Fishbone analysis identified reasons for low PrEP initiation as lack of: healthcare worker training, screening, and facility-based PrEP sensitization. Training of healthcare providers offering PrEP and facility based PrEP sensitizations were conducted.  At baseline, only 20/109 (18%) high-risk pregnant women and 12/78 (15%) high-risk breastfeeding women were initiated on PrEP. Among high-risk pregnant women, PrEP initiation rate increased to 125/220 (57%) at midline (p&amp;lt;0.0001) and to 264/265 (100%) at endline (p&amp;lt;0.001). Among high-risk breastfeeding women, PrEP initiation rate increased to 120/182 (67%) at midline (p&amp;lt;0.0001) and to 202/203 (100%) at endline (p&amp;lt;0.0001).