Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW

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

Natasha Davies A * and Renee Heffron https://orcid.org/0000-0001-6039-0352 B C *
+ Author Affiliations
- Author Affiliations

A Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Johannesburg, South Africa.

B Departments of Global Health and Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104, USA.

C Corresponding author. Email: rheffron@uw.edu

Sexual Health 15(6) 501-512 https://doi.org/10.1071/SH18067
Submitted: 2 April 2018  Accepted: 15 September 2018   Published: 19 November 2018

Abstract

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.

Additional keywords: guidelines, HIV, PrEP, safer conception.


References

[1]  Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, et al Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367 399–410.
Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.Crossref | GoogleScholarGoogle Scholar |

[2]  Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |

[3]  Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, Mutanhaurwa R, Chirwa LI, Kasonde M, Abebe D, Buliva E, Gvetadze RJ, Johnson S, Sukalac T, Thomas VT, Hart C, et al Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012; 367 423–34.
Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana.Crossref | GoogleScholarGoogle Scholar |

[4]  World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, Switzerland: WHO; 2015.

[5]  Price JT, Wheeler SB, Stranix-Chibanda L, Hosek SG, Watts DH, Siberry GK, Spiegel HML, Stringer JS, Chi BH. Cost-effectiveness of pre-exposure HIV prophylaxis during pregnancy and breastfeeding in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2016; 72 S145–53.
Cost-effectiveness of pre-exposure HIV prophylaxis during pregnancy and breastfeeding in Sub-Saharan Africa.Crossref | GoogleScholarGoogle Scholar |

[6]  World Health Organization. Preventing HIV during pregnancy and breastfeeding in the context of PREP. Geneva, Switzerland: WHO; 2017.

[7]  Global Burden of Disease Collaborators 2015. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV 2016; 3 e361–87.
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015.Crossref | GoogleScholarGoogle Scholar |

[8]  Population HIV Impact Assesment (PHIA) Project. Swaziland HIV incidence measurement survey 2: a population-based HIV impact assessment (SHIMS2). New York, USA: ICAP Columbia University; 2017. Available online at: https://phia.icap.columbia.edu/wp-content/uploads/2017/11/Swaziland_new.v8.pdf [verified 28 March 2018].

[9]  Population HIV Impact Assessment (PHIA) Project. Lesotho population-based HIV impact assessment LePHIA 2016–2017. New York, USA: ICAP Columbia University; 2017. Available online at: https://phia.icap.columbia.edu/wp-content/uploads/2018/02/Lesotho-Summary-Sheet_A4.2.7.18.HR_.pdf [verified 28 March 2018].

[10]  Population HIV Impact Assessment (PHIA) Project. Zambia population-based HIV impact assessment ZAMPHIA 2015–2016. New York, USA: ICAP Columbia University; 2017. Available online at: https://phia.icap.columbia.edu/wp-content/uploads/2016/09/ZAMBIA-Factsheet.FIN_.pdf [verified 28 March 2018].

[11]  Mugo NR, Heffron R, Donnell D, Wald A, Were EO, Rees H, Celum C, Kiarie JN, Cohen CR, Kayintekore K, Baeten JM. Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS 2011; 25 1887–95.
Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples.Crossref | GoogleScholarGoogle Scholar |

[12]  Thomson KA, Hughes J, Baeten JM, John-Stewart G, Celum C, Cohen CR, Ngure K, Kiarie J, Mugo N, Heffron R. Increased risk of HIV acquisition among women throughout pregnancy and during the postpartum period: a prospective per-coital-act analysis among women with HIV-infected partners. J Infect Dis 2018; 218 16–25.

[13]  Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med 2014; 11 e1001608
Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |

[14]  Matthews LT, Beyeza-Kashesya J, Cooke I, Davies N, Heffron R, Kaida A, Kinuthia J, Mmeje O, Semprini AE, Weber S. Consensus statement: supporting safer conception and pregnancy for men and women living with and affected by HIV. AIDS Behav 2018; 22 1713–24.

