Motivations of Pregnant Women Initiating HIV Preexposure Prophylaxis Within Routine Antenatal Clinics Enrolled in a Randomized Trial in Western Kenya.

Vertical HIV transmission remains a public health challenge in high-burden areas. This cross-sectional study analyzed baseline data from 600 pregnant women without HIV in western Kenya who initiated preexposure prophylaxis (PrEP) between January 2022 and July 2023. We examined associations between participant characteristics, self-perceived HIV risk, and PrEP initiation motivations. Overall, 36.3% reported high HIV risk perception. High self-perceived risk was associated with having multiple sexual partners, high empiric risk scores, intimate partner violence (IPV), and anxiety. Unplanned pregnancies and IPV correlated with specific PrEP motivations. Findings highlight the need for tailored counseling, IPV screening, and integrated maternal and child health services to improve PrEP uptake and reduce vertical transmission.