PrEP Uptake Among Pregnant and Breastfeeding Women at Kapiri Urban Clinic

PrEP Uptake Among Pregnant and Breastfeeding Women at Kapiri Urban Clinic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article PrEP Uptake Among Pregnant and Breastfeeding Women at Kapiri Urban Clinic Hiwena Malawo, Mowa Zambwe, Richard Mutemwa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7753366/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction HIV globally is a public health challenge especially among P/BFW who are a priority population as they put at risk unborn or breastfeeding babies of HIV. Use of PREP has proven significant. However, little research literature exists which shows the uptake of PrEP among P/BFW in a low resourced country like Zambia. The purpose of this study was therefore to explore factors influencing PrEP uptake among P/BFW at Kapiri Urban Clinic in Kapiri district of the Republic of Zambia. Methods The study approach was quantitative, a sample size of 348 participants were selected randomly. A questionnaire was applied to collect data; and STATA version 15 was used for the analysis. Results Linear regression results show factors associated to PrEP among the study population were marital status with results suggesting a status closer to marriage reduced PrEP uptake by − .233, higher level of education of participants reduced PrEP uptake by − .241, and misinformation on risk Factors for PrEP reduced uptake by − .229. Higher Partner’s Education increased PrEP uptake by 0.359. Conclusion This study was successful in establishing the factors associated with PrEP among pregnant and breastfeeding women at Kapiri Urban Clinic. These were age, marital status, level of education, partner education and misinformation on risk factors and the cultural factors included perception of being HIV positive, having multiple sexual partners and being an adulterer. PrEP Socio-demographic factors Kapiri Urban Clinic Breastfeeding and Pregnant women Introduction Antiretroviral medication is used by HIV-uninfected people as part of HIV pre-exposure prophylaxis (PrEP), which aims to prevent HIV infection, taken orally as a daily pill (usually containing tenofovir plus emtricitabine, or TDF/FTC). New data indicate that long-acting injectable PrEP may soon be an alternative option. Only daily oral PrEP is available in the majority of low-income nations; however, not all kinds of PrEP are available everywhere in the world. Global statistics on PrEP uptake among pregnant and breastfeeding women are limited, with significant variations across regions. The World Health Organization has recommended PrEP for pregnant and breastfeeding women at substantial risk of HIV, but implementation remains inconsistent globally 1 . In sub-Saharan Africa, studies highlight moderate uptake in some contexts. For instance, a demonstration project in Kenya found that 14% of women attending antenatal clinic were initiated on PrEP after receiving counseling, indicating both interest and barriers such as stigma and knowledge gaps 2 . Efforts to increase PrEP uptake have focused on integrating PrEP services into maternal and child health programs. Studies suggest that embedding PrEP delivery within antenatal and postnatal care services improves accessibility and uptake among PBW 3 . Additionally, interventions that address healthcare provider attitudes and build capacity for PrEP delivery have shown promise in enhancing service delivery 4 . In 2016, the Zambian Ministry of Health adopted the 2015 WHO guidelines recommending daily oral PrEP for people at substantial risk of HIV infection, defined as HIV incidence greater than 3 per 100 person-years. The aim of this research was to determine the barriers and enabling factors of PrEP uptake during pregnancy and breastfeeding, at Kapiri urban clinic in Zambia. Statement of the problem Pregnant and breastfeeding women (PBFW) at high risk of HIV are recommended to use pre-exposure prophylaxis (PrEP) by the World Health Organization, yet global scale-up is still far below targets. Only 28% of the 3 million people projected to be on PrEP in 2020 in low- and middle- income countries had started using it, with uptake concentrated in a handful of countries, including Kenya and South Africa 5 . Research from sub-Saharan Africa suggests poor initiation and retention in PrEP among this population, with barriers related to stigma, misinformation, partner dynamics, and health system constraints 3 . At Kapiri Urban Clinic, routine data for January–March 2024 showed that of 69 clients who continued PrEP, only 9 were pregnant or breastfeeding women, indicating very low uptake among this priority population. This gap highlights a pressing need to examine socio-demographic, cultural, and structural factors affecting PrEP uptake in PBFW at this site. Justification of the study The Pregnant and breastfeeding women population is a very vital and highly vulnerable population with regard HIV. This study will expand the body of knowledge and will help inform policy development. Main Objective To establish the association between PrEP uptake and being pregnant and breastfeeding among women at Kapiri Urban Clinic. Study setting The study was designed to determine the factors influencing PrEP uptake among pregnant and breast-feeding women at Kapiri Urban Clinic in Kapiri Mposhi district, Zambia, which is centred on coordinates (13.9779° S,28.6848° E). It is located 60 km from Kabwe and 140 Kms away from Ndola district. It shares its eastern district borders with Mkushi, western borders with Mpongwe, Masaiti and Ngabwe district while the northwestern borders with Ngabwe 6 . The clinic itself has an outpatient department but it does not have an inpatient department, with only one doctor and on a weekly ante-natal day the average initial ANC attendance is 37. Methods Research approach A quantitative approach was applied Research setting The study was conducted at Kapiri Urban Clinic in Kapiri Mposhi, this is because Kapiri Urban Clinic is a high-volume site with a large catchment area and population and thus has a high number of women accessing ante-natal services. Study Population The study targeted at pregnant and breastfeeding women accessing ante-natal and postpartum services at Kapiri Urban Clinic in Kapiri Mposhi District. This is because these women are exposed to acquiring HIV through their partners and thus also risk transmitting the virus to the unborn child and/or breastfeeding baby. Sampling techniques A sample of 348 P/BFW was selected randomly. Slovins sample size formula was applied as outlined below. N is the Population size, Z is the Critical value of the normal distribution at the required confidence level, p is the Sample proportion, e is the Margin of error The population size was 2662 which was the number women in our target population at Kapiri Urban Clinic, at a 95% confidence level or critical value of 1.96, sample proportion was at 50% and margin of error was at 5%. The determined sample size was 348 after substituting the values in Slovins formula. Data collection techniques A questionnaire was used to collect data. Data analysis STATA version 15 was applied and the test statistics used were the mean, frequency distribution tables and multi-variable analysis using multiple linear regression. Ethical considerations The University of Lusaka Research Ethics Committee and National Health Research Authority approved the study. Informed consented was obtained from the participants by way of signing. Anonymity and confidentiality of participants was observed. And the subjects were informed that their participation did not entail an individual economic benefit. And that they could terminate their participation in the survey at any time they felt like. Presentation of Results Demographic characteristics The mean age of the clients was 29 and the minimum age was 19 and the maximum age was 42. This describes that the age range was inclusive and not biased towards either the higher or lower percentile. The distribution of the marital status was such that the highest proportion of our target population was married which constituted 180 pregnant and breastfeeding women which was 52 per cent of the sample size while the least category of these women was that the widowed which constituted only 29 women translating to 8 per cent of the sample size. Furthermore, most of the participants enrolled in the study had attained tertiary education with the absolute number of them being 207 that translated to 59 per cent of the sample size with the least being those that had no formal education and those that ended up to having primary education constituting 14 per cent and 9 per cent of the sample size respectfully. Table 1: Multiple linear regression of factors associated with PrEP uptake and being pregnant and breastfeeding women at Kapiri Urban Clinic. Coefficient P Value {95% Confidence interval} Age 0.0059638 0.214 -0.03643,0.0153919 Marital Status -0.2332826 0.0000000 0.03021672, -0.164398 Level of Education -0.2405675 0.0010000 -0.3866331, -0.0945019 Heard of PrEP -0.0336186 0.7390000 -0.2322162, 0.164979 Partner Education 0.3599560 0.0000000 0.03021672, -0.164401 Partner HIVStatus -0.1812545 0.0000000 -0.2733718, -000891373 Risk-factors -0.2287781 0.0060000 -0.3915037,-0.0660525 The research question investigated how PrEP uptake relates to pregnant and breastfeeding women at Kapiri Urban Clinic, and the results indicated that the statistically significant variables are (i) Marital status; being married or being under a certain marital status has a negative relationship with the uptake of PrEParation (-0.2333). Because it acts on 0.000, its p-value indicator shows that this effect is statistically significant. The other significant factor was level of education, as the result shows that as the level of education increases among the target population, PrEP uptake decreases by 0.2406. This effect is statistically significant (p-value = 0.001). The third factor of significance was (iii) Partner's education, as the coefficient showed that higher partner education was positively associated with PrEP_uptake of 0.36. This effect is statistically significant (p-value = 0.000); another significant factor was (iv) Partner's HIV status, results showing that the partner's HIV status varied negatively with PrEP uptake; partners being HIV positive, or with partners who are HIV positive, reduced uptake by 0.1813. This effect is statistically significant (p-value = 0.000) and another significant factor is (v) risk factors for PrEP. A coefficient showed that, with an individual in the target population having to know some of the risks that are a consideration for PrEP, they lose 0.2288 in terms of PrEP uptake. This effect is statistically significant at (p-value = 0.006). The