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Cited by 13HIV/AIDS Research and InterventionsMaternal Mental Health During Pregnancy and PostpartumHIV, Drug Use, Sexual Risk

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

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Stanton, Amelia M., O'Cleirigh, Conall, Knight, Lucia, Davey, Dvora L. Joseph, Myer, Landon, Joska, John A., Mayer, Kenneth H., Bekker, Linda‐Gail +1 more·2022·Journal of the International AIDS Society
DOI 10.1002/jia2.26026PMC PMC9575939
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Abstract

Introduction: Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion: PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions: For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.

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  • The Practical Approach to Care Kit (PACK) was developed to support clinical decision making and standardize care, including mental health care, in low- and middle-income primary care settings.

    “Recently, the Practical Approach to Care Kit (PACK), a tool kit from the University of Cape Town, was developed to support clinical decision making and standardize care, including mental health care, in low- and middle-income primary care settings [56].”

    From Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis (2026) · cites this paper as [56]

    The Discussion section on research priorities addresses mental health screening and counselling in sub-Saharan Africa, but does not describe the Practical Approach to Care Kit (PACK). Searches for PACK and for clinical decision-making and standardized primary care found no passage in our copy addressing the tool or its development. (LLM, conf=0.75)

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Authors
Stanton, A. M., O'Cleirigh, C., Knight, L., Davey, D. L. J., Myer, L., Joska, J. A., Mayer, K. H., Bekker, L., & Psaros, C.
Affiliations
  • Boston University (US)
  • Massachusetts General Hospital Boston Massachusetts USA
  • University of Cape Town (ZA)
  • School of Public Health University of Cape Town Cape Town South Africa
  • Beth Israel Deaconess Medical Center (US)
  • Harvard University (US)
Corresponding author
Stanton, Amelia M.
ORCID
Venue
Journal of the International AIDS Society
Publisher
Wiley
Published
2022-10
Volume
25
Issue
10
Pages
e26026-e26026
ISSN
1758-2652 (ISSN-L)
DOI
10.1002/jia2.26026
PMC
PMC9575939
OpenAlex
W4306667993
Cited by
13
References
8
Citations by year
2026: 5 · 2025: 3 · 2024: 1 · 2023: 4
FWCI
0.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the International AIDS Society (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • OpenBU (Boston University) (publishedVersion, cc-by)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
National Institute of Mental Health (K23MH131438)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
pre-exposure prophylaxis, PrEP adherence, PrEP persistence, depression, intimate partner violence, traumatic stress, pregnant women, postpartum women, HIV prevention, mental health screening, prenatal care, postpartum care, PrEP implementation, sub-Saharan Africa
MeSH terms
Adolescent, Female, Humans, Mental Health, Pregnancy, Research, HIV Infections, Africa South of the Sahara, Anti-HIV Agents, Postpartum Period, Pre-Exposure Prophylaxis

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