{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:37:09Z","timestamp":1787870229069,"version":"build-2784847793"},"reference-count":52,"publisher":"Wiley","issue":"S5","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":37,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD106862"],"award-info":[{"award-number":["R01HD106862"]}],"id":[{"id":"10.13039\/100000071","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":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In 2023, one\u2010fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre\u2010exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long\u2010acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC\/PNC) is a crucial person\u2010centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC\/PNC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched three databases for English\u2010language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and\/or postpartum women accessing PrEP through ANC\/PNC, and reported on initiation (receipt of prescription or self\u2010reported use), continuation (persistent use over time) and\/or adherence (self\u2010reported and\/or objective).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow\u2010up time) precluded meta\u2010analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow\u2010up periods from 1 month post\u2010enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self\u2010reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk\u2010based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two\u2010way SMS communication (Kenya) and real\u2010time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation\/adherence compared to standard\u2010of\u2010care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Integrating oral PrEP into ANC\/PNC showed high initiation among pregnant\/postpartum women; however, continuation and adherence were suboptimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Oral PrEP integration into ANC\/PNC can reach pregnant\/postpartum women. Maximizing its impact will require offering long\u2010acting PrEP, person\u2010centred interventions to support adherence\/continued use and differentiated delivery responsive to women's needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO Number<\/jats:title>\n                    <jats:p>CRD42024513442<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70035","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T09:51:38Z","timestamp":1759917098000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Oral pre\u2010exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-9332","authenticated-orcid":false,"given":"Anke","family":"Rotsaert","sequence":"first","affiliation":[{"name":"Department of Public Health Institute of Tropical Medicine  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8867-3415","authenticated-orcid":false,"given":"Zaynab","family":"Essack","sequence":"additional","affiliation":[{"name":"Centre for Community\u2010Based Research Human Sciences Research Council  Pietermaritzburg South Africa"},{"name":"South African Research Ethics Training Initiative University of KwaZulu\u2010Natal Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Bosman","sequence":"additional","affiliation":[{"name":"Centre for Community\u2010Based Research Human Sciences Research Council  Pietermaritzburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dvora Joseph","family":"Davey","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Geffen School of Medicine University of California  Los Angeles California USA"},{"name":"Department of Epidemiology &amp; Biostatistics School of Public Health University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Hensen","sequence":"additional","affiliation":[{"name":"Department of Public Health Institute of Tropical Medicine  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Global HIV & AIDS statistics \u2014 Fact sheet | UNAIDS[Internet]. 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