Experiences, Attitudes and Preferences of Postpartum Cisgender Women for HIV Prevention and Pre-Exposure Prophylaxis Education during Routine Postpartum Care.

Abstract

The postpartum period presents an opportunity to deliver comprehensive sexual health education. Understanding preferences of postpartum cisgender women (CGW) towards integration of HIV prevention education into postpartum care is necessary to support acceptability, appropriateness, and feasibility. Postpartum CGW were recruited during their postpartum hospital stay in Bronx, NY. Participants completed a survey including two best-worst scaling exercises that elicited preferences for receiving HIV prevention information and PrEP messaging. Utility scores were estimated using a hierarchical Bayes multinomial logit model and mathematically transformed into a probability scale presented as preference scores (PS), with higher numbers representing greater preference. Among 259 participants, 53% had never heard of PrEP before. Receiving information from a doctor was most preferred (13.4, 95%CI 12.7-14.0) followed by receiving information about HIV prevention combined with taking care of their health after having a baby (11.6, 95% CI 10.9-12.3). Latent class analysis revealed three classes: participants with greater preference for high touch services (e.g., in-person visits, doctor providing information), integrated information (e.g., HIV prevention information given in combination with sexual or maternal health information) and high technology services (e.g., a mobile phone application, telehealth visit). Participants preferred PrEP messaging related to themes of effectiveness, motherhood, safety and autonomy. Latent class analysis of PrEP messaging revealed two classes: one with participants preferring messages related to motherhood and safety and another preferring messages related to control and autonomy. The heterogeneity in preferences for receiving information at the patient level suggests a need for patient-centered, differentiated service delivery to support maximum receptivity.