{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:14:51Z","timestamp":1792761291522,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Maternal antiretroviral therapy (ART) with viral suppression prior to conception, during pregnancy and throughout the breastfeeding period accompanied by infant postnatal prophylaxis (PNP) forms the foundation of current approaches to preventing vertical HIV transmission. Unfortunately, infants continue to acquire HIV infections, with half of these infections occurring during breastfeeding. A consultative meeting of stakeholders was held to review the current state of PNP globally, including the implementation of WHO PNP guidelines in different settings and identifying the key factors affecting PNP uptake and impact, with an aim to optimize future innovative strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>WHO PNP guidelines have been widely implemented with adaptations to the programme context. Some programmes with low rates of antenatal care attendance, maternal HIV testing, maternal ART coverage and viral load testing capacity have opted against risk\u2010stratification and provide an enhanced PNP regimen for all infants exposed to HIV, while other programmes provide infant daily nevirapine antiretroviral (ARV) prophylaxis for an extended duration to cover transmission risk throughout the breastfeeding period. A simplified risk stratification approach may be more relevant for high\u2010performing vertical transmission prevention programmes, while a simplified non\u2010risk stratified approach may be more appropriate for sub\u2010optimally performing programmes given implementation challenges. In settings with concentrated epidemics, where the epidemic is often driven by key populations, infants who are found to be exposed to HIV should be considered at high risk for HIV acquisition. All settings could benefit from newer technologies that promote retention during pregnancy and throughout the breastfeeding period. There are several challenges in enhanced and extended PNP implementation, including ARV stockouts, lack of appropriate formulations, lack of guidance on alternative ARV options for prophylaxis, poor adherence, poor documentation, inconsistent infant feeding practices and in inadequate retention throughout the duration of breastfeeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tailoring PNP strategies to a programmatic context may improve access, adherence, retention and HIV\u2010free outcomes of infants exposed to HIV. Newer ARV options and technologies that enable simplification of regimens, non\u2010toxic potent agents and convenient administration, including longer\u2010acting formulations, should be prioritized to optimize the effect of PNP in the prevention of vertical HIV transmission.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26032","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T08:50:01Z","timestamp":1676883001000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Antiretroviral postnatal prophylaxis to prevent HIV vertical transmission: present and future strategies"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5485-8692","authenticated-orcid":false,"given":"Martina","family":"Penazzato","sequence":"first","affiliation":[{"name":"HIV Department World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivy","family":"Kasirye","sequence":"additional","affiliation":[{"name":"HIV Department World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Ruel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mukui","sequence":"additional","affiliation":[{"name":"Drugs for Neglected Diseases Initiative Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrie","family":"Bekker","sequence":"additional","affiliation":[{"name":"Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health Stellenbosch University Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-9234","authenticated-orcid":false,"given":"Mohendran","family":"Archary","sequence":"additional","affiliation":[{"name":"Department of Paediatrics University of KwaZulu\u2010Natal Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Musoke","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Makerere University and MUJHU Research Collaboration Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaffiq","family":"Essajee","sequence":"additional","affiliation":[{"name":"United Nations International Children's Emergency Fund New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George K.","family":"Siberry","sequence":"additional","affiliation":[{"name":"Office of HIV\/AIDS, Bureau of Global Health United States Agency for International Development (USAID) Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-3023","authenticated-orcid":false,"given":"Mary","family":"Mahy","sequence":"additional","affiliation":[{"name":"Strategic Information Department UNAIDS Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Simnoue","sequence":"additional","affiliation":[{"name":"World Health Organization Cameroon Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Simione","sequence":"additional","affiliation":[{"name":"Ministry of Health Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Zech","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians &amp; Surgeons Columbia University New York City United\u00a0States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Mushavi","sequence":"additional","affiliation":[{"name":"Ministry of Health Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine J.","family":"Abrams","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians &amp; Surgeons Columbia University New York City United\u00a0States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PNP meeting participants","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"UNAIDS. Confronting inequalities lessons for pandemic responses from 40 years of AIDS.2021(cited 2022 Aug 27)https:\/\/www.unaids.org\/en\/resources\/presscentre\/pressreleaseandstatementarchive\/2021\/july\/20210714_global\u2010aids\u2010update."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002487"},{"issue":"5","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"e25783","DOI":"10.1002\/jia2.25783","article-title":"HIV acquisition in pregnancy: implications for mother\u2010to\u2010child transmission at the population level in sub\u2010Saharan Africa","volume":"224","author":"Marston M","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001616"},{"issue":"5","key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"25778","DOI":"10.1002\/jia2.25778","article-title":"Updates to the spectrum\/AIM model for the UNAIDS 2020 HIV estimates","volume":"2021","author":"Stover J","year":"2021","journal-title":"J Int AIDS Soc"},{"issue":"9","key":"e_1_2_8_7_1","first-page":"1227","article-title":"Adherence to antiretroviral therapy during and after pregnancy: cohort study on women receiving care in Malawi's option B+ program","volume":"63","author":"Haas AD","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"4","key":"e_1_2_8_8_1","first-page":"422","article-title":"Frequency of viremic episodes in HIV\u2010infected women initiating antiretroviral therapy during pregnancy: a cohort study","volume":"64","author":"Myer L","year":"2017","journal-title":"Clin Infect Dis"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25209"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61653-X"},{"issue":"3","key":"e_1_2_8_11_1","first-page":"171","article-title":"Triple antiretroviral compared with zidovudine and single\u2010dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother\u2010to\u2010child transmission of HIV\u20101 (Kesho Bora study): a randomised controlled trial","volume":"1","author":"Kesho Bora Study Group,","year":"2011","journal-title":"Lancet Infect Dis"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907736"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001612"},{"issue":"10","key":"e_1_2_8_14_1","first-page":"CD011323","article-title":"Antiretroviral interventions for preventing breast milk transmission of HIV","volume":"4","author":"White AB","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001700"},{"key":"e_1_2_8_16_1","unstructured":"World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach \u2010 Second edition.2016."},{"key":"e_1_2_8_17_1","unstructured":"Joint United Nations Programme on HIV\/AIDS.Start Free Stay Free AIDS Free: a super\u2010fast\u2010track framework for ending AIDS among children adolescents and young women by 2020.2016."},{"key":"e_1_2_8_18_1","unstructured":"IvyK ElaineA ChristineK ChristineM MugaggaK NomthandazoL et\u00a0al.Enhanced postnatal prophylaxis for HIV\u2010exposed infants in the AIDS FREE priority countries: a policy review. In:International Conference on AIDS and STIs in Africa (ICASA).Durban;2021."},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2055-6640(20)30343-5"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001700"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26032","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26032","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T05:53:55Z","timestamp":1701928435000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1002\/jia2.26032"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26032","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]},"assertion":[{"value":"2022-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26032"}}