scholarly journals Global and national guidance for the use of pre-exposure prophylaxis during peri-conception, pregnancy and breastfeeding

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 501 ◽  
Author(s):  
Natasha Davies ◽  
Renee Heffron
Keyword(s):  
Hiv Prevention ◽  
Clinical Guidelines ◽  
National Level ◽  
Safety Data ◽  
Implementation Strategies ◽  
Prevention Strategy ◽  
Sub Saharan Africa ◽  
Current Status ◽  
National Guidelines ◽  
Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) is a well-established biomedical HIV prevention strategy and recommended to reduce HIV risk during peri-conception, pregnancy and breastfeeding. Efforts are needed to translate global recommendations into national guidelines and implementation strategies. This article presents the current status of policy guidance for the use of PrEP during peri-conception, pregnancy and breastfeeding, with a particular focus on high prevalence countries, including those in sub-Saharan Africa. PrEP clinical guidelines released by ministries of health or other national-level health bodies, with a particular focus on recommendations for PrEP use during peri-conception, pregnancy and breastfeeding, were reviewed and summarised. Among countries with PrEP guidelines and/or policy, pregnancy is recognised as a period with increased HIV vulnerability, and some recommend PrEP use specifically during pregnancy. Only one country notes that PrEP is contraindicated during pregnancy, recognising a gap in complete safety data from women using PrEP throughout pregnancy. PrEP is not contraindicated as a peri-conception HIV prevention strategy in any country, but only three countries have specific guidance for peri-conception HIV prevention. Multiple barriers to the implementation of PrEP during pregnancy and breastfeeding are discussed, including barriers at the policy, health systems, social and personal levels. Although pregnancy is a period of heightened risk and fertility rates are high in many settings with high HIV burden, few PrEP policies have included guidance for PrEP use specific to peri-conception, pregnancy and breastfeeding periods. This gap can be overcome by the development or adoption of national clinical guidelines and implementation strategies from exemplary countries.

Male Circumcision as an HIV Prevention Strategy in Sub-Saharan Africa

JAMA ◽  
2008 ◽  
Vol 300 (21) ◽  
pp. 2539 ◽  
Author(s):  
Lawrence O. Gostin ◽  
Catherine A. Hankins
Keyword(s):  
Hiv Prevention ◽  
Male Circumcision ◽  
Prevention Strategy ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

2019 ◽  
Vol 24 (5) ◽  
pp. 1281-1289 ◽  
Author(s):  
Patrick O’Byrne ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
At Risk ◽  
Hiv Prevention ◽  
Qualitative Analysis ◽  
Thematic Analysis ◽  
Prevention Strategy ◽  
Perceptions Of Risk ◽  
Uptake Rates ◽  
Exposure Prophylaxis

AbstractWhile pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, its uptake is limited. To address barriers, we piloted a nurse-led PrEP clinic in an STI clinic and had public health nurses refer patients during STI follow-up. We recorded the number of PrEP offers and declines and clinic uptake. We conducted a thematic analysis of patients’ responses from nursing notes written at the time patients declined PrEP. From August 6, 2018 to August 5, 2019, nurses offered a PrEP referral to 261 patients who met our criteria; only 47.5% accepted. Qualitative analysis identified four themes: (1) perceptions of risk, (2) lack of interest, (3) inability to manage, and (4) concerns about PrEP. Our patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless “other”. This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.

scholarly journals Biomedical prevention: what is the current status?

2010 ◽  
Vol 4 (5) ◽  
pp. 679-682
Author(s):  
David D. Celentano ◽  
Wendy W. Davis ◽  
Chris C. Beyrer
Keyword(s):  
Male Circumcision ◽  
Hiv Transmission ◽  
Sub Saharan Africa ◽  
Current Status ◽  
Post Exposure Prophylaxis ◽  
Biomedical Hiv Prevention ◽  
Hiv Prevention Strategies ◽  
Biomedical Prevention ◽  
Sub Saharan ◽  
Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

scholarly journals Integrating Pre-Exposure Prophylaxis Delivery in Public Health Family Planning Clinics: Lessons Learned From a Programmatic Implementation Project in Kenya

2021 ◽  
Vol 3 ◽  
Author(s):  
Kenneth K. Mugwanya ◽  
John Kinuthia
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Implementation Strategies ◽  
Hiv Infections ◽  
Lessons Learned ◽  
African Women ◽  
Data Systems ◽  
Prep Implementation ◽  
Exposure Prophylaxis ◽  
Delivery Models

Sexually active African women are a priority population for HIV prevention due to the disproportionately high frequency of new HIV infections. Family planning (FP) clinics offer an already trusted platform that can be used to reach women for HIV prevention services, including pre-exposure prophylaxis (PrEP). In the recent PrEP Implementation in Young Women and Adolescent (PrIYA program), we piloted PrEP implementation in FP clinics in Kisumu, Kenya, and demonstrated that it was possible to integrate PrEP provision in FP systems with a program-dedicated staff. In this perspective, we describe experiences and strategies employed to introduce PrEP implementation in FP clinics and lessons learned. We identified the following lessons for PrEP introduction in FP clinics in Kenya: (1) possible to integrate and generate high enthusiasm for PrEP delivery in FP clinics but persistence on PrEP is a challenge, (2) involvement of national and regional stakeholders is critical for buy-in, contextualization, and sustainability, (3) delivery models that do not integrate fully with existing staff and systems are less sustainable, (4) creatinine testing at PrEP initiation may not be necessary, (5) fully integrated HIV and FP data systems need to be developed, and (6) incorporating implementation science evaluation is important to understand and document effective implementation strategies. In summary, integration of HIV prevention and FP services provides an opportunity to promote one-stop women-centered care efficiently. However, a broader focus on delivery models that utilize existing staff and novel strategies to help women identify their own risk for HIV are needed to ensure greater success and sustainability.

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