model suggests that factors such as marital status, education level, partner's education, partner’s HIV status, and risk factors for PrEP are significantly related to PrEP_uptake. However, age and having heard about PrEP do not have a statistically significant impact on uptake based on this model. Discussion Marital Status and PrEP Uptake This study found that marital status had a significant negative effect on PrEP uptake, with being married or having a particular marital status associated with a decrease in uptake by 0.2333. The p-value of 0.000 indicates that this result is statistically significant. This finding aligns with previous research conducted in Zambia, which indicated that marital status influences the decisions to adopt preventive measures such as PrEP. For instance, a study by Tembo et al. 7 found that married women were less likely to access PrEP, possibly due to cultural norms surrounding marriage and sexual activity, as well as the perception of a lower risk of HIV transmission within marriage. Education and PrEP Uptake The results of this study indicate that higher levels of education are inversely related to PrEP uptake, with the coefficient showing a decrease of 0.2406 in uptake as education increases. This association was statistically significant with a p-value of 0.001. Similar findings have been observed in other studies conducted in Zambia. For example, the study by Phiri et al. 12 highlighted that individuals with higher education levels tended to be more aware of HIV risks, but paradoxically, they were less likely to perceive the need for PrEP due to their perceived lower HIV vulnerability. This finding could be explained by a more general understanding of HIV prevention among educated individuals, which might reduce the urgency of using PrEP. Partner's Education and PrEP Uptake The study found that a higher level of education in a partner was positively associated with increased PrEP uptake by 0.36. This result is consistent with findings from other research conducted in Zambia, such as by Chabala et al. 8 , where a partner's education was found to influence health decisions, including the adoption of PrEP. Educated partners may be more likely to understand the benefits of PrEP, discuss it openly, and encourage their partners to initiate or continue using the medication. Partner's HIV Status and PrEP Uptake This study also found that having an HIV-positive partner (or a partner who is HIV-positive) was negatively associated with PrEP uptake, with a coefficient of -0.1813. This effect was statistically significant (p-value = 0.000). This finding reflects the broader context of HIV-related stigma and fear of disclosure, which has been highlighted in other Zambian studies. According to Mweemba et al. 9 , women with HIV-positive partners often face challenges in accessing HIV prevention services like PrEP due to the stigma attached to HIV-positive status and concerns about their partner’s reaction. This negative association may be compounded by the belief that if a partner is HIV-positive, PrEP may not be seen as necessary, or it may be more difficult for women to negotiate its use. Knowledge of Risk Factors and PrEP Uptake Finally, the study showed that knowing a risk factor for PrEP was negatively associated with uptake, with a decrease of 0.2288 in uptake when participants were aware of risk factors. This finding, with a statistically significant p-value of 0.006, is somewhat counterintuitive. In contrast to other studies where knowledge of risk factors for HIV was associated with higher rates of PrEP uptake such as in the work by Lungu et al., 10 , this study suggests that awareness of risk factors may actually reduce the perceived need for PrEP. This could be due to a variety of factors, including misinformation or the perception that PrEP is only necessary for those with certain high-risk behaviors, rather than for all individuals at risk, stigma and health communication gap among the individuals enrolled in the study. Conclusion The research sheds light on the reasoning that led to the low uptake of PrEP by breastfeeding and pregnant women. In order to achieve the objective of the study analyzing the prevalence of PrEP use, cultural and socio demographic factors, and the link between such factors and the use of PrEP, this research exposes important determinants in the barriers and facilitators to use of this HIV prevention method. The implementation of this research will help the correct barriers to motivate appropriate use of PrEP by these women. With regard to the findings of this study among the mentioned factors that are associated with PrEP uptake in our target population, marital status, education and partner’s education, HIV status of either partner, or risk factor awareness showed significant influence to uptake. When correlating age and unearned knowledge on PrEP to PrEP’s uptake, there is nothing to enjoy as they proved to be statistically insignificant with PrEP use. It shows that people have thresholds beyond which their individual and relational factors do not consider PrEP use or more clearly said one-dimensional PrEP adoption. Recommendations Recommendation for a future research with a qualitative approach to bring forth the richness of a survey, feelings and beliefs of this sample. Outreach campaigns should be conducted to correct misconceptions and educate people that