Improving the Delivery of Pre-exposure Prophylaxis (PrEP) to Eliminate Vertical HIV Transmission

Over half of HIV infections globally occur among cisgender women. High HIV incidence among young (ie, 15–30 years old) African cisgender women persists during pregnancy and postpartum, and there is evidence that HIV acquisition risk more than doubles during this period. A new HIV infection has important short- and long-term consequences for the mother’s health. Acute maternal HIV infection is also associated with increased vertical transmission risk, making prevention of HIV among pregnant and breastfeeding populations a global health priority. As access to antiretroviral therapy continues to expand, new—and often undiagnosed—maternal HIV infections during pregnancy and breastfeeding contribute to a growing proportion of new pediatric HIV cases, and urgent focus of interventions to eliminate vertical HIV transmission. To address this important gap, The World Health Organization (WHO) and several national HIV programs recommend offering pre-exposure prophylaxis (PrEP) to pregnant and breastfeeding populations at substantial risk for HIV. To fully realize the promise of PrEP in antenatal and postnatal settings, however, “real world” clinical and implementation data are urgently needed. Further, there is a need for research on novel, long-acting tools that prevent HIV acquisition in all populations, including pregnant and breastfeeding populations.

Despite their high risk for HIV acquisition, the delivery of PrEP services to pregnant and breastfeeding women has lagged compared to other populations. Through this collection, we seek to address this gap. We will share the success and challenges of delivery models, including integrated delivery within antenatal/postnatal platforms. We will highlight patient preferences and needs, and the approaches that may best address them. We will also include studies about clinical outcomes associated with different delivery models, including for daily oral, injectable, and vaginal ring PrEP formulations. Ultimately, our goal is to bring attention to the important role of PrEP in HIV prevention during pregnancy and breastfeeding, and to advance our knowledge by disseminating relevant clinical and implementation research.

This Research Topic includes the following themes for contributors to address:
• Implementation strategies used to deliver PrEP into antenatal or postnatal services
• Innovative community or differentiated models of PrEP promotion/delivery in pregnant and breastfeeding women
• Formative research to inform the roll out of PrEP in national or regional programs
• Facilitators and barriers to PrEP delivery within antenatal and postnatal care
• Cost or cost-effectiveness models
• Mathematical modelling of the impact of PrEP
• Formative studies or clinical trials about delivering new PrEP modalities in pregnant and breastfeeding women, including injectable and vaginal ring formulations

Topic Editor Dvora Joseph Davey has received a grant from Gilead Corporation and free study drugs from Gilead and Cephied corporations. Irene Njuguna has received funds from Gilead Sciences for particpation in grant reviews. All other Topic Editors declare no competing interests with regards to the Research Topic subject.