Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa

Davey, Dvora Joseph; Bekker, Linda‐Gail; Gomba, Yolanda; Coates, Thomas J.; Myer, Landon; Johnson, Leigh F.

doi:10.1097/qad.0000000000002221

Cited by 33 publications

(24 citation statements)

References 28 publications

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“…South Africa has also recently approved PrEP for pregnant women [ 15 ]. The provision of PrEP for high–risk women at ANC clinics could substantially reduce new HIV acquisition during pregnancy and postpartum as well as vertical transmission of HIV [ 51 ]. This study has identified risk factors that should be considered in prioritizing women for PrEP.…”

Section: Discussionmentioning

confidence: 99%

Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross–sectional survey, South Africa: Assay–based incidence measurement

et al. 2021

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Introduction New HIV infection during pre-conception and pregnancy is a significant contributor of mother–to–child transmission of HIV in South Africa. This study estimated HIV incidence (defined as new infection within the last one year from the time of the survey which included both new infections occurred during pregnancy or just before pregnancy) among pregnant women and described the characteristics of recently infected pregnant women at national level. Methods Between 1 October and 15 November 2017, we conducted a national cross–sectional survey among pregnant women aged 15–49 years old attending antenatal care at 1,595 public facilities. Blood specimens were collected from pregnant women and tested for HIV in a centralised laboratory. Plasma viral load and Limiting Antigen Avidity Enzyme Immunosorbent Assay (LAg) tests were further performed on HIV positive specimens to differentiate between recent and long–term infections. Recent infection was defined as infection that occurred within one year from the date of collection of blood specimen for the survey. Data on age, age of partner, and marital status were collected through interviews. Women whose specimens were classified as recent by LAg assay and with viral loads >1,000 copies/mL were considered as recently infected. The calculated proportion of HIV positive women with recent infection was adjusted for assay–specific parameters to estimate annual incidence. Survey multinomial logistic regression was used to examine factors associated with being recently infected using HIV negative women as a reference group. Age–disparate relationship was defined as having a partner 5 or more years older. Results Of 10,049 HIV positive participants with LAg and viral load data, 1.4% (136) were identified as recently infected. The annual HIV incidence was 1.5% (95% confidence interval (CI): 1.2–1.7). In multivariable analyses, being single (adjusted odds ratio, aOR: 3.4, 95% CI: 1.8–6.2) or cohabiting (aOR: 3.8, 95% CI: 1.8–7.7), compared to being married as well as being in an age–disparate relationship among young women (aOR: 3.1, 95% CI: 2.0–4.7; reference group: young women (15–24years) whose partners were not 5 years or more older) were associated with higher odds of recent infection. Conclusions Compared to previous studies among pregnant women, the incidence estimated in this study was substantially lower. However, the UNAIDS target to reduce incidence by 75% by 2020 (which is equivalent to reducing incidence to <1%) has not been met. The implementation of HIV prevention and treatment interventions should be intensified, targeting young women engaged in age–disparate relationship and unmarried women to fast track progress towards the UNAIDS target.

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Section: Discussionmentioning

confidence: 99%

Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross–sectional survey, South Africa: Assay–based incidence measurement

et al. 2021

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“…Pre-exposure prophylaxis in pregnant and breastfeeding mothers can reduce vertical transmission by 40%. 13 Pre-exposure prophylaxis is safe in breastfeeding – with minimal infant-drug exposure. 14 The use of PrEP as part of a comprehensive package of interventions in countries with a high HIV prevalence is endorsed by the WHO in both antenatal and postnatal care.…”

Section: Changes In the Hiv Epidemic Over The Past Decade: Estimates mentioning

confidence: 99%

World AIDS Day 2020: Reflections on global and South African progress and continuing challenges

Pillay

2021

Southern African Journal of HIV Medicine

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Background: Reflecting on progress and challenges in meeting global human immunodeficiency virus (HIV) targets is often done ahead of World AIDS Day. This article reflects on progress and the continuing challenges in meeting targets in South Africa (SA).Objective: To review policy and implementation related progress and continuing challenges towards eliminating HIV as a public health threat by 2030.Method: Policy analysis and review of modeling data from Thembisa 4.3.Results: South Africa has made significant progress in the adoption of policies with two exceptions. While there are gaps in reaching the 90-90-90 implementation targets, progress has been made in the past decade.Conclusion: While progress has been made in the past decade towards the global targets, much work remains to ensure that HIV transmission is curtailed and those that require treatment are initiated on treatment and are virally suppressed.

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“…Acceptability and feasibility have been reported in qualitative studies from the region [36‐39]. Modelling studies also suggest that integration of PrEP into antenatal services could significantly reduce the number of new HIV infections [40,41]. The identification of pregnant and breastfeeding women at highest risk of HIV acquisition could make this potential yield even greater.…”

Section: Resultsmentioning

confidence: 99%

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

et al. 2020

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Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

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Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa

Cited by 33 publications

References 28 publications

Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross–sectional survey, South Africa: Assay–based incidence measurement

Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross–sectional survey, South Africa: Assay–based incidence measurement

World AIDS Day 2020: Reflections on global and South African progress and continuing challenges

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

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