In 2020, the Uganda Ministry of Health (MoH) rolled out HIV oral pre-exposure prophylaxis (PrEP) among pregnant and breastfeeding women at substantial risk of HIV acquisition (‘high-risk’) as part of a comprehensive prevention strategy. However, review of PrEP registers at Katakwi General Hospital from January 2020 to April 2022 indicated that few high-risk women were initiated on PrEP. We conducted a continuous quality improvement (CQI) project to increase PrEP initiation among high-risk pregnant and breastfeeding women at Katakwi General Hospital.