How can PrEP help vulnerable pregnant and postpartum women?

Pre-exposure prophylaxis (PrEP) is a new and effective way to help pregnant and breastfeeding women prevent HIV—and in turn, mother-to-child transmission of HIV. However, minimal guidance exists to help providers effectively identify and counsel the pregnant and postpartum women that could most benefit from PrEP. In a new commentary, Bixby researchers begin to outline potential guidelines and prioritize areas for additional research.

Provider with patient in counseling
In particular, the researchers recommend that providers counsel at-risk pregnant and postpartum women on PrEP as part of a larger, shared and ongoing conversation about all available HIV prevention strategies. To help women identify the strategies that best suit their needs, providers should incorporate women’s personal circumstances, such as relationship status, and preferences. Providers should also revisit those circumstances and preferences often since, as they change, so can HIV risk. Studies on other similarly complex reproductive health counseling topics, such as contraceptive choice, support this same shared decision-making approach.

The commentary also identifies many gaps in the current protocols that inform how providers care for pregnant and postpartum women, most of which do not account for the additional testing or support that those vulnerable to HIV may need. Ensuring that more HIV prevention studies include at-risk pregnant and postpartum women is the first step toward helping providers understand how to more effectively care for and counsel them.