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HIV Prevention Tools Across the Pregnancy Continuum: What Works, What Does Not, and What Can We Do Differently?

  • Behavioral-Bio-Medical Interface (RJ DiClemente and JL Brown, Section Editors)
  • Published:
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Abstract

Purpose of Review

Multiple tools exist to support the primary prevention of HIV in pregnant and postpartum women; however, there are opportunities to enhance their use and impact. This review summarizes the current status of HIV prevention tools and existing gaps and opportunities to improve their use along the pregnancy care continuum.

Recent Findings

HIV screening efforts have steadily improved with close to universal screening of pregnant women in several East and Southern African countries. Strategies to implement partner testing through the distribution of HIV self-test kits are promising though linkage to care remains challenging. Syphilis screening rates are increasing though detection of other sexually transmitted infections could benefit from improved diagnostic capacity. Male and female condoms are rarely used and are often not the optimal tool of choice during pregnancy. Oral pre-exposure prophylaxis (PrEP) is a promising tool, although barriers such as the need for daily adherence, side effects, and stigma may limit its use. There is a growing pipeline of PrEP agents with alternative delivery platforms that might suit women’s preferences better and supports the notion that choice is vital to improving HIV prevention coverage during the pregnancy-postpartum continuum.

Summary

Clear guidance on which tools to use and how to use them, safety data supporting their use, and surveillance data documenting the scale and effectiveness of the tools will be imperative in establishing a path to more impactful prevention efforts among pregnant and postpartum women.

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Authors and Affiliations

  1. Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA

    Melissa Latigo Mugambi, Jillian Pintye, Renee Heffron & Grace John-Stewart

  2. School of Nursing, University of Washington, Seattle, WA, USA

    Jillian Pintye

  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Renee Heffron & Grace John-Stewart

  4. University of Alabama Birmingham, Birmingham, AB, USA

    Renee Heffron

  5. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Ruanne Vanessa Barnabas

  6. Harvard Medical School, Boston, MA, USA

    Ruanne Vanessa Barnabas

  7. Department of Medicine, University of Washington, Seattle, WA, USA

    Grace John-Stewart

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  1. Melissa Latigo Mugambi
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  2. Jillian Pintye
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  4. Ruanne Vanessa Barnabas
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Contributions

MLM designed and conceptualized the study with input from all authors. MLM and JP wrote the first draft of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Melissa Latigo Mugambi.

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This is a review, and no human subjects were involved in the production of this research piece. No consent to participate or for publication applicable.

Competing Interests

MLM reports grants from the National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation. GJ-S reports grants from NIH, CDC, Thrasher Foundation, IMPAACT and stock options from the Malaika HIV vaccine outside the submitted work. GJ-S sits on the DSMB of the VITALITY and Tatelo trials. RVB reports grants from NIH and the Bill and Melinda Gates Foundation; and conference abstract and manuscript writing support from Regeneron Pharmaceuticals, outside the submitted work.

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Mugambi, M.L., Pintye, J., Heffron, R. et al. HIV Prevention Tools Across the Pregnancy Continuum: What Works, What Does Not, and What Can We Do Differently?. Curr HIV/AIDS Rep 19, 293–300 (2022). https://doi.org/10.1007/s11904-022-00621-1

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