Abstract
Objective We seek to evaluate risk factors for eligibility for preexposure prophylaxis (PrEP)
among pregnant people with opioid use disorder (OUD).
Study Design This is a single-site retrospective cohort study of pregnant people admitted for
management of OUD at an urban, tertiary care center from 2013 to 2022. PrEP eligibility
was defined based on (1) modified American College of Obstetricians and Gynecologists'
(ACOG) 2014 criteria: diagnosis of a sexually transmitted infection (STI), engagement
in transactional sex work, intravenous drug use (IVDU), or incarceration and (2) modified
2021 Centers for Disease Control (CDC) criteria: diagnosis of bacterial STI (e.g.,
gonorrhea or syphilis) or transactional sex work. Risk factors associated with PrEP
eligibility were evaluated using chi- square or Fischer's exact tests for categorical
variables and t -tests or Wilcoxon rank-sum tests for continuous variables. Multivariable regression
was used to control for confounding covariates, defined as p < 0.10 on bivariate analysis. p < 0.05 was used to indicate statistical significance.
Results A total of 132 individuals met inclusion criteria, of whom 101 (76.5%) were deemed
eligible for PrEP by meeting one or more modified 2014 ACOG criteria: 42 (31.8%) were
incarcerated or had one or more STIs, while 30 (22.7%) endorsed engaging in transactional
sex work and 68 (58.6%) endorsed IVDU. Using modified 2021 CDC criteria, 37 (28%)
met PrEP eligibility, with 12 (9.1%) diagnosed specifically with a bacterial STI and
30 (22.7%) engaging in transactional sex work. Only comorbid psychiatric illness was
associated with an increased risk for PrEP eligibility based on 2014 criteria, which
persisted after controlling for maternal race/ethnicity (aRR 1.52, 95% confidence
interval [CI] 1.24–1.86), and 2021 criteria, which persisted after controlling for
nulliparity (aRR 2.12, 95% CI 1.30–3.57).
Conclusion A significant number of pregnant people with OUD meet one or more criteria for PrEP,
with comorbid psychiatric conditions increasing the risk of meeting criteria.
Key Points
Comorbid psychiatric illness is significantly associated with high risk of PrEP eligibility.
A large proportion of pregnant individuals with active OUD meet criteria for PrEP
prescribing.
Risk-based screening algorithms for PrEP eligibility have limitations.
Keywords PrEP - pregnancy - OUD - HIV
