Guidelines to support HIV-affected individuals and couples to achieve pregnancy safely: Update 2018

Davies, Nick; Ashford, Gail; Bekker, Linda Gail; Chandiwana, Nomathemba; Cooper, Diane; Dyer, Silke; Jankelowitz, Lauren; Mhlongo, Otty; Mnyani, Coceka Nandipha; Mulaudzi, Muhangwi B.; Moorhouse, Michelle; Myer, Landon; Patel, Malika; Pleaner, Melanie; Ramos, Tatiana Cabral da Silva; Rees, Helen; Schwartz, Sheree; Smit, Jenni; Zyl, Doreen S van

doi:10.4102/sajhivmed.v19i1.915

Cited by 28 publications

(21 citation statements)

References 85 publications

(127 reference statements)

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“…In 2016, SA adopted the universal test and treat (UTT) strategy, which makes provision for ART initiation immediately after an HIV-positive test [6]. UTT will enable more HIV-positive women to access ART services prior to pregnancy and conceive with an undetectable viral load, which is critical for PMTCT as well as maternal health [7,8]. Initiating treatment as early as possible before pregnancy or early in pregnancy enables to achieve undetectable viral load at delivery and reduces the risk of in-utero and intrapartum transmission [9].…”

Section: Introductionmentioning

confidence: 99%

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

et al. 2020

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Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIVpositive status prior to the current pregnancy among women attending antenatal care. Methods Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy. Results Of 10,065 eligible HIV-positive women, 60.8% (95% confidence interval (CI):59.9%-61.7%) knew their HIV status prior to the current pregnancy, of whom 91.1% (95% CI: 90.4%-91.7%) initiated ART prior to the current pregnancy. Knowledge of HIV-positive status was lower

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Section: Introductionmentioning

confidence: 99%

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

et al. 2020

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“…Until recently the South African Department of Health did not recommended PrEP for pregnant women , despite modelling studies demonstrating the important potential influence on eliminating maternal‐to‐child transmission of HIV (eMTCT) , stating that it was medically “contraindicated” in programmatic delivery. However, PrEP use among pregnant and breastfeeding women has been permitted in the context of clinical trials .…”

Section: Introductionmentioning

confidence: 99%

Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?

et al. 2020

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Introduction HIV incidence is high during pregnancy and breastfeeding with HIV acquisition risk more than doubling during pregnancy and the postpartum period compared to when women are not pregnant. The World Health Organization recommends offering pre‐exposure prophylaxis (PrEP) to pregnant and postpartum women at substantial risk of HIV infection. However, maternal PrEP national guidelines differ and most countries with high maternal HIV incidence are not offering PrEP. We conducted a systematic review of recent research on PrEP safety in pregnancy to inform national policy and rollout. Methods We used a standard Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) approach to conduct a systematic review by searching for completed, ongoing, or planned PrEP in pregnancy projects or studies from http://www.clinicaltrials.gov, PubMed and NIH RePORTER from 2014 to March 2019. We performed a systematic review of studies that assess tenofovir disoproxil fumarate (TDF)‐based oral PrEP safety in pregnant and breastfeeding HIV‐uninfected women. Results and discussion We identified 14 completed (n = 5) and ongoing/planned (n = 9) studies that evaluate maternal and/or infant outcomes following PrEP exposure during pregnancy or breastfeeding. None of the completed studies found differences in pregnancy or perinatal outcomes associated with PrEP exposure. Nine ongoing studies, to be completed by 2022, will provide data on >6200 additional PrEP‐exposed pregnancies and assess perinatal, infant growth and bone health outcomes, expanding by sixfold the data on PrEP safety in pregnancy. Research gaps include limited data on (1) accurately measured PrEP exposure within maternal and infant populations including drug levels needed for maternal protection; (2) uncommon perinatal outcomes (e.g. congenital anomalies); (3) infant outcomes such as bone growth beyond one year following PrEP exposure; (4) outcomes in HIV‐uninfected women who use PrEP during pregnancy and/or lactation. Conclusions Expanding delivery of PrEP is an essential strategy to reduce HIV incidence in pregnancy and breastfeeding women. Early safety studies of PrEP among pregnant women without HIV infection are reassuring and ongoing/planned studies will contribute extensive new data to bolster the safety profile of PrEP use in pregnancy. However, addressing research gaps is essential to expanding PrEP delivery for women in the context of pregnancy.

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“…There are supportive guidelines in South Africa recommending that safer conception counselling be part of routine HIV care (23,24), which intend to provide PLHIV with options for achieving their fertility desires. South African policies promote the SRH rights of PLHIV and promote provider-initiated discussions on reproductive goals for PLHIV (25,26).…”

Section: Introductionmentioning

confidence: 99%

Fertility desires of people living with HIV: Does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

Milford¹,

Beksinska

Greener³

et al. 2020

Preprint

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Background There is a need for information and healthcare support for fertility desires and contraceptive needs of people living with HIV (PLHIV), and to provide safer conception support for sero-discordant couples wanting to conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and ART access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.

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Guidelines to support HIV-affected individuals and couples to achieve pregnancy safely: Update 2018

Cited by 28 publications

References 85 publications

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?

Fertility desires of people living with HIV: Does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

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