[15]  Ngure K, Kimemia G, Dew K, Njuguna N, Mugo N, Celum C, Baeten JM, Heffron R. Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. J Int AIDS Soc 2017; 20 21309
Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples.Crossref | GoogleScholarGoogle Scholar |

[16]  Asemota OA, Klatsky P. Access to infertility care in the developing world: the family promotion gap. Semin Reprod Med 2015; 33 17–22.
Access to infertility care in the developing world: the family promotion gap.Crossref | GoogleScholarGoogle Scholar |

[17]  Heffron R, Pintye J, Matthews LT, Weber S, Mugo N. PrEP as peri-conception HIV prevention for women and men. Curr HIV/AIDS Rep 2016; 13 131–9.
PrEP as peri-conception HIV prevention for women and men.Crossref | GoogleScholarGoogle Scholar |

[18]  Pintye J, Drake AL, Kinuthia J, Unger JA, Matemo D, Heffron RA, Barnabas RV, Kohler P, McClelland RS, John-Stewart G. A risk assessment tool for identifying pregnant and postpartum women who may benefit from preexposure prophylaxis. Clin Infect Dis 2017; 64 751–8.

[19]  Brady M, Mullick S, Friedland B, Plagianos M, Du Plessis LTM. Learning from women about HIV risk, HIV testing behaviors, and prevention practices in Mpumalanga, South Africa: a descriptive study to inform microbicides introduction. New York, USA: Population Council; 2015.

[20]  Chi BH, Rosenberg NE, Mweemba O, Powers KA, Zimba C, Maman S, Kasaro M, Mollan KR, Stringer JS, Mutale W. Involving both parents in HIV prevention during pregnancy and breastfeeding. Bull World Health Organ 2018; 96 69–71.
Involving both parents in HIV prevention during pregnancy and breastfeeding.Crossref | GoogleScholarGoogle Scholar |

[21]  Bekker L-G, Black V, Myer L, Cooper D, Mall S, Mnyami C, Mahabeer I, Gilbert L, Schwartz S. Guideline on safer conception in fertile HIV-infected individuals and couples. SAJHIVMed. 2011; 12 31–44.

[22]  Division of Reproductive Health Ministry of Public Health and Sanitation. Kenya family planning guidelines for service providers. Nairobi, Kenya: Ministry of Health; 2010.

[23]  Loutfy M, Kennedy VL, Poliquin V, Dzineku F, Dean NL, Margolese S, Symington A, Money DM, Hamilton S, Conway T, Khan S, Yudin MH. No. 354-Canadian HIV pregnancy planning guidelines. J Obstet Gynaecol Can 2018; 40 94–114.

[24]  National AIDS & STI Control Program Ministry of Health Kenya. Guidelines on use of antiretroviral drugs for treating and preventing HIV infections in Kenya. Nairobi, Kenya: Ministry of Health; 2016.

[25]  Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O’Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2017; 3 168–84.

[26]  Brady M, Rodger A, Asboe D, Cambiano V, Clutterbuck D, Desai M, Field N, Harbottle J, Jamal Z, McCormack S, Palfreeman A, Portman M, Quinn K, Tenant-Flowers M, Wilkins E, Young I. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2017. London, UK: British HIV Association; 2017.

[27]  Davies N, Ashford G, Bekker LG, Chandiwana N, Cooper D, Dyer SJ, Jankelowitz L, Mhlongo O, Mnyani CN, Mulaudzi MB, Moorhouse M, Myer L, Patel M, Pleaner M, Ramos T, Rees H, Schwartz S, Smit J, van Zyl DS. Guidelines to support HIV-infected individuals and couples to achieve pregnancy safely: update 2018. South Afr J HIV Med 2018; 19 a915
Guidelines to support HIV-infected individuals and couples to achieve pregnancy safely: update 2018.Crossref | GoogleScholarGoogle Scholar |

[28]  Mugo NR, Hong T, Celum C, Donnell D, Bukusi EA, John-Stewart G, Wangisi J, Were E, Heffron R, Matthews LT, Morrison S, Ngure K, Baeten JM. Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: a randomized clinical trial. JAMA 2014; 312 362–71.
Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar |

[29]  World Health Organization. WHO technical brief: preventing HIV in pregnancy and breastfeeding in the context of PrEP. Geneva, Switzerland: WHO; 2017. Available online at: http://apps.who.int/iris/bitstream/handle/10665/255866/WHO-HIV-2017.09-eng.pdf;jsessionid=5B9D5C27A336E706DEAB4CD42266E62B?sequence=1 [verified 31 March 2018].

