" PrEP protects us": Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Twaambo Euphemia Hamoonga; Wilbroad Mutale; Lauren M Hill; Jude Igumbor; Benjamin H Chi

doi:10.3389/frph.2023.1084657

" PrEP protects us": Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Front Reprod Health. 2023 Apr 19:5:1084657. doi: 10.3389/frph.2023.1084657. eCollection 2023.

Authors

Twaambo Euphemia Hamoonga^{1

2}, Wilbroad Mutale¹, Lauren M Hill³, Jude Igumbor², Benjamin H Chi⁴

Affiliations

¹ School of Public Health, University of Zambia, Lusaka, Zambia.
² School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁴ School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Abstract

Background: Although pre-exposure prophylaxis (PrEP) is recommended for pregnant and breastfeeding women at elevated HIV risk, uptake has been low in Zambia.

Methods: In in-depth interviews, we explored beliefs about PrEP among 24 HIV-negative pregnant and breastfeeding Zambian women. Thematic analysis was used to identify behavioural, normative and control beliefs likely to influence PrEP uptake.

Results: Most women viewed PrEP as a good method of protecting themselves and their babies from HIV infection. Partners were cited as key referents in decision making about PrEP use. Many women felt that PrEP use was not entirely in their control. Most reported that they would not use PrEP if their partners did not approve. Health care providers with negative attitudes, long distance to clinics, and extended waiting times were cited as barriers to PrEP uptake.

Conclusion: HIV-negative pregnant and breastfeeding women had a positive attitude towards PrEP but barriers to uptake are multifaceted.

Keywords: PrEP; Zambia; beliefs; breastfeeding; intention; pregnant; sub-Saharan Africa; theory of planned behaviour.

Grants and funding

Research funding and trainee support for TEH was provided by the UNC-UNZA-Wits Partnership for HIV and Women's Reproductive Health which is funded by the Fogarty International Center (D43 TW010558). Additional investigator and administrative support was provided by the National Institute of Allergy and Infectious Diseases (K24 AI120796, P30 AI050410) and the National Institute of Mental Health (K01 MH121186).