Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa
Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa
复制标题
DOI：
10.1097/qad.0000000000002221
复制
发表时间：
2019-07-01
期刊：
影响因子：
3.8
通讯作者：
Johnson, Leigh F.
中科院分区：
文献类型：
--
作者：
Davey, Dvora L. Joseph;Bekker, Linda-Gail;Johnson, Leigh F.
目的：未感染艾滋病毒的孕妇和哺乳期妇女感染艾滋病毒的风险很高，有助于艾滋病毒的垂直传播。暴露前预防（PrEP）在怀孕期间是安全的，但在包括南非在内的许多国家，怀孕期间的PrEP不是政策。我们评估了使用南非艾滋病毒模型为孕妇/哺乳期妇女提供PrEP的潜在影响。方法：我们的模型考虑了两种情况：一种保守的情况，与肯尼亚孕妇PrEP计划中报告的经验相匹配（高风险和低风险女性的摄取概率分别为32%和11%）; 80%的孕妇开始使用PrEP的乐观情景。我们将其与女性性工作者，MSM和青春期女孩/年轻女性的PrEP进行了比较。假设妇女在整个怀孕和母乳喂养期间保持PrEP，并在其他情况下假设相等的平均PrEP持续时间（2年）。结果：在2020年至2030年期间，如果向怀孕/母乳喂养的母亲提供PrEP，我们预计艾滋病毒总传播减少2.5%[95%可信区间（CI）：2.4-2.6%]和7.2%（95%CI：6.8-7.5%）在乐观的情况下，这是相似的，在女性性工作者和MSM的PrEP方案（分别为1.9%和3.0%）。没有PrEP，76 000（95% CI：64，000-90，000）预计将出现新的垂直传播病例;提供PrEP可能会将这些感染减少13%（95% CI：13-14%），在保守情况下为41%（95% CI：39-44%）。结论：孕妇对PrEP的高水平吸收和坚持在南非，母乳喂养的妇女可以大大减少母婴感染艾滋病毒的情况。版权所有（C）2019威科医疗集团All rights reserved.
Objective: HIV-uninfected pregnant and breastfeeding women are at high risk of HIV acquisition, contributing to vertical transmission of HIV. Preexposure prophylaxis (PrEP) is safe in pregnancy, but PrEP in pregnancy is not policy in many countries including South Africa. We evaluated the potential impact of providing PrEP for pregnant/breastfeeding women using a HIV model for South Africa.Methods: Our model considers two scenarios: a conservative scenario that matches the experience reported in the Kenyan PrEP programme for pregnant women (probability of uptake = 32% and 11% in high-risk and low-risk women, respectively); and an optimistic scenario with PrEP initiated by 80% of all pregnant women. We compared this with PrEP for female sex workers, MSM and adolescent girls/young women. Women are assumed to remain on PrEP throughout pregnancy and breastfeeding, and an equivalent average PrEP duration (2 years) is assumed in other scenarios.Results: Between 2020 and 2030, if PrEP is provided to pregnant/breastfeeding mothers, we project a 2.5% reduction in total HIV transmission [95% credibility interval (CI): 2.4-2.6%] in the conservative scenario and 7.2% (95% CI: 6.8-7.5%) in the optimistic scenario, which is similar to that in the female sex worker and MSM PrEP scenarios (1.9% and 3.0%, respectively). Without PrEP, 76 000 (95% CI: 64 000-90 000) new cases of vertical transmission are expected; PrEP provision may reduce these infections by 13% (95% CI: 13-14%) in the conservative scenario and 41% (95% CI: 39-44%) in the optimistic scenario.Conclusion: High levels of uptake of and adherence to PrEP among pregnant/breastfeeding women could substantially reduce maternal and infant HIV acquisition in South Africa. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.