[30]  Department of Health Republic of South Africa. Guidelines for expanding combination prevention and treatment options for sex workers: oral pre-exposure prophylaxis (PrEP) and test and treat (T&T). Pretoria, South Africa: South African Department of Health; 2016. Available online at: http://www.nicd.ac.za/assets/files/PrEP%20and%20TT%20Guidelines%20-%20Final%20Draft%20-%2011%20May%202016.pdf [verified 6 November 2018].

[31]  Kenya Ministry of Health; National AIDS and STI Control Program (NASCOP). Guidelines on use of antiretroviral drugs for treating and preventing HIV infection: a rapid advice. Nairobi, Kenya: Ministry of Health; 2014. Available online at: https://aidsfree.usaid.gov/sites/default/files/tx_kenya_2014.pdf [verified 6 November 2018].

[32]  Ministry of Health, Republic of Uganda. Technical guidance on pre-exposure prophylaxis (PrEP) for persons at high risk of HIV in Uganda. Kampala, Uganda: Ministry of Health; 2016.

[33]  Ministry of Health, Republic of Uganda. Consolidated guidelines for prevention and treatment of HIV in Uganda. Kampala, Uganda: Ministry of Health; 2016. Available online at: https://aidsfree.usaid.gov/sites/default/files/uganda_hiv_gl_2016.pdf [verified 6 November 2018].

[34]  Ministry of Health, Government of Lesotho. National guidelines on the use of antiretroviral therapy for prevention and treatment. Maseru, Lesotho: Ministry of Health; 2016. Available online at: https://aidsfree.usaid.gov/sites/default/files/lesotho_art_2016.pdf [verified 6 November 2018].

[35]  National Medicines and Therapeutics Policy Advisory Committee (NMTPAC), the AIDS and TB Directorate, Ministry of Health and Child Care. Guidelines for antiretroviral therapy for the prevention and treatment of HIV in Zimbabwe. Harare, Zimbabwe: National Medicine and Therapeutics Policy Advisory Committee and the AIDS and TB Directorate, Ministry of Health and Child Care; 2013. Available online at: https://aidsfree.usaid.gov/sites/default/files/zw_arv_therapy_prevention.pdf [verified 6 November 2018].

[36]  Republic of Botswana, Ministry of Health. Handbook of the Botswana 2016 integrated HIV clinical care guidelines. Gaborone, Botswana: Ministry of Health; 2016. Available online at: https://aidsfree.usaid.gov/sites/default/files/botswana_art_2016.pdf [verified 6 November 2018].

[37]  Nigeria National AIDS and STI Control Programme, Federal Ministry of Health. National guidelines for HIV prevention treatment and care. Abuja, Nigeria: Federal Ministry of Health; 2016. Available online at: http://apps.who.it/medicinedocs/documents/s23252en/s23252en.pdf [verified 6 November 2018].

[38]  Ministry of Health, Kingdom of Swaziland. Swaziland integrated HIV management guidelines. Mbabane, Swaziland: Ministry of Health; 2015. Available online at: https://aidsfree.usaid.gov/sites/default/files/tx_swaziland_2015.pdf [verified 6 November 2018].

[39]  Ministry of Health, Malawi. Malawi guidelines for clinical management of HIV in children and adults (3rd edition). Lilongwe, Malawi: Ministry of Health; 2016. Available online at: https://aidsfree.usaid.gov/sites/default/files/malawi_art_2016.pdf [verified 6 November 2018].

[40]  US Public Health Service. Pre-exposure prophylaxis for the prevention of HIV infection in the United States – 2014: a clinical practice guideline. Washington, DC, USA: US Public Health Service; 2014. Available online at: https://www.avac.org/sites/default/files/resource-files/PrEPguidelines2014.pdf [verified 6 November 2018].

[41]  Gilead. Truvada check-list pour le médecin prescripteur. Foster City, USA: Gilead; 2018. Available online at: http://ansm.sante.fr/content/download/101989/1293117/version/2/file/RTU_Truvada_Check-List-Prescripteurs_20-02-2017.pdf [verified 28 March 2018].

[42]  Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O’Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2017; 3 168–84.

