Missed HIV prevention opportunities: the PrEP cascade among pregnant or parenting adolescent girls and young women in South Africa

Introduction Pregnant or parenting adolescent girls and young women (PPYW) are at greater risk of sexual exposure to HIV than their peers, yet tailored HIV prevention efforts for PPYW remain limited. Methods We analysed cross-sectional data (2020–2023) from a sample of PPYW (median age 21.5, IQR = 20.3–22.5) in the Eastern Cape, South Africa. Results Approximately 88% of PPYW who were HIV-negative ( n = 646) had a HIV test in the last few years. Of these—58% knew about PrEP ( n = 328). Of those who knew about PrEP, 31% had ever been offered PrEP ( n = 100; 15% of HIV-negative PPYW), and 62% of those who were offered PrEP had ever taken PrEP ( n = 62; 10% of HIV-negative PPYW). Compared to PPYW who have not had a HIV test in the last few years, PPYW who had accessed HIV testing were more likely to be aware of PrEP (aOR = 2.39, 95% CI:1.44–3.97, p = 0.001), have been offered PrEP (aOR = 2.96, 95% CI:1.16–7.55, p = 0.023), and taken PrEP (aOR = 4.57, 95% CI:1.09–19.16, p = 0.038). Conclusions This study highlights missed opportunities in PrEP delivery and offers recommendations to enhance PrEP awareness and uptake among PPYW. Despite high HIV testing rates in this key population, awareness of PrEP, its offer, and uptake remain low.