🔬 Groundbreaking Findings from the FastPrEP Study at University of Cape Town

A newly published study from the University of Cape Town's Desmond Tutu HIV Centre has shed critical light on oral pre-exposure prophylaxis (PrEP) use among pregnant and parenting young women in South Africa. Titled "Oral PrEP use among pregnant or parenting young women in South Africa: evidence from a large community-based implementation study," this research analyzes data from 4,876 young women aged 15-29 who initiated PrEP between August 2022 and June 2024 in Cape Town. The findings reveal that 44% of these initiators were pregnant or parenting, with 10% currently pregnant, highlighting a significant portion of this high-risk group engaging with HIV prevention tools.

Lead authors, including Jenny Chen-Charles and Dvora Joseph Davey from UCT, employed logistic regression models to assess discontinuation rates at one and four months post-initiation, using pharmacy refill data as a proxy for adherence. Adjusted odds ratios (aOR) showed pregnant or parenting women had 1.30 times higher odds of discontinuation at one month (95% CI: 1.14–1.49) and 1.41 times at four months (95% CI: 1.12–1.78) compared to their non-parenting peers. Among pregnant/parenting participants, those aged 15-24 faced even steeper challenges, with aORs of 1.31 and 1.41 respectively versus older counterparts.

This University of Cape Town-led effort underscores the role of academic institutions in addressing South Africa's HIV epidemic, where young women bear disproportionate burden. The median age of participants was 21.6 years, reflecting the youth focus essential for higher education researchers tackling public health crises.

Context of HIV Risk Among Young Women in South Africa

South Africa faces one of the world's highest HIV burdens, with antenatal clinic surveys indicating around 30% prevalence among pregnant women. Adolescent girls and young women (AGYW) aged 15-24 are particularly vulnerable, acquiring HIV at rates five times higher than young men due to biological, socio-economic, and gender-based factors. Pregnancy and early parenthood amplify this risk, alongside potential vertical transmission to infants.

In Cape Town's peri-urban communities like Klipfontein-Mitchells Plain—where FastPrEP operated—HIV incidence remains elevated. The study's backdrop emphasizes why oral PrEP, a daily pill combining tenofovir disoproxil fumarate and emtricitabine, is vital. Approved for use during pregnancy and breastfeeding since South Africa's 2020 guideline update, PrEP offers over 99% efficacy against HIV when adhered to consistently.

Academic researchers at institutions like UCT play a pivotal role in translating global evidence into local strategies, informing national policies and training future public health professionals. For those interested in such impactful careers, opportunities abound in higher education research jobs.

Key Challenges in PrEP Adherence for Pregnant and Parenting Youth

The FastPrEP data pinpoint life-stage barriers: pregnant and parenting young women juggle clinic visits, childcare, stigma, and daily pill burdens. Younger participants (15-24) showed heightened discontinuation, likely due to school, informal work, or unstable housing prevalent in 32% of similar cohorts.

• Higher odds of early dropout linked to fixed government clinics versus mobile services (aOR: 0.71 for mobile).
• Limited partner involvement and HIV risk perception gaps exacerbate persistence issues.
• Socio-economic stressors like food insecurity (affecting 64%) and poverty hinder routine adherence.

Expert opinions align: UCT's Linda-Gail Bekker notes the need for "youth-responsive interventions." Complementary studies, like the PrEP cascade analysis in Eastern Cape, report only 10% uptake among 646 pregnant/parenting young women (PPYW), despite 88% recent HIV testing. Barriers include low awareness (58%), rare offers (15%), echoing national gaps.

Methods and Innovations in the FastPrEP Implementation

FastPrEP, funded by the Bill & Melinda Gates Foundation, scaled PrEP across mobile clinics, government facilities, and community sites in Cape Town's health sub-district. UCT's Human Research Ethics Committee approved the protocol (HREC REF# 713/2021). Researchers adjusted models for age, contraceptive use, risk perception, and relationship status, revealing mobile delivery's edge—convenience reduces dropout by 29%.

This mirrors broader UCT innovations, like PrEP-PP demonstrations showing high initiation but variable persistence in pregnant/postpartum women. Step-by-step: Women screened for HIV risk, counseled on daily dosing (one pill, with/without food), refilled monthly, monitored via tenofovir levels in subsets.

Such rigorous, university-driven trials equip clinical research jobs seekers with real-world data skills.

Photo by Yimeng Zhao on Unsplash

Stakeholder Perspectives: From Researchers to Service Providers

UCT affiliates like Elona Toska (also Oxford) advocate integrating PrEP with maternal-child health (MCH) services. "Differentiated delivery aligns with young mothers' realities," per study conclusions. Government clinics report staffing strains, while mobile units foster trust.

Young women in qualitative arms voiced needs for partner counseling and stigma reduction. Experts from Desmond Tutu Centre emphasize long-acting PrEP (injectables/cabotegravir) prioritization for this group, reducing daily adherence burdens.Read the full FastPrEP study.

In South Africa's context, where 370,000 youth acquired HIV globally in 2024 (145,000 AGYW), multi-stakeholder collaboration is key.

Implications for HIV Prevention Policy and Practice

The study urges life-stage interventions: youth clubs, SMS reminders, MCH bundling. Mobile clinics' success suggests scaling decentralized models, potentially halving early discontinuations. Nationally, over 1.2 million PrEP initiations by 2023 signal momentum, but PPYW lag.

Academics influence policy via evidence; UCT's work bolsters South Africa's 95-95-95 goals. Explore university jobs in South Africa for policy roles.

Case Studies and Real-World Examples

In Cape Town, a 20-year-old mother restarted PrEP via mobile outreach after clinic barriers. Eastern Cape cohort showed school-employed PPYW twice as likely aware (aOR 1.66). PrEP-PP trials reported 79% self-reported adherence in pregnancy, but objective measures lower.

Long-term: Modeling predicts 13% infant HIV reduction via maternal PrEP. UCT's POWER study (2017-2020) pioneered youth platforms, informing FastPrEP.

Future Outlook: Long-Acting PrEP and Research Directions

With cabotegravir approvals, UCT prioritizes PPYW rollout—two-monthly injections suit parenting demands. Ongoing trials test adherence apps, peer support. By 2030, integrated services could avert thousands infections.

• Expand mobile/Youth Zones.
• Partner engagement programs.
• Equity focus: rural/peri-urban scaling.

Higher ed drives this: Academic career advice prepares researchers.

Photo by Francisco Venâncio on Unsplash

Actionable Insights for Stakeholders and Young Women

For providers: Offer PrEP routinely in antenatal care, use refill tracking. Young women: Discuss with partners, choose mobile access. Researchers: Build on FastPrEP for longitudinal data.

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