# Missed HIV prevention opportunities: the PrEP cascade among pregnant or parenting adolescent girls and young women in South Africa

## TL;DR

This study examines how pregnant or parenting young women in South Africa are missing chances to access HIV prevention tools like PrEP, despite high HIV testing rates.

## Contribution

The study identifies gaps in PrEP awareness and uptake among a vulnerable group and provides insights for improving prevention strategies.

## Key findings

- Only 10% of HIV-negative PPYW had ever taken PrEP.
- PPYW who accessed HIV testing were more likely to be aware of PrEP and have taken it.
- Despite high HIV testing rates, PrEP awareness and uptake remain low among PPYW.

## Abstract

Pregnant or parenting adolescent girls and young women (PPYW) are at greater risk of sexual exposure to HIV than their peers, yet tailored HIV prevention efforts for PPYW remain limited.

We analysed cross-sectional data (2020–2023) from a sample of PPYW (median age 21.5, IQR = 20.3–22.5) in the Eastern Cape, South Africa.

Approximately 88% of PPYW who were HIV-negative (n = 646) had a HIV test in the last few years. Of these—58% knew about PrEP (n = 328). Of those who knew about PrEP, 31% had ever been offered PrEP (n = 100; 15% of HIV-negative PPYW), and 62% of those who were offered PrEP had ever taken PrEP (n = 62; 10% of HIV-negative PPYW). Compared to PPYW who have not had a HIV test in the last few years, PPYW who had accessed HIV testing were more likely to be aware of PrEP (aOR = 2.39, 95% CI:1.44–3.97, p = 0.001), have been offered PrEP (aOR = 2.96, 95% CI:1.16–7.55, p = 0.023), and taken PrEP (aOR = 4.57, 95% CI:1.09–19.16, p = 0.038).

This study highlights missed opportunities in PrEP delivery and offers recommendations to enhance PrEP awareness and uptake among PPYW. Despite high HIV testing rates in this key population, awareness of PrEP, its offer, and uptake remain low.