{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:48:28Z","timestamp":1758862108180,"version":"3.41.2"},"reference-count":31,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW009340","D43 TW010060"],"award-info":[{"award-number":["D43 TW009340","D43 TW010060"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["P30 MH062294"],"award-info":[{"award-number":["P30 MH062294"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite widespread success in reducing vertical HIV transmission, most antenatal care (ANC) programmes in eastern and southern Africa have not emphasized primary prevention of maternal HIV acquisition during pregnancy and lactation\/breastfeeding. We hypothesized that combination HIV prevention interventions initiated alongside ANC could substantially reduce maternal HIV incidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We constructed a multi\u2010state model describing male\u2010to\u2010female HIV transmission in steady heterosexual partnerships during pregnancy and lactation\/breastfeeding, with initial conditions based on population distribution estimates for Malawi and Zambia in 2020. We modelled individual and joint increases in three HIV prevention strategies at or soon after ANC initiation: (1) HIV testing of male partners, resulting in HIV diagnosis and less condomless sex among those with previously undiagnosed HIV; (2) initiation (or re\u2010initiation) of suppressive antiretroviral therapy (ART) for male partners with diagnosed but unsuppressed HIV; and (3) adherent pre\u2010exposure prophylaxis (PrEP) for HIV\u2010negative female ANC patients with HIV\u2010diagnosed or unknown\u2010status male partners. We estimated the percentage of within\u2010couple, male\u2010to\u2010female HIV transmissions that could be averted during pregnancy and lactation\/breastfeeding with these strategies, relative to base\u2010case conditions in which 45% of undiagnosed male partners become newly HIV diagnosed via testing, 75% of male partners with diagnosed but unsuppressed HIV initiate\/re\u2010initiate ART and 0% of female ANC patients start PrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Increasing uptake of any single strategy by 20 percentage points above base\u2010case levels averted 10%\u221211% of maternal HIV acquisitions during pregnancy and lactation\/breastfeeding in the model. Joint uptake increases of 20 percentage points in two interventions averted an estimated 19%\u221223% of transmissions, and with a 20\u2010percentage\u2010point increase in uptake of all three interventions, 29% were averted. Strategies achieving 95% male testing, 90% male ART initiation\/re\u2010initiation and 40% female PrEP use reduced incident infections by 45%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combination HIV prevention strategies provided alongside ANC and sustained through the post\u2010partum period could substantially reduce maternal HIV incidence during pregnancy and lactation\/breastfeeding in eastern and southern Africa.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26128","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T05:52:49Z","timestamp":1688536369000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combination HIV prevention during pregnancy and the post\u2010partum period in Malawi and Zambia: a mathematical modelling analysis"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7980-9846","authenticated-orcid":false,"given":"Kimberly A.","family":"Powers","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilbroad","family":"Mutale","sequence":"additional","affiliation":[{"name":"School of Public Health University of Zambia Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora E.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-642X","authenticated-orcid":false,"given":"Lauren A.","family":"Graybill","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie R.","family":"Mollan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9711-2249","authenticated-orcid":false,"given":"Kellie","family":"Freeborn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friday","family":"Saidi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"},{"name":"UNC Project Malawi Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Maman","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla L.","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Directorate of Public Health Zambia Ministry of Health Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Jahn","sequence":"additional","affiliation":[{"name":"Department of HIV and AIDS Malawi Ministry of Health Lilongwe Malawi"},{"name":"International Training and Education Center for Health (I\u2010TECH), Department of Global Health University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose K.","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Department of HIV and AIDS Malawi Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey S. 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