PrEP is a form of prevention and not a sign of having HIV. Inviting male partners to such activities could also be helpful in solving partner consent and support issues. Moreover, sensitivity training should be conducted at the community level as that could counteract shyness by working to highlight such problems as cultural factors that also contribute to stigma. Finally, to overcome PrEP uptake gaps in Zambia, targeted efforts to combat socio-demographic determinants, cultural patterns, and systemic problems in the healthcare system are all required. Declarations Ethics Approval and Consent to Participate : The study was approved by the University of Lusaka Research Ethics Committee and the Zambia National Health Research Authority (NHRA). All participants provided written informed consent before participation as you will see attached the informed consent for in the appendices section right after the references. Consent to Publish : Not applicable. Funding : This research received no external funding. Competing Interests : The authors declare that they have no competing interests. References World Health Organization. (2021), WHO Guidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. Geneva:. Google Scholar . Baeten JM, et al.. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women . N Engl J Med. 2022;367:399–410. 10.1056/NEJMoa1108524 . Haberer JE. Integrating PrEP delivery into maternal and child health services: lessons from an implementation science approach. Curr HIV/AIDS Rep. 2019;16(4):334–44. https://doi.org/10.1007/s11904-019-00456-7 . Kinuthia J, Pintye J, Abuna F, Mugwanya K, Lagat H, Onyango D, Baeten JM, Celum C, John-Stewart G, Drake AL. (2021). Pre-exposure prophylaxis uptake and adherence among Kenyan women in a pragmatic implementation study within maternal and child health. UNAIDS. Pre-exposure prophylaxis use expands, but not fast enough. Switzerland: Joint United Nations Programme on HIV/AIDS. Geneva; 2022. Kapiri Mposhi town council. (2022), Kapiri Mposhi, Zambia. Tembo S. Barriers to uptake of pre-exposure prophylaxis (PrEP) among married women in Zambia: a qualitative study. BMC Public Health. 2020;20:1485. https://doi.org/10.1186/s12889-020-09578-y . Chabala C, Musonda P, Mwale J, Kapasa M. (2019). The role of partner’s education in the uptake of HIV prevention strategies among couples in Zambia. African Journal of AIDS Research , 18(3), pp.189–197. https://doi.org/10.2989/16085906.2019.1648303 clinics. AIDS , 35(2), pp.253–263. https://doi.org/10.1097/QAD.0000000000002731. Mweemba C. Stigma and fear of disclosure: Challenges to PrEP uptake among women with HIV-positive partners in Zambia. J Int AIDS Soc. 2021;24(7):e25712. https://doi.org/10.1002/jia2.25712 . Lungu A. Knowledge of HIV risk factors and its impact on PrEP uptake among young adults in Zambia. BMC Infect Dis. 2022;22:456. https://doi.org/10.1186/s12879-022-07456-5 . Additional Declarations No competing interests reported. Supplementary Files Appendices.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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New data indicate that long-acting injectable PrEP may soon be an alternative option. Only daily oral PrEP is available in the majority of low-income nations; however, not all kinds of PrEP are available everywhere in the world. Global statistics on PrEP uptake among pregnant and breastfeeding women are limited, with significant variations across regions. The World Health Organization has recommended PrEP for pregnant and breastfeeding women at substantial risk of HIV, but implementation remains inconsistent globally\u003csup\u003e1\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn sub-Saharan Africa, studies highlight moderate uptake in some contexts. For instance, a demonstration project in Kenya found that 14% of women attending antenatal clinic were initiated on PrEP after receiving counseling, indicating both interest and barriers such as stigma and knowledge gaps\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEfforts to increase PrEP uptake have focused on integrating PrEP services into maternal and child health programs. Studies suggest that embedding PrEP delivery within antenatal and postnatal care services improves accessibility and uptake among PBW\u003csup\u003e3\u003c/sup\u003e. Additionally, interventions that address healthcare provider attitudes and build capacity for PrEP delivery have shown promise in enhancing service delivery\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e In 2016, the Zambian Ministry of Health adopted the 2015 WHO guidelines recommending daily oral PrEP for people at substantial risk of HIV infection, defined as HIV incidence greater than 3 per 100 person-years.\u003c/p\u003e\u003cp\u003eThe aim of this research was to determine the barriers and enabling factors of PrEP uptake during pregnancy and breastfeeding, at Kapiri urban clinic in Zambia.