TY - JOUR T1 - Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00401 VL - 11 IS - 2 SP - e2200401 AU - Theodore Ruel AU - Martina Penazzato AU - Jennifer M. Zech AU - Moherndran Archary AU - Tim R. Cressey AU - Ameena Goga AU - Joseph Harwell AU - Raphael J. Landovitz AU - Maria Grazia Lain AU - Marc Lallemant AU - Eleanor Namusoke-Magongo AU - Irene Mukui AU - Sallie R. Permar AU - Andrew J. Prendergast AU - Roger Shapiro AU - Elaine J. Abrams Y1 - 2023/04/28 UR - http://www.ghspjournal.org/content/11/2/e2200401.abstract N2 - Key MessagesPostnatal prophylaxis continues to play an essential role in efforts to eliminate new pediatric HIV infections and maximize HIV-free survival.New approaches to postnatal prophylaxis using currently available modern oral antiretroviral drugs could surmount many current barriers.Long-acting agents and delivery platforms currently in development for treating people living with HIV have great potential as postnatal prophylaxis for infants.Studies of novel postnatal prophylactic agents are possible and imperative in the near future and must be prioritized early in the antiretroviral drug development pipeline.Close collaboration between researchers, community representatives, industry, regulators, and policymakers will be the critical ingredient to ensure HIV-free survival for all infants with HIV exposure.With new advances in antiretroviral drugs for HIV prevention and treatment, as well as increasing coverage globally, the landscape around vertical transmission of HIV is rapidly changing. It is estimated that 82% of pregnant women globally received antiretroviral therapy (ART) in 2021.1 Increasingly, women in sub-Saharan Africa are transitioning to optimized dolutegravir-based antiretroviral regimens, offering greater potency and durability. Women with HIV also have access to better care, including integrated antenatal and HIV services, viral load monitoring, multi-month ART dispensing, and patient-centered differentiated service delivery models with postnatal follow-up of the mother-infant dyad.2 However, a substantial number of vertical transmissions continue to occur perinatally and during breastfeeding, driven by shortfalls in testing, treatment coverage, adherence, and retention in care among mothers. Among an estimated 160,000 children with new HIV infections globally in 2021, 48% had mothers who had not started ART, 22% had mothers who discontinued their treatment, and 8% had mothers on treatment but were not able to maintain virologic suppression.1 Furthermore, incident HIV infections among pregnant and breastfeeding women contribute to an increasing proportion of new pediatric infections.3Postnatal prophylaxis—the provision of antiretroviral drugs to … ER -