PrEP for Pregnant and Breastfeeding People: Advocacy, Policy, and Programmatic Tools
Evidence shows that offering PrEP is a safe and effective HIV prevention strategy for pregnant and breastfeeding people.
Guidance from the World Health Organization (WHO) supports provision of PrEP to pregnant and breastfeeding people (PBFP) who are at continuing substantial risk of HIV infection. Evidence has shown that people have an increased need for HIV prevention during pregnancy and the postnatal period, and that people who become infected with HIV during pregnancy and breastfeeding have a higher chance of transmitting HIV to their infants as compared to people who became infected with HIV before becoming pregnant.
Developed by the CHOICE collaboration of the EpiC and RISE programs, and revised under MOSAIC (Maximizing Options to Advance Informed Choice for HIV Prevention), with support from PEPFAR through USAID, the PrEP for Pregnant and Breastfeeding People Package is designed for use by policy makers, program implementers, and healthcare workers to expand provision of PrEP to PBFP. The evidence-informed materials are designed to be adapted to reflect local context and priorities, national policy and guidelines, and implementation context surrounding provision of PrEP to PBFP.
At the core of this package are sample clinical practice guidelines which include eligibility screening and management recommendations, with a specific focus on clinical considerations warranting special attention in this population. The package also includes adaptable implementation support and training materials including an integrated implementation guide, a facilitator guide and training PowerPoint, case studies, a pre/post training knowledge test, a facility assessment tool, surveillance tools, and a pregnancy wheel job aid that includes key messages on PrEP for PBFP for providers. The training courses include an oral PrEP only, PrEP ring only, and an integrated oral PrEP or PrEP ring course to suit various national PrEP policy and programming contexts.
Additionally, the package includes a brief to support policy stakeholders to help advance the integration of WHO-recommended actions into their nationally endorsed prevention of vertical transmission strategies. The brief outlines the rationale for including PrEP for PBFP as part of prevention of vertical transmission policies and key language to consider integrating into the policies.
These materials are designed to help Ministries of Health expand access to high-quality PrEP for PBFP to ultimately help adolescent girls and young women, and other women, prevent HIV.
Clinical Practice Guidelines
Training Package
The training package includes method specific training course slides and supplemental materials including an integrated implementation guide, facilitator guide, learner guide, pre- and post-test and answer key. Users can navigate to the training package that is best suited to their national PrEP policy and programming contexts by clicking on the desired PrEP method below.
Implementation and Surveillance Materials
- Assessment of Facility Readiness for PrEP Provision in Antenatal and Postnatal Care Services
- Tools for Active Safety Surveillance of Maternal and Infant Health Outcomes for Pregnant and Breastfeeding Users of Oral PrEP and PrEP Ring
- CHOICE PrEP for PBFP Pregnancy Wheel (English / French)
Research and Insights
- PrEP Ring for Pregnant and Breastfeeding Women: Summary of research findings in eastern and southern Africa
- PrEP Ring Safety Data in Pregnant and Breastfeeding Women
- HIV Prevention Options During Pregnancy and Breastfeeding—What’s in the Pipeline? (Presentation / Recording)
Policy Tools