\u003c/p\u003e\n\u003ch3\u003eStatement of the problem\u003c/h3\u003e\n\u003cp\u003ePregnant and breastfeeding women (PBFW) at high risk of\u0026ensp;HIV are recommended to use pre-exposure prophylaxis (PrEP) by the World Health Organization, yet global scale-up is still far below targets. Only 28% of the 3\u0026nbsp;million people projected to be on PrEP in 2020 in low- and middle-\u0026ensp;income countries had started using it, with uptake concentrated in a handful of countries, including Kenya and South Africa\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eResearch from sub-Saharan Africa suggests poor initiation and retention in PrEP among this population, with barriers related to\u0026ensp;stigma, misinformation, partner dynamics, and health system constraints\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAt Kapiri Urban Clinic, routine data for January\u0026ndash;March 2024 showed that of 69 clients who continued PrEP, only 9 were pregnant or\u0026ensp;breastfeeding women, indicating very low uptake among this priority population. This gap highlights a pressing need to examine socio-demographic, cultural, and structural factors affecting PrEP uptake in\u0026ensp;PBFW at this site.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eJustification of the study\u003c/h2\u003e\u003cp\u003eThe Pregnant and breastfeeding women population is a very vital and highly vulnerable population with regard HIV. This study will expand the body of knowledge and will help inform policy development.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMain Objective\u003c/h3\u003e\n\u003cp\u003eTo establish the association between PrEP uptake and being pregnant and breastfeeding among women at Kapiri Urban Clinic.\u003c/p\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eThe study was designed to determine the factors influencing PrEP uptake among pregnant and breast-feeding women at Kapiri Urban Clinic in Kapiri Mposhi district, Zambia, which is centred on coordinates (13.9779\u0026deg; S,28.6848\u0026deg; E). It is located 60 km from Kabwe and 140 Kms away from Ndola district. It shares its eastern district borders with Mkushi, western borders with Mpongwe, Masaiti and Ngabwe district while the northwestern borders\u0026ensp;with Ngabwe\u003csup\u003e6\u003c/sup\u003e. The clinic itself has an outpatient department but it does not have\u0026ensp;an inpatient department, with only one doctor and on a weekly ante-natal day the average initial ANC attendance is 37.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch approach\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quantitative approach was applied\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc187778076\"\u003e\u003cstrong\u003eResearch setting\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Kapiri Urban Clinic in Kapiri Mposhi, this is because Kapiri Urban Clinic is a high-volume site with a large catchment area and population and thus has a high number of women accessing ante-natal services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study targeted at pregnant and breastfeeding women accessing ante-natal and postpartum services at Kapiri Urban Clinic in Kapiri Mposhi District. This is because these women are exposed to acquiring HIV through their partners and thus also risk transmitting the virus to the unborn child and/or breastfeeding baby.\u003c/p\u003e\n\u003cp id=\"_Toc187778078\"\u003e\u003cstrong\u003eSampling techniques\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA sample of 348 P/BFW was selected randomly. Slovins sample size formula was applied as outlined below.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"327\" height=\"83\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1759822599.jpg\" alt=\"Sample size formula 1\"\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;N is the Population size,\u003c/p\u003e\n\u003cp\u003eZ is the Critical value of the normal distribution at the required confidence level,\u003c/p\u003e\n\u003cp\u003ep is the Sample proportion,\u003c/p\u003e\n\u003cp\u003ee is the Margin of error\u003c/p\u003e\n\u003cp\u003eThe population size was 2662 which was the number women in our target population at Kapiri Urban Clinic, at a 95% confidence level or critical value of 1.96, sample proportion was at 50% and margin of error was at 5%. The determined sample size was 348 after substituting the values in Slovins formula.\u003c/p\u003e\n\u003cp id=\"_Toc187778079\"\u003e\u003cstrong\u003eData collection techniques\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA questionnaire was used to collect data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSTATA version 15 was applied and the test statistics used were the mean, frequency distribution tables and multi-variable analysis using multiple linear regression.\u003c/p\u003e\n\u003cp id=\"_Toc187778082\"\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Lusaka Research Ethics Committee and National Health Research Authority approved the study. Informed consented was obtained from the participants by way of signing. \u0026nbsp;Anonymity and confidentiality of participants was observed. And the subjects were informed that their participation did not entail an individual economic benefit. And that they could terminate their participation in the survey at any time they felt like.\u003c/p\u003e"},{"header":"Presentation of Results","content":"\u003cp\u003e\u003cem\u003eDemographic characteristics\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of the clients was 29 and the minimum age was 19 and the maximum age was 42. This describes that the age range was inclusive and not biased towards either the higher or lower percentile. The distribution of the marital status was such that the highest proportion of our target population was married which constituted 180 pregnant and breastfeeding women which was 52 per cent of the sample size while the least category of these women was that the widowed which constituted only 29 women translating to 8 per cent of the sample size. Furthermore, most of the participants enrolled in the study had attained tertiary education with the absolute number of them being 207 that translated to 59 per cent of the sample size with the least being those that had no formal education and those that ended up to having primary education constituting 14 per cent and 9 per cent of the sample size respectfully.