Defining gaps in pre-exposure prophylaxis delivery for pregnant and post-partum women in high-burden settings using an implementation science framework

Jillian Pintye; Dvora L Joseph Davey; Anjuli D Wagner; Grace John-Stewart; Rachel Baggaley; Linda-Gail Bekker; Connie Celum; Benjamin H Chi; Thomas J Coates; Allison K Groves; Jessica E Haberer; Renee Heffron; John Kinuthia; Lynn T Matthews; James A McIntyre; Dhayendre Moodley; Lynne M Mofenson; Nelly Mugo; Andrew Mujugira; Landon Myer; Steven Shoptaw; Lynda Stranix-Chibanda; Jared M Baeten; PrEP in Pregnancy Working Group

doi:10.1016/S2352-3018(20)30102-8

Defining gaps in pre-exposure prophylaxis delivery for pregnant and post-partum women in high-burden settings using an implementation science framework

Lancet HIV. 2020 Aug;7(8):e582-e592. doi: 10.1016/S2352-3018(20)30102-8.

Authors

Jillian Pintye¹, Dvora L Joseph Davey², Anjuli D Wagner³, Grace John-Stewart⁴, Rachel Baggaley⁵, Linda-Gail Bekker⁶, Connie Celum⁷, Benjamin H Chi⁸, Thomas J Coates⁹, Allison K Groves¹⁰, Jessica E Haberer¹¹, Renee Heffron¹², John Kinuthia¹³, Lynn T Matthews¹⁴, James A McIntyre¹⁵, Dhayendre Moodley¹⁶, Lynne M Mofenson¹⁷, Nelly Mugo¹⁸, Andrew Mujugira¹⁹, Landon Myer²⁰, Steven Shoptaw⁹, Lynda Stranix-Chibanda²¹, Jared M Baeten⁷; PrEP in Pregnancy Working Group

Affiliations

¹ Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA. Electronic address: [email protected].
² Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³ Department of Global Health, University of Washington, Seattle, WA, USA.
⁴ Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.
⁵ World Health Organization, Geneva, Switzerland.
⁶ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
⁷ Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
⁸ Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
⁹ Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
¹⁰ Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA.
¹¹ Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
¹² Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
¹³ Department of Global Health, University of Washington, Seattle, WA, USA; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
¹⁴ Department of Medicine, University of Alabama, Birmingham, AL, USA.
¹⁵ Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Anova Health Institute, Johannesburg, South Africa.
¹⁶ CAPRISA, University of KwaZulu Natal, Durban, South Africa.
¹⁷ Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
¹⁸ Department of Global Health, University of Washington, Seattle, WA, USA; Kenya Medical Research Institute (KEMRI), Center for Clinical Research, Nairobi, Kenya.
¹⁹ Department of Global Health, University of Washington, Seattle, WA, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
²⁰ Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
²¹ College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.

Abstract

Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Anti-HIV Agents / administration & dosage*
Anti-HIV Agents / therapeutic use
Female
HIV Infections / prevention & control*
Health Plan Implementation
Humans
Infectious Disease Transmission, Vertical / prevention & control
Postnatal Care
Pre-Exposure Prophylaxis*
Pregnancy

Substances

Anti-HIV Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding