@article {Abadane2200129, author = {Sheena Sharifi Abadan and Liz Hawryluk and Michele Montandon and Nicole Flowers and Jane Schueller and Robyn Eakle and Pragna Patel and Michelle S. Chevalier and Sangeeta Rana and Anouk Amzel}, title = {Preexposure Prophylaxis Among Pregnant and Lactating People in 18 PEPFAR-Supported Countries: A Review of HIV Strategies and Guidelines}, volume = {10}, number = {6}, elocation-id = {e2200129}, year = {2022}, doi = {10.9745/GHSP-D-22-00129}, publisher = {Global Health: Science and Practice}, abstract = {Key FindingsSince the World Health Organization officially endorsed preexposure prophylaxis (PrEP) for pregnant and lactating people (PLP) in 2017, the proportion of national HIV guidelines that endorsed PrEP for PLP under any circumstance increased from 41\% before 2017 to 73\% in 2017 and after, and the proportion of U.S. President{\textquoteright}s Emergency Plan for AIDS Relief country operational plans (COPs) increased from 11\% in 2018 to 83\% in 2020, with no particular trends by geographic region or prevalence rates.Although there has been improvement in inclusion of PLP in PrEP guidelines and strategies, gaps remain. Only 36\% of national guidelines published in 2017 or later included PLP specifically as a priority population for PrEP; however, 83\% of 2020 PEPFAR COPs included them.Having clear global normative guidance based on available evidence provides the opportunity to streamline national policy development, as it can preclude the need for each country to undergo independent research.Key ImplicationNational policy makers, program implementers, and other key stakeholders should continue to develop and operationalize inclusive national HIV strategic plans and guidelines on PrEP for PLP to reduce new infections in PLP and eliminate vertical transmission of HIV.Introduction:Pregnant and lactating people (PLP) experience heightened risk of acquiring HIV, which adversely impacts their health and increases the risk for vertical HIV transmission. Preexposure prophylaxis (PrEP), as part of a combination prevention package, including condoms, sexually transmitted infection prevention, and regular HIV testing, is a safe, efficacious method to prevent HIV infections among PLP and their infants. This article examines the evolution of strategies and guidance on PrEP services for PLP from 18 countries supported by the U.S. President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR).Methods:The 18 countries implement PEPFAR-supported prevention of vertical transmission of HIV and PrEP programs. We reviewed a total of 18 national HIV strategic plans, 28 national HIV guidelines, and 54 PEPFAR country operational plans (COPs) published in 2013{\textendash}2020. We compared documents from 2013 to 2017 to those from 2017 to 2020 to assess for differences after the release of the 2017 World Health Organization recommendations supporting the use of PrEP by PLP at substantial risk of acquiring HIV.Results:National HIV guidelines and PEPFAR COPs that endorsed PrEP for PLP through any categorization increased from 41\% to 73\% and 11\% to 83\%, respectively, in the pre-2017 and post-2017 periods. While many documents approved PrEP but not specifically for PLP (10 national strategic plans, 6 national guidelines, and 28 COPs), none of the documents explicitly prohibited PrEP for PLP.Conclusion:National HIV guidelines and PEPFAR COPs expanded inclusion of PLP in PrEP eligibility when comparing the pre-2017 and the post-2017 groups. However, policy gaps remain as only 36\% (4/11) of the post-2017 national HIV guidelines included PLP as a specific priority population for PrEP. Inclusive national HIV strategic plans and guidelines on PrEP for PLP, together with effective program implementation, remain critical for reducing new infections in PLP and eliminating vertical transmission of HIV.}, URL = {https://www.ghspjournal.org/content/10/6/e2200129}, eprint = {https://www.ghspjournal.org/content/10/6/e2200129.full.pdf}, journal = {Global Health: Science and Practice} }