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1: Multiple linear regression of factors associated with PrEP uptake and being pregnant and breastfeeding women at Kapiri Urban Clinic.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e{95% Confidence interval}\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0059638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.03643,0.0153919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.2332826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0000000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.03021672, -0.164398\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.2405675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0010000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.3866331, -0.0945019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeard of PrEP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.0336186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.7390000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.2322162, 0.164979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.3599560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0000000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.03021672, -0.164401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner HIVStatus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.1812545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0000000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.2733718, -000891373\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk-factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.2287781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e0.0060000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 271px; background-color: rgb(44, 130, 201);\"\u003e\n \u003cp\u003e-0.3915037,-0.0660525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research question investigated how PrEP uptake relates to pregnant and breastfeeding women at Kapiri Urban Clinic, and the results indicated that the statistically significant variables are (i) Marital status; being married or being under a certain marital status has a negative relationship with the uptake of PrEParation (-0.2333). Because it acts on 0.000, its p-value indicator shows that this effect is statistically significant. The other significant factor was level of education, as the result shows that as the level of education increases among the target population, PrEP uptake decreases by 0.2406. This effect is statistically significant (p-value = 0.001). The third factor of significance was (iii) Partner\u0026apos;s education, as the coefficient showed that higher partner education was positively associated with PrEP_uptake of 0.36. This effect is statistically significant (p-value = 0.000); another significant factor was (iv) Partner\u0026apos;s HIV status, results showing that the partner\u0026apos;s HIV status varied negatively with PrEP uptake; partners being HIV positive, or with partners who are HIV positive, reduced uptake by 0.1813. This effect is statistically significant (p-value = 0.000) and another significant factor is (v) risk factors for PrEP. A coefficient showed that, with an individual in the target population having to know some of the risks that are a consideration for PrEP, they lose 0.2288 in terms of PrEP uptake. This effect is statistically significant at (p-value = 0.006).\u003c/p\u003e\n\u003cp\u003eThe model suggests that factors such as marital status, education level, partner\u0026apos;s education, partner\u0026rsquo;s HIV status, and risk factors for PrEP are significantly related to PrEP_uptake. However, age and having heard about PrEP do not have a statistically significant impact on uptake based on this model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eMarital Status and PrEP Uptake\u003c/h2\u003e\u003cp\u003eThis study found that marital status had a significant negative effect on PrEP uptake, with being married or having a particular marital status associated with a decrease in uptake by 0.2333. The p-value of 0.000 indicates that this result is statistically significant. This finding aligns with previous research conducted in Zambia, which indicated that marital status influences the decisions to adopt preventive measures such as PrEP. For instance, a study by Tembo et al.\u003csup\u003e7\u003c/sup\u003e found that married women were less likely to access PrEP, possibly due to cultural norms surrounding marriage and sexual activity, as well as the perception of a lower risk of HIV transmission within marriage.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eEducation and PrEP Uptake\u003c/h2\u003e\u003cp\u003eThe results of this study indicate that higher levels of education are inversely related to PrEP uptake, with the coefficient showing a decrease of 0.2406 in uptake as education increases. This association was statistically significant with a p-value of 0.001. Similar findings have been observed in other studies conducted in Zambia. For example, the study by Phiri et al.