[43]  Tan DHS, Hull MW, Yoong D, Tremblay C, O’Byrne P, Thomas R, Kille J, Baril J-G, Cox J, Giguere P, Harris M, Hughes C, MacPherson P, O’Donnell S, Reimer J, Singh A, Barrett L, Bogoch I, Jollimore J, Lambert G, et al Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017; 189 E1448–58.

[44]  Loutfy M, Logan Kennedy V, Poliquin V, Dzineku F, Dean NL, Margolese S, Symington A, Money DM, Hamilton S, Conway T, Khan S, Yudin M. No. 354-Canadian HIV Pregnancy Planning Guidelines. J Obstet Gynaecol Can 2018; 40 94–114.

[45]  World Bank Group. World Bank open data. Washington, DC, USA: World Bank Group; 2018. Available online at: https://data.worldbank.org/ [verified 15 March 2018].

[46]  Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS Country Data. Geneva, Switzerland: UNAIDS; 2018. Available online at: http://www.unaids.org/en/regionscountries/countries [verified 31 March 2018].

[47]  Mofenson LM. Tenofovir pre-exposure prophylaxis for pregnant and breastfeeding women at risk of HIV infection: the time is now. PLoS Med 2016; 13 e1002133
Tenofovir pre-exposure prophylaxis for pregnant and breastfeeding women at risk of HIV infection: the time is now.Crossref | GoogleScholarGoogle Scholar |

[48]  Mugo NR, Ngure K, Kiragu M, Irungu E, Kilonzo N. PrEP for Africa: what we have learnt and what is needed to move to program implementation. Curr Opin HIV AIDS 2016; 11 80–6.
PrEP for Africa: what we have learnt and what is needed to move to program implementation.Crossref | GoogleScholarGoogle Scholar |

[49]  Heffron R, Ngure K, Odoyo J, Bulya N, Tindimwebwa E, Hong T, Kidoguchi L, Donnell D, Mugo N, Bukusi E, Katabira E, Asiimwe S, Morton J, Morrison S, Haugen H, Mujugira A, Haberer JE, Ware NC, Wyatt MA, Marzinke MA, Frenkel LM, Celum C, Baeten JM. Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa. Gates Open Res 2018; 1 1–23.

[50]  Bailey JL, Molino ST, Vega AD, Badowski M. A review of HIV pre-exposure prophylaxis: the female perspective. Infect Dis Ther 2017; 6 363–82.
A review of HIV pre-exposure prophylaxis: the female perspective.Crossref | GoogleScholarGoogle Scholar |

[51]  Geary CW, Bukusi EA. Women and ARV-based HIV prevention – challenges and opportunities. J Int AIDS Soc 2014; 17 19356

[52]  Koechlin FM, Fonner VA, Dalglish SL, O’Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges M, Kennedy CE. Values and preferences on the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature. AIDS Behav 2017; 21 1325–35.
Values and preferences on the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |

[53]  Mack N, Wong C, McKenna K, Lemons A, Odhiambo J, Agot K. Human resource challenges to integrating HIV pre-exposure prophylaxis (PrEP) into the public health system in Kenya: a qualitative study. Afr J Reprod Health 2015; 19 54–62.

[54]  Katirayi L, Chadambuka A, Muchedzi A, Ahimbisibwe A, Musarandega R, Woelk G, Tylleskar T, Moland KM. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives. Reprod Health 2017; 14 124
Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives.Crossref | GoogleScholarGoogle Scholar |

[55]  Althabe F, Moore JL, Gibbons L, Berrueta M, Goudar SS, Chomba E, Derman RJ, Patel A, Saleem S, Pasha O, Esamai F, Garces A, Liechty EA, Hambidge K, Krebs NF, Hibberd PL, Goldenberg RL, Koso-Thomas M, Carlo WA, Cafferata ML, Buekens P, McClure EM. Adverse maternal and perinatal outcomes in adolescent pregnancies: the Global Network’s Maternal Newborn Health Registry study. Reprod Health 2015; 12 S8
Adverse maternal and perinatal outcomes in adolescent pregnancies: the Global Network’s Maternal Newborn Health Registry study.Crossref | GoogleScholarGoogle Scholar |

[56]  World Health Organization. Position paper on mainstreaming adolescent pregnancy in efforts to make pregnancy safer. Geneva, Switzerland: WHO; 2010.

