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We aimed to explore PBW\u2019s preferences of various long-acting PrEP modalities. In-depth interviews were conducted with PBW at three sites: Cape Town, East London (South Africa), and Gaborone (Botswana). We conducted thematic analysis, guided by the Health Belief Model, to examine participants\u2019 HIV risk perception during pregnancy and breastfeeding, their perceived individual-level facilitators and barriers of each PrEP modality, and the support needed by participants for PrEP uptake and continuation. 40 participants were interviewed, aged 18\u201339 years (mean 27 years), including 13 adolescent girls and young women (AGYW; 18\u201324 years). Participants were either pregnant (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200920) or breastfeeding (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200920). Perceived HIV risk during pregnancy motivated PrEP use. Long-acting methods were preferred over daily pills for convenience and perceived reliability, with injectables most favoured due to familiarity with contraceptive injections. However, concerns about pain and side effects persisted. Monthly oral PrEP was seen as easier than daily pills but raised similar concerns about adherence. Implants were met with fear and mistrust, often rooted in negative contraceptive experiences, though some valued their long-term protection. The vaginal ring was least acceptable due to unfamiliarity and discomfort with insertion. Participants emphasised the importance of external support (e.g. reminders), privacy and discretion, and community transparency to support PrEP adherence and reduce stigma. Addressing barriers \u2013 especially concerns about the safety and effectiveness of new modalities and challenges around adherence \u2013 could help improve strategies to better assist PBW in utilising long-acting PrEP modalities.\n                  <\/jats:p>","DOI":"10.1007\/s10461-025-04856-y","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T03:11:57Z","timestamp":1756437117000},"page":"162-177","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Empowering Women\u2019s PrEP Choices: Qualitative Insights into Long-Acting PrEP Preferences and Decision-Making during Pregnancy and Breastfeeding in South Africa and Botswana"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5040-0905","authenticated-orcid":false,"given":"Jenny","family":"Chen-Charles","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey","family":"De Vos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prisca","family":"Vundhla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avuyonke","family":"Gebengu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elzette","family":"Rousseau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda-Gail","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remco","family":"Peters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aamirah","family":"Mussa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Morroni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elona","family":"Toska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chibuzor M.","family":"Babalola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey D.","family":"Klausner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dvora Joseph","family":"Davey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"4856_CR1","unstructured":"UNAIDS, Global. 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Klausner was incorrectly written as Jeffery Klausner\u201d.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":7,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":8,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":9,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s10461-025-04925-2","URL":"https:\/\/doi.org\/10.1007\/s10461-025-04925-2","order":10,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No competing interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics approval for the study in the South African sites (Cape Town and East London) was obtained from the University of Cape Town (HREC: 619\/2022; 027\/2024), and approval for the Botswana site was granted by the Botswana Health Research Development Committee (Ref: HRDC #0098). 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