\u003csup\u003e12\u003c/sup\u003e highlighted that individuals with higher education levels tended to be more aware of HIV risks, but paradoxically, they were less likely to perceive the need for PrEP due to their perceived lower HIV vulnerability. This finding could be explained by a more general understanding of HIV prevention among educated individuals, which might reduce the urgency of using PrEP.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePartner's Education and PrEP Uptake\u003c/h2\u003e\u003cp\u003eThe study found that a higher level of education in a partner was positively associated with increased PrEP uptake by 0.36. This result is consistent with findings from other research conducted in Zambia, such as by Chabala et al.\u003csup\u003e8\u003c/sup\u003e, where a partner's education was found to influence health decisions, including the adoption of PrEP. Educated partners may be more likely to understand the benefits of PrEP, discuss it openly, and encourage their partners to initiate or continue using the medication.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003ePartner's HIV Status and PrEP Uptake\u003c/h2\u003e\u003cp\u003eThis study also found that having an HIV-positive partner (or a partner who is HIV-positive) was negatively associated with PrEP uptake, with a coefficient of -0.1813. This effect was statistically significant (p-value\u0026thinsp;=\u0026thinsp;0.000). This finding reflects the broader context of HIV-related stigma and fear of disclosure, which has been highlighted in other Zambian studies. According to Mweemba et al.\u003csup\u003e9\u003c/sup\u003e, women with HIV-positive partners often face challenges in accessing HIV prevention services like PrEP due to the stigma attached to HIV-positive status and concerns about their partner\u0026rsquo;s reaction. This negative association may be compounded by the belief that if a partner is HIV-positive, PrEP may not be seen as necessary, or it may be more difficult for women to negotiate its use.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of Risk Factors and PrEP Uptake\u003c/h2\u003e\u003cp\u003eFinally, the study showed that knowing a risk factor for PrEP was negatively associated with uptake, with a decrease of 0.2288 in uptake when participants were aware of risk factors. This finding, with a statistically significant p-value of 0.006, is somewhat counterintuitive. In contrast to other studies where knowledge of risk factors for HIV was associated with higher rates of PrEP uptake such as in the work by Lungu et al.,\u003csup\u003e10\u003c/sup\u003e, this study suggests that awareness of risk factors may actually reduce the perceived need for PrEP. This could be due to a variety of factors, including misinformation or the perception that PrEP is only necessary for those with certain high-risk behaviors, rather than for all individuals at risk, stigma and health communication gap among the individuals enrolled in the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe research sheds light on the reasoning that led to the low uptake of PrEP by breastfeeding and pregnant women. In order to achieve the objective of the study analyzing the prevalence of PrEP use, cultural and socio demographic factors, and the link between such factors and the use of PrEP, this research exposes important determinants in the barriers and facilitators to use of this HIV prevention method. The implementation of this research will help the correct barriers to motivate appropriate use of PrEP by these women. With regard to the findings of this study among the mentioned factors that are associated with PrEP uptake in our target population, marital status, education and partner\u0026rsquo;s education, HIV status of either partner, or risk factor awareness showed significant influence to uptake. When correlating age and unearned knowledge on PrEP to PrEP\u0026rsquo;s uptake, there is nothing to enjoy as they proved to be statistically insignificant with PrEP use. It shows that people have thresholds beyond which their individual and relational factors do not consider PrEP use or more clearly said one-dimensional PrEP adoption.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eRecommendation for a future research with a qualitative approach to bring forth the richness of a survey, feelings and beliefs of this sample. Outreach campaigns should be conducted to correct misconceptions and educate people that PrEP is a form of prevention and not a sign of having HIV. Inviting male partners to such activities could also be helpful in solving partner consent and support issues. Moreover, sensitivity training should be conducted at the community level as that could counteract shyness by working to highlight such problems as cultural factors that also contribute to stigma. Finally, to overcome PrEP uptake gaps in Zambia, targeted efforts to combat socio-demographic determinants, cultural patterns, and systemic problems in the healthcare system are all required.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e: The study was approved by the University of Lusaka Research Ethics Committee and the Zambia National Health Research Authority (NHRA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent before participation as you will see attached the informed consent for in the appendices section right after the references.