Missed Opportunities for HIV Prevention in Perinatal Care Settings in the United States.

Lealah Pollock,Marliese Warren,Judy Levison

doi:10.3389/frph.2021.680046

Lealah Pollock, Marliese Warren + Show 1 more

Open Access

https://doi.org/10.3389/frph.2021.680046

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Abstract

Universal opt-out HIV screening in pregnancy is an essential intervention toward eliminating perinatal HIV transmission in the US. However, it fails to identify pregnant people who are HIV negative at the time of testing but are at ongoing risk for HIV acquisition. Those of us involved in caring for women living with HIV are acutely aware of the many diagnoses of HIV that might have been prevented if only a partner had been tested for HIV or preexposure prophylaxis (PrEP) had been offered to a patient. This perspective article will review current recommendations and evidence-based interventions to evaluate missed opportunities for HIV prevention in US perinatal care settings. We identified three barriers to implementation of HIV prevention strategies during pregnancy and breastfeeding: (1) HIV risk for women is underestimated and poorly defined in clinical practice; (2) Partner testing is challenging and implementation studies in the US are lacking; and (3) PrEP remains underutilized. In March 2020, the National Perinatal HIV Hotline convened a group of clinicians and researchers specializing in perinatal HIV care to a case-based discussion of missed opportunities in perinatal HIV prevention. From our review of the literature via PubMed search as well as expert opinions gathered in this discussion, we make recommendations for addressing these barriers.

Highlights

Universal HIV testing in pregnancy is an essential step in preventing perinatal HIV transmission
Providers Unaware of HIV Risk In 2017, the Centers for Disease Control (CDC) [11] identified indications for preexposure prophylaxis (PrEP) use by heterosexually active men and women, including HIV-negative women not in a monogamous relationship with a recently tested HIV-negative partner who have at least one of the following risk factors: infrequent condom use with one or more partners of unknown HIV status who are known to be at substantial risk of HIV infection, in an ongoing sexual relationship with an HIV-positive partner, or infection with syphilis or gonorrhea diagnosed or reported in the last 6 months
We identified three areas that contribute to missed opportunities for HIV prevention in pregnancy and breastfeeding: [1] HIV risk awareness among women is low and HIV risk for women is challenging to identify and define in clinical practice; [2] Partner testing is far from routine and implementation studies in the US are lacking; and [3] PrEP remains underutilized among women, especially during pregnancy and breastfeeding

Summary

INTRODUCTION

Universal HIV testing in pregnancy is an essential step in preventing perinatal HIV transmission. Providers Unaware of HIV Risk In 2017, the Centers for Disease Control (CDC) [11] identified indications for PrEP use by heterosexually active men and women, including HIV-negative women not in a monogamous relationship with a recently tested HIV-negative partner who have at least one of the following risk factors: infrequent condom use with one or more partners of unknown HIV status who are known to be at substantial risk of HIV infection, in an ongoing sexual relationship with an HIV-positive partner, or infection with syphilis or gonorrhea diagnosed or reported in the last 6 months Using these criteria, Fruhauf and Colemen [12] estimated that 10% of their pregnant population in Baltimore were eligible for PrEP.

DISCUSSION

Findings

DATA AVAILABILITY STATEMENT