Assuring Comprehensive Perinatal, Maternal and Infant Health and the Elimination of Perinatal HIV in the United States

approaches to optimize perinatal, maternal/parental and infant health for persons affected by HIV. The recipient will also disseminate resources and technical assistance through large educational and best-practice-sharing networks. These activities will result in an increased awareness by clinical and public health professionals of strategies to achieve and maintain elimination of perinatal HIV in the United States as well as approaches to optimize the health of families affected by HIV. The provision of technical assistance and capacity building to improve perinatal HIV care and prevention systems will also create opportunities to utilize aspects of The Framework for the prevention of congenital syphilis or other perinatal infections.In 2012, CDC published a framework for the elimination of perinatal HIV transmission in the United States (The Framework). Based on the latest national data, elimination of perinatal HIV transmission may have occurred in the United States: in 2019, CDC received 32 reports of U.S.-born infants with diagnosed perinatal infection. To maintain low numbers of diagnoses of perinatal HIV each year, and to ensure the short- and long-term safety of perinatal HIV prevention interventions, it will be necessary to build upon past work to implement The Framework. The 6 components of The Framework include: 1) reproductive health, family planning and prepregnancy care services for women of childbearing age with HIV, 2) HIV testing and comprehensive case-finding by public health, 3) assurance of clinical care and behavioral health services for pregnant women with HIV and their infants, 4) continuous quality improvement of local perinatal HIV health systems through a case review and community action process such as the FIMR-HIV methodology, 5) research and long-term monitoring to ensure preventive interventions and contemporary antiretroviral medications are not only efficacious but also safe, and 6) thorough HIV data surveillance to evaluate and direct public health prevention programs.In a previous CDC-funded activity, PS17-1712, an Elimination of Perinatal HIV Task Force comprised of clinical and public health subject matter experts as well as women with HIV identified key issues necessary to maintain gains in perinatal prevention and to optimize the health and wellbeing of women with HIV and their children. Acquisition of HIV during pregnancy from male partners was identified as an ongoing concern, and strategies such as partner HIV testing during pregnancy are needed not only to prevent transmission to pregnant women and children, but also to provide HIV treatment for the health of partners. New strategies to ensure that HIV treatment and preventive interventions are not only effective, but also safe during conception, throughout pregnancy and lactation are needed. In addition, up-to-date, comprehensive, and timely surveillance systems are needed for continuous and vigilant monitoring of the long-term safety of prenatal and early-life antiretroviral exposure. Women with HIV in the United States are increasingly expressing desires to breastfeed their infants, and recommendations in the United States regarding infant feeding for people with HIV are evolving. Developing and disseminating information to support women with HIV and their providers is needed to ensure infant feeding approaches optimize infant and maternal health.As considerations of perinatal HIV transmission evolve in this era, it will be necessary to maintain a public health and clinical workforce capable of dealing with the many issues.  This NOFO will support activities that contribute to maintaining the gains in perinatal HIV prevention and perhaps further reduce the annual number of perinatal HIV infections.  It also will contribute to improvements in maternal, paternal and child health along the HIV prevention and care continuums.If additional funds become available, this NOFO will provide opportunities to share infrastructure and resources with health care providers and public health professionals to utilize similar approaches to reduce other congenital or perinatal infections, including congenital syphilis, in the United States.