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eWorld Health Organization. (2021), \u003cem\u003eWHO Guidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. Geneva:. Google Scholar\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBaeten JM, et al.. \u003cem\u003eAntiretroviral prophylaxis for HIV prevention in heterosexual men and women\u003c/em\u003e. N Engl J Med. 2022;367:399\u0026ndash;410. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa1108524\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHaberer JE. Integrating PrEP delivery into maternal and child health services: lessons from an implementation science approach. Curr HIV/AIDS Rep. 2019;16(4):334\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11904-019-00456-7\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKinuthia J, Pintye J, Abuna F, Mugwanya K, Lagat H, Onyango D, Baeten JM, Celum C, John-Stewart G, Drake AL. (2021). Pre-exposure prophylaxis uptake and adherence among Kenyan women in a pragmatic implementation study within maternal and child health.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eUNAIDS. Pre-exposure prophylaxis use expands, but not fast enough. Switzerland: Joint United Nations Programme on HIV/AIDS. Geneva; 2022.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKapiri Mposhi town council. (2022), Kapiri Mposhi, Zambia.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTembo S. Barriers to uptake of pre-exposure prophylaxis (PrEP) among married women in Zambia: a qualitative study. BMC Public Health. 2020;20:1485. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-020-09578-y\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChabala C, Musonda P, Mwale J, Kapasa M. (2019). \u003cem\u003eThe role of partner\u0026rsquo;s education in the uptake of HIV prevention strategies among couples in Zambia. African Journal of AIDS Research\u003c/em\u003e, 18(3), pp.189\u0026ndash;197. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2989/16085906.2019.1648303\u003c/span\u003e\u003c/span\u003e \u003cem\u003eclinics. AIDS\u003c/em\u003e, 35(2), pp.253\u0026ndash;263. https://doi.org/10.1097/QAD.0000000000002731.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMweemba C. Stigma and fear of disclosure: Challenges to PrEP uptake among women with HIV-positive partners in Zambia. J Int AIDS Soc. 2021;24(7):e25712. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jia2.25712\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLungu A. Knowledge of HIV risk factors and its impact on PrEP uptake among young adults in Zambia. BMC Infect Dis. 2022;22:456. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12879-022-07456-5\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PrEP, Socio-demographic factors, Kapiri Urban Clinic, Breastfeeding and Pregnant women","lastPublishedDoi":"10.21203/rs.3.rs-7753366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7753366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eHIV globally is a public health challenge especially among P/BFW who are a priority population as they put at risk unborn or breastfeeding babies of HIV. Use of PREP has proven significant. However, little research literature exists which shows the uptake of PrEP among P/BFW in a low resourced country like Zambia. The purpose of this study was therefore to explore factors influencing PrEP uptake among P/BFW at Kapiri Urban Clinic in Kapiri district of the Republic of Zambia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe study approach was quantitative, a sample size of 348 participants were selected randomly. A questionnaire was applied to collect data; and STATA version 15 was used for the analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eLinear regression results show factors associated to PrEP among the study population were marital status with results suggesting a status closer to marriage reduced PrEP uptake by \u0026minus;\u0026thinsp;.233, higher level of education of participants reduced PrEP uptake by \u0026minus;\u0026thinsp;.241, and misinformation on risk Factors for PrEP reduced uptake by \u0026minus;\u0026thinsp;.229. Higher Partner\u0026rsquo;s Education increased PrEP uptake by 0.359.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study was successful in establishing the factors associated with PrEP among pregnant and breastfeeding women at Kapiri Urban Clinic. These were age, marital status, level of education, partner education and misinformation on risk factors and the cultural factors included perception of being HIV positive, having multiple sexual partners and being an adulterer.\u003c/p\u003e","manuscriptTitle":"PrEP Uptake Among Pregnant and Breastfeeding Women at Kapiri Urban Clinic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-07 07:43:41","doi":"10.21203/rs.3.rs-7753366/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3fcbac8b-afd3-4554-82b6-47407f31f9f0","owner":[],"postedDate":"October 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T07:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-07 07:43:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7753366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7753366","identity":"rs-7753366","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}