[57]  Christofides NJ, Jewkes RK, Dunkle KL, Nduna M, Shai NJ, Sterk C. Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. J Int AIDS Soc 2014; 17 18585
Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study.Crossref | GoogleScholarGoogle Scholar |

[58]  World Health Organization. Adolescent pregnancy. Geneva, Switzerland: WHO; 2018 [updated January 2018]. Available online at: http://www.who.int/mediacentre/factsheets/fs364/en/ [verified 31 March 2018].

[59]  Gavin AR, Lindhorst T, Lohr MJ. The prevalence and correlates of depressive symptoms among adolescent mothers: results from a 17-year longitudinal study. Women Health 2011; 51 525–45.
The prevalence and correlates of depressive symptoms among adolescent mothers: results from a 17-year longitudinal study.Crossref | GoogleScholarGoogle Scholar |

[60]  Prevention Access Campaign. Risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load. Messaging Primer and Consensus Statement. USA: Prevention Access Campaign; 2018.

[61]  Joint United Nations Programme on HIV/AIDS (UNAIDS). Ending AIDS: progress towards the 90–90–90 targets. Global AIDS Update 2017. Geneva, Switzerland: UNAIDS; 2017.

[62]  Matthews LT, Moore L, Crankshaw TL, Milford C, Mosery FN, Greener R, Psaros C, Safren SA, Bangsberg DR, Smit JA. South Africans with recent pregnancy rarely know partner’s HIV serostatus: implications for serodiscordant couples interventions. BMC Public Health 2014; 14 843
South Africans with recent pregnancy rarely know partner’s HIV serostatus: implications for serodiscordant couples interventions.Crossref | GoogleScholarGoogle Scholar |

[63]  Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JHS, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, et al Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med 2016; 375 830–9.
Antiretroviral therapy for the prevention of HIV-1 transmission.Crossref | GoogleScholarGoogle Scholar |

[64]  Campbell MS, Mullins JI, Hughes JP, Celum C, Wong KG, Raugi DN, Sorensen S, Stoddard JN, Zhao H, Deng W, Kahle E, Panteleeff D, Baeten JM, McCutchan FE, Albert J, Leitner T, Wald A, Corey L, Lingappa JR. Viral linkage in HIV-1 seroconverters and their partners in an HIV-1 prevention clinical trial. PLoS One 2011; 6 e16986
Viral linkage in HIV-1 seroconverters and their partners in an HIV-1 prevention clinical trial.Crossref | GoogleScholarGoogle Scholar |

[65]  Crankshaw TL, Mindry D, Munthree C, Letsoalo T, Maharaj P. Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa. J Int AIDS Soc 2014; 17 18832
Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa.Crossref | GoogleScholarGoogle Scholar |

[66]  Mindry DL, Milford C, Greener L, Greener RM, Maharaj P, Letsoalo T, Munthree C, Crankshaw TL, Smit JA. Client and provider knowledge and views on safer conception for people living with HIV (PLHIV). Sex Reprod Healthc 2016; 10 35–40.
Client and provider knowledge and views on safer conception for people living with HIV (PLHIV).Crossref | GoogleScholarGoogle Scholar |

[67]  Koenig LJ, Lyles C, Smith DK. Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies. Am J Prev Med 2013; 44 S91–8.
Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies.Crossref | GoogleScholarGoogle Scholar |

[68]  van der Straten A, Stadler J, Luecke E, Laborde N, Hartmann M, Montgomery ET, VOICE-C Study Team Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE-C qualitative study in Johannesburg, South Africa. J Int AIDS Soc 2014; 17 19146

[69]  Montgomery ET, van der Straten A, Stadler J, Hartmann M, Magazi B, Mathebula F, Laborde N, Soto-Torres L. Male partner influence on women’s HIV prevention trial participation and use of pre-exposure prophylaxis: the importance of “understanding”. AIDS Behav 2015; 19 784–93.
Male partner influence on women’s HIV prevention trial participation and use of pre-exposure prophylaxis: the importance of “understanding”.Crossref | GoogleScholarGoogle Scholar |

[70]  Bailey BA. Partner violence during pregnancy: prevalence, effects, screening, and management. Int J Women’s Health 2010; 2 183–97.
Partner violence during pregnancy: prevalence, effects, screening, and management.Crossref | GoogleScholarGoogle Scholar |