Preexposure Prophylaxis Among Pregnant and Lactating People in 18 PEPFAR-Supported Countries: A Review of HIV Strategies and Guidelines

Figures & Tables

TABLE 1.

Review of PrEP for PLP Language in National HIV Strategic Plans, National HIV Guidelines, and PEPFAR COPs^a

Country	National HIV Strategic Plan (Plan Years)	National HIV Guidelines 2013–2017 (Publication Year)	National HIV Guidelines 2017–2020 (Publication Year)	COP 2018 (FY 19)	COP 2019 (FY 20)	COP 2020 (FY 21)
Botswana	N (2010–2016)^b	Limited (2016)	N/A	NS	Limited	Y
Cameroon	NS (2018–2022)	X (2015)	N/A	NS	NS	NS
Côte d’Ivoire	N (2015–2019)	N/A	NS (2019)	NS	NS	Y
Democratic Republic of the Congo	N (2018–2021)	Limited (2016)	NS (2018)	N	NS	NS
Eswatini	Y (2018–2023)	N (2015)	N/A	NS	Y	Y
Haiti	NS (2018–2023)	N (2013)	N/A	NS	NS	NS
Kenya	NS (2020–2024)	Limited (2016)	Limited (2018)	NS	NS	Y
Lesotho	Y (2018–2023)	NS (2016)	N/A	NS	Y	Y
Malawi	NS (2015–2020)	X (2016)	Y (2019)	NS	Y	Y
Mozambique	Limited (2020–2024)	N (2015)	N/A	NS	NS	Y
Namibia	Y (2017–2022)	Limited (2016)	Y (2019)	NS	Y	Y
Nigeria	NS (2017–2021)	NS (2016)	N/A	X	NS	Y
Rwanda	NS (2013–2020)	N (2016)	Limited (2018)	NS	NS	Y
South Africa	NS (2017–2022)	Y (2016)	Y (2019)	NS	NS	Y
United Republic of Tanzania	Limited (2017–2022)	N (2015)	NS (2019)	NS	NS	Y
Uganda	NS (2015–2020)	NS (2016)	Limited (2018)	Y	NS	Y
Zambia	NS (2017–2021)	Y (2016)	Y (2020)	Limited	Y	Y
Zimbabwe	NS (2015–2020)	Limited (2016)	Limited (2019)	NS	Y	Y

Abbreviations: COP, country operational plan; DREAMS, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe; FY, fiscal year; PEPFAR, U.S. President’s Emergency Plan for AIDS Relief; PLP, pregnant and lactating people; PrEP, preexposure prophylaxis; SDC, serodifferent couple.
^aClassification of PrEP for PLP language in these documents: Y, PrEP specified for PLP as a priority population; Limited, PrEP specified for PLP in limited circumstances (SDCs, DREAMS participants, etc.);
NS, PrEP specified as a prevention method, but PLP not specified; X, PrEP specified as a prevention method, but not approved or included for implementation; N, PrEP not specified or mentioned at all; N/A, Document does not exist or was not available.
↵^bThere was no publicly available national strategic plan that included the time period after 2017.

TABLE 2.

Review of National HIV Strategic Plans

Document Categories	Countries, %(No.)
PrEP specified for PLP under any circumstance (i.e., as a priority population or in limitedcircumstances)	28 (5)
PrEP specified for PLP as a priority population	17 (3)^a
PrEP specified for PLP in limited circumstances	11 (2)^b
PrEP specified as a prevention method but PLP not specified	56 (10)^c
PrEP specified as a prevention method but not approved or included for implementation	0
PrEP not specified or mentioned at all	17 (3)^d
Total reviewed	18

Abbreviation: PLP, pregnant and lactating people; PrEP, preexposure prophylaxis.
↵a Eswatini, Lesotho, and Namibia.
↵b Mozambique and United Republic of Tanzania.
↵c Cameroon, Haiti, Kenya, Malawi, Nigeria, Rwanda, South Africa, Uganda, Zambia, and Zimbabwe.
↵d Botswana, Cote d’Ivoire, and Democratic Republic of the Congo.

TABLE 3.

Review of National HIV Guidelines, Pre-2017 and Post-2017

Document Categories	2013–2017, % (No.)	2017–2020, % (No.)
PrEP specified for PLP under any circumstance (i.e., as a priority population or in limited circumstances)	41 (7)	73 (8)
PrEP specified for PLP as a priority population	12 (2)^a	36 (4)^b
PrEP specified for PLP in limited circumstances	29 (5)^c	36 (4)^d
PrEP specified as a prevention method but PLP not specified	18 (3)^e	27 (3)^f
PrEP specified as a prevention method but not approved or included for implementation	12 (2)^g	0
PrEP not specified or mentioned at all	29 (5)^h	0
Total reviewed	17	11

Abbreviations: PLP, pregnant and lactating people; PrEP, preexposure prophylaxis.
↵^aSouth Africa and Zambia.
↵^bMalawi, Namibia, South Africa, and Zambia.
↵^cBotswana, Democratic Republic of the Congo, Kenya, Namibia, and Zimbabwe.
↵^dKenya, Rwanda, Uganda, and Zimbabwe.
↵^eLesotho, Nigeria, and Uganda.
↵^fCote d’Ivoire, Democratic Republic of the Congo, and United Republic of Tanzania.
↵^gCameroon and Malawi.
↵^hEswatini, Haiti, Mozambique, Rwanda, and United Republic of Tanzania.

TABLE 4.

Review of PEPFAR COPs, 2018–2020

Document Categories	2018, % (No.)	2019, % (No.)	2020, % (No.)
PrEP specified for PLP under any circumstance (i.e., as a priority population or in limited circumstances)	11 (2)	39 (7)	83 (15)
PrEP specified for PLP as a priority population	6 (1)^a	33 (6)^b	83 (15)^c
PrEP specified for PLP in limited circumstances	6 (1)^d	6 (1)^e	0
PrEP specified as a prevention method but PLP not specified	78 (14)^f	61 (11)^g	17 (3)^h
PrEP specified as a prevention method but not approved or included for implementation	6 (1)ⁱ	0	0
PrEP not specified or mentioned at all	6 (1)^j	0	0
Total reviewed, No.	18	18	18

Abbreviations: COP, country operational plan; PLP, pregnant and lactating people; PEPFAR, U.S. President’s Emergency Plan for AIDS Relief; PrEP, preexposure prophylaxis.
↵a Uganda.
↵b Eswatini, Lesotho, Malawi, Namibia, Zambia, and Zimbabwe.
↵c Botswana, Cote d’Ivoire, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, United Republic of Tanzania, Uganda, Zambia, and Zimbabwe.
↵d Zimbabwe.
↵e Botswana.
↵f Botswana, Cameroon, Cote d’Ivoire, Eswatini, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, United Republic of Tanzania, and Zimbabwe.
↵g Cameroon, Cote d’Ivoire, Democratic Republic of the Congo, Haiti, Kenya, Mozambique, Nigeria, Rwanda, South Africa, United Republic of Tanzania, and Uganda.
↵h Cameroon, Democratic Republic of the Congo, and Haiti.
↵i Nigeria.
↵j Democratic Republic of the Congo.