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Dobromir Dimitrov, PhD Marie-Claude Boily, PhD Jeannie Marrazzo , MD, MPH Elizabeth R. Brown, PhD

Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings. Dobromir Dimitrov, PhD Marie-Claude Boily, PhD Jeannie Marrazzo , MD, MPH Elizabeth R. Brown, PhD. Introduction.

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Dobromir Dimitrov, PhD Marie-Claude Boily, PhD Jeannie Marrazzo , MD, MPH Elizabeth R. Brown, PhD

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  1. Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings Dobromir Dimitrov, PhD Marie-Claude Boily, PhD Jeannie Marrazzo, MD, MPH Elizabeth R. Brown, PhD

  2. Introduction • The HIV prevalence among pregnant women in Sub-Saharan region is extremely high (South Africa, 30%). • Several studies suggest that the risk of HIV acquisition during pregnancy is doubled for pregnant women and even for their male partners in serodiscordent couples1,2 • High maternal viral load has been associated with higher risk for mother-to-child transmission (MTCT) which suggests that HIV infections acquired during pregnancy carry higher risk (up to 15-fold increase) of MTCT3,4 1Gray et al. 2005, Lancet 366, 1182-1188, 2Mugo et al. 2011, AIDS 25, 1887-1895 3Leroy et al. 2001, AIDS 15, 517-522, 4Birkhead et al. 2010, Obstetrics And Gynecology 115, 1247-1255

  3. Study Design • Objectives: To evaluate the potential public-health impact of providing efficacious microbicide to pregnant women in addition to non-pregnant women in high prevalence settings in terms of: • cumulative HIV infections prevented in women and men • HIV infections during pregnancy prevented • the fraction of MTCT prevented • Methods: Compartmental deterministic model of HIV transmission in heterosexual population with different levels of: • HIV acquisition risk during pregnancy • Relative MTCT risk if HIV is acquired during pregnancy

  4. Main results Relative MTCT risk if HIV is acquired during pregnancy: 25% additional reduction in MTCT 6% to 9% increase in effectiveness

  5. Conclusions • Consistent use of efficacious MB by non-pregnant women may prevent substantial fraction of the new infections over 10 years. It may reduce the expected HIV prevalence but is unlikely to eliminate the epidemic. • Providing HIV prevention tools to pregnant women in the context of wide-scale interventions would be desirable as it would help to increase the effectiveness of the intervention, especially if HIV acquisition risk during pregnancy is elevated. • The usage of MB by pregnant women would significantly reduce the number of HIV infections acquired during pregnancy and help prevent MTCTs but should not be a substitute for PMTCT.

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