This presentation will discuss HIV incidence during pregnancy and breastfeeding as well as factors (hormonal, immunological, behavioural, sexual and genital infections, and low male participation in antenatal care and HIV testing) that increase risk of HIV acquisition this period. In addition, we will look at the contribution of acute HIV infection to vertical HIV infection and underlying factors driving the increased risk of transmission.
I will highlight existing HIV prevention interventions with focus on behavioural and biomedical interventions. Behavioural interventions discussed will include enhanced HIV counseling, use of lay community based workers to provide HIV prevention counselling and male partner referral for circumcision, sexually transmitted infections or HIV treatment implemented in several sub-Saharan African countries.
The role of oral antiretroviral pre-exposure prophylaxis (PrEP) during pregnancy and breastfeeding, maternal and infant outcomes following PrEP use, importance of integrating PrEP delivery within maternal and child health clinics and whether a risk based approach is better compared to universal PrEP delivery model will be discussed. Barriers to oral PrEP uptake and continuation and perspectives of health providers on determinants that impact ability to deliver PrEP will be described. Strategies to promote PrEP use among pregnant and breastfeeding women including differentiated service delivery models will be discussed.
The talk will also cover use of use of currently available long‐acting formulations that is carbotegravir, six-month injectable lenacapavir and dapivirine ring during pregnancy and breast feeding including efficacy, maternal and infant outcomes as well as effect of added choice of biomedical interventions on HIV prevention coverage. Potential challenges during implementation at scale and the role of all stakeholders including governments, donors, civil society, or manufacturers among others to ensure seamless and impactful rollout will be highlighted. There will be focus on requirements for provision of lenacapavir regarded as 2024 Breakthrough of the year by the Science Magazine. Lenacapavir represents a transformative opportunity to dramatically reduce the number of new HIV infections.
Finally, we will deliberate on how to protect women through and NOT from research in order to reduce evidence gaps regarding safety and efficacy of new antiretroviral formulations during pregnancy and breastfeeding.