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Abstract：
Pregnant and lactating people (PLP) experience heightened risk of acquiring HIV, which adversely impacts their health and increases the risk for vertical HIV transmission. Preexposure prophylaxis (PrEP), as part of a combination prevention package, including condoms, sexually transmitted infection prevention, and regular HIV testing, is a safe, efficacious method to prevent HIV infections among PLP and their infants. This article examines the evolution of strategies and guidance on PrEP services for PLP from 18 countries supported by the U.S. President\'s Emergency Plan for AIDS Relief (PEPFAR).
The 18 countries implement PEPFAR-supported prevention of vertical transmission of HIV and PrEP programs. We reviewed a total of 18 national HIV strategic plans, 28 national HIV guidelines, and 54 PEPFAR country operational plans (COPs) published in 2013-2020. We compared documents from 2013 to 2017 to those from 2017 to 2020 to assess for differences after the release of the 2017 World Health Organization recommendations supporting the use of PrEP by PLP at substantial risk of acquiring HIV.
National HIV guidelines and PEPFAR COPs that endorsed PrEP for PLP through any categorization increased from 41% to 73% and 11% to 83%, respectively, in the pre-2017 and post-2017 periods. While many documents approved PrEP but not specifically for PLP (10 national strategic plans, 6 national guidelines, and 28 COPs), none of the documents explicitly prohibited PrEP for PLP.
National HIV guidelines and PEPFAR COPs expanded inclusion of PLP in PrEP eligibility when comparing the pre-2017 and the post-2017 groups. However, policy gaps remain as only 36% (4/11) of the post-2017 national HIV guidelines included PLP as a specific priority population for PrEP. Inclusive national HIV strategic plans and guidelines on PrEP for PLP, together with effective program implementation, remain critical for reducing new infections in PLP and eliminating vertical transmission of HIV.
The 18 countries implement PEPFAR-supported prevention of vertical transmission of HIV and PrEP programs. We reviewed a total of 18 national HIV strategic plans, 28 national HIV guidelines, and 54 PEPFAR country operational plans (COPs) published in 2013-2020. We compared documents from 2013 to 2017 to those from 2017 to 2020 to assess for differences after the release of the 2017 World Health Organization recommendations supporting the use of PrEP by PLP at substantial risk of acquiring HIV.
National HIV guidelines and PEPFAR COPs that endorsed PrEP for PLP through any categorization increased from 41% to 73% and 11% to 83%, respectively, in the pre-2017 and post-2017 periods. While many documents approved PrEP but not specifically for PLP (10 national strategic plans, 6 national guidelines, and 28 COPs), none of the documents explicitly prohibited PrEP for PLP.
National HIV guidelines and PEPFAR COPs expanded inclusion of PLP in PrEP eligibility when comparing the pre-2017 and the post-2017 groups. However, policy gaps remain as only 36% (4/11) of the post-2017 national HIV guidelines included PLP as a specific priority population for PrEP. Inclusive national HIV strategic plans and guidelines on PrEP for PLP, together with effective program implementation, remain critical for reducing new infections in PLP and eliminating vertical transmission of HIV.
摘要：
背景：孕妇和哺乳期患者（PLP）感染艾滋病毒的风险增加，这对他们的健康产生了不利影响，并增加了垂直传播艾滋病毒的风险。暴露前预防（PrEP），作为组合预防方案的一部分，包括避孕套,性传播感染预防，定期进行艾滋病毒检测，是一个保险箱,在PLP及其婴儿中预防HIV感染的有效方法。本文研究了在美国总统艾滋病紧急救援计划（PEPFAR）的支持下，来自18个国家的PLP的PrEP服务策略和指南的演变。
方法：18个国家实施了PEPFAR支持的预防艾滋病毒垂直传播和PrEP计划。我们共审查了18个国家艾滋病毒战略计划，28个国家艾滋病毒指导方针，2013-2020年发布了54个PEPFAR国家业务计划(COP)。我们将2013年至2017年的文件与2017年至2020年的文件进行了比较，以评估2017年世界卫生组织建议发布后的差异，该建议支持PLP在感染艾滋病毒的重大风险中使用PrEP。
结果：国家HIV指南和PEPFARCOP通过任何分类认可PLP的PrEP从41％增加到73％，从11％增加到83％，分别,在2017年前和2017年后期间。虽然许多文件批准了PrEP，但不是专门针对PLP(10个国家战略计划，6个国家准则，和28个COP)，没有任何文件明确禁止PLP的PrEP。
结论：国家HIV指南和PEPFARCOP在比较2017年前和2017年后的人群时，扩大了PLP在PrEP资格中的纳入。然而,政策差距仍然存在,因为只有36%(4/11)的2017年后国家HIV指南将PLP作为PrEP的特定优先人群.包容性国家艾滋病毒战略计划和PLPPrEP指南，加上有效的计划实施，对于减少PLP的新感染和消除艾滋病毒的垂直传播仍然至关重要。
方法：18个国家实施了PEPFAR支持的预防艾滋病毒垂直传播和PrEP计划。我们共审查了18个国家艾滋病毒战略计划，28个国家艾滋病毒指导方针，2013-2020年发布了54个PEPFAR国家业务计划(COP)。我们将2013年至2017年的文件与2017年至2020年的文件进行了比较，以评估2017年世界卫生组织建议发布后的差异，该建议支持PLP在感染艾滋病毒的重大风险中使用PrEP。
结果：国家HIV指南和PEPFARCOP通过任何分类认可PLP的PrEP从41％增加到73％，从11％增加到83％，分别,在2017年前和2017年后期间。虽然许多文件批准了PrEP，但不是专门针对PLP(10个国家战略计划，6个国家准则，和28个COP)，没有任何文件明确禁止PLP的PrEP。
结论：国家HIV指南和PEPFARCOP在比较2017年前和2017年后的人群时，扩大了PLP在PrEP资格中的纳入。然而,政策差距仍然存在,因为只有36%(4/11)的2017年后国家HIV指南将PLP作为PrEP的特定优先人群.包容性国家艾滋病毒战略计划和PLPPrEP指南，加上有效的计划实施，对于减少PLP的新感染和消除艾滋病毒的垂直传播仍然至关重要。
