A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya

Brown, Joelle; Njoroge, Betty; Akama, Eliud; Breitnauer, Brooke; Leddy, Anna M.; Darbes, Lynae A.; Omondi, Richard; Mmeje, Okeoma

doi:10.1521/aeap.2016.28.6.524

Cited by 19 publications

(19 citation statements)

References 39 publications

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“…In the past decade, worldwide, there has been a steady increase in research, service delivery, and advocacy to support women living with HIV to make informed decisions about whether, when, and how to become mothers [1,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. National normative guidelines on safer conception have been issued in Canada [26], South Africa [9], and the United Kingdom [27], and the World Health Organization delineates strategies for achieving safe and healthy pregnancy in its guidelines on the sexual and reproductive health and rights of women living with HIV [10].…”

Section: Background/rationalementioning

confidence: 99%

“…In addition, however, there is a need to ensure that services are prepared to address HIV-positive women's desire to have children in the future. Policymakers and service delivery organizations in Tanzania and elsewhere can consider building on existing national guidelines from South Africa, consensus statements from safer conception researchers and advocates for people living with HIV (PLHIV), and a safer conception toolkit that has been tested in Kenya, for instance [1,9,17]. In addition, once PrEP becomes available more widely, this may present an opportunity to test the acceptability of pre-conception PrEP for seronegative partners in mixed-status relationships.…”

Section: Plos Onementioning

confidence: 99%

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Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Yam

Kahabuka²,

Mbita³

et al. 2020

PLoS ONE

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Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive womenincluding female sex workers-often plan to have children someday. Various "safer conception" strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego's Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was "too little." Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13-4.20) and having fewer children (AOR 0.65, 95% CI 0.48-0.87). Viral suppression was not associated with fertility desire.

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Section: Background/rationalementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Yam

Kahabuka²,

Mbita³

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

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“…One barrier to fully minimizing HIV transmission risk during peri‐conception is knowledge about safer conception options among individuals and providers and the initiation of discussion about these methods (individually and as a package) between providers and patients . Tools have been developed to empower providers to initiate discussions with couples about pregnancy plans and guidance from the World Health Organization promotes safer conception counselling . Yet prevailing community perspectives and assumptions about sexual and perinatal HIV transmission by people living with HIV prevent many individuals and couples from actively seeking safer conception counselling or services .…”

Section: Introductionmentioning

confidence: 99%

Implementation of a comprehensive safer conception intervention for HIV‐serodiscordant couples in Kenya: uptake, use and effectiveness

et al. 2019

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Introduction Safer conception strategies minimize HIV risk during condomless sex to become pregnant. Gaps remain in understanding the acceptability, feasibility and choices HIV ‐serodiscordant couples make when multiple safer conception options are available. Methods We conducted a pilot study of a comprehensive safer conception package for HIV ‐serodiscordant couples with immediate fertility desires in Kenya from March 2016 to April 2018. The intervention package included antiretroviral therapy ( ART ) for HIV ‐positive partners, oral pre‐exposure prophylaxis (Pr EP ) for HIV ‐negative partners, daily fertility and sexual behaviour tracking via short message service ( SMS ) surveys, counselling on self‐insemination, and referrals for voluntary medical male circumcision and fertility care. Couples attended monthly visits until pregnancy with HIV testing for negative partners at each visit. We estimated the number of expected HIV seroconversions using a counterfactual cohort simulated from gender‐matched couples in the placebo arm of a previous Pr EP clinical trial. We used bootstrap methods to compare expected and observed seroconversions. Results Of the 74 enrolled couples, 54% were HIV ‐negative female/ HIV ‐positive male couples. The 6 and 12‐month cumulative pregnancy rates were 45.3% and 61.9% respectively. In the month preceding pregnancy, 80.9% of HIV ‐positive partners were virally suppressed, 81.4% of HIV ‐negative partners were highly adherent to Pr EP , and SMS surveys indicated potential timing of condomless sex to peak fertility (median of sex acts = 10, interquartile range ( IQR ) 7 to 12; median condomless sex acts = 3.5, IQR 1 to 7). Most (95.7%) pregnancies were protected by ≥2 strategies: 57.4% were protected by high Pr EP and ART adherence, male circumcision with or without timed condomless sex; 10 (21.3%) were protected by viral suppression in the HIV ‐positive partner and male circumcision with or without timed condomless sex; 8 (17.0%) were protected by high Pr EP adherence and male circumcision with or without timed condomless sex. We observed 0 HIV seroconversions (95% CI 0.0 to 6.0 per 100 person years), indicating a 100% reduction in HIV risk ( p = 0.04). Conclus...

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“…Those studies, along with our findings, highlight the urgent need for integrating family planning, and interventions for safer conception into HIV care and treatment [ 29 , 38 ]. Another study evaluated a Safer Conception Toolkit for HIV care and treatment providers and HIV discordant couples trying to conceive in Kenya [ 39 ]. A recent study in South Africa found high uptake of safer contraception methods suggesting that combination prevention methods are acceptable to clients and appropriate for scale-up [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia

et al. 2018

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IntroductionAttempts to conceive and pregnancy may increase HIV transmission to sex partners and infants. Our study evaluated the association between fertility intentions and HIV acquisition among Zambian HIV-serodiscordant couples.MethodsWe collected demographic, behavioral, clinical exposures, and data on fertility intentions in a cohort of HIV-serodiscordant couples in Lusaka, Zambia from 2005 to 2012. We evaluated factors associated with fertility intentions stratified by gender using multivariable logistic regression. Multivariable Cox proportional hazard models were used to evaluate the associations between fertility intentions and HIV acquisition controlling for a priori confounders and covariates that substantially (>10%) changed the effect estimates in univariate analyses.ResultsAmong 1,029 serodiscordant couples, 311 agreed that they wanted children in the future (30%), 368 agreed they did not want children (36%), and 344 couples disagreed about having children (34%), with men more likely than women to want children. Women wanting child(ren) was associated with increased odds of baseline pregnancy (adjusted odds ratio [aOR] = 4.80 (95% confidence interval [CI] = 2.93, 7.85)), fewer previous pregnancies (aOR = 0.85 per additional pregnancy (95% CI = 0.78, 0.93)), and partner fertility intention (aOR = 2.89 (95% CI = 2.14, 3.91)) adjusting for woman’s age, literacy, years cohabiting and HIV status. Men wanting child(ren) was associated with younger age (aOR = 0.96 per year (95% CI = 0.93, 0.99)), fewer years cohabiting (aOR = 0.95 (95% CI = 0.92, 0.98)), number of previous partners’ pregnancies (aOR = 0.90 (95% CI = 0.82, 0.98)), and partner fertility intention (aOR = 3.00 (95% CI = 2.21, 4.07)) adjusting for partner’s age, literacy, HIV status and partner’s baseline pregnancy. In adjusted survival analyses, HIV-negative women were more likely to seroconvert if they themselves wanted children (aHR = 2.36 (95% CI = 1.41, 3.96)) vs. did not want children, or if their partner wanted children (aHR = 2.34 (95% CI = 1.33, 4.11)) vs. did not want children, or if the couple agreed that they wanted children (aHR = 2.08 (95% CI = 1.01, 4.30)), adjusting for women’s age, women’s literacy, previous pregnancies and time in study. HIV-negative men were more likely to seroconvert if their female partner wanted a child in the next 12-months (aHR = 1.94 (95% CI = 1.02, 3.68)) vs. did not want children, and when both partners wanted children (aHR = 2.02 (CI = 1.09, 3.73)) vs. they did not want children, adjusting for men’s age and literacy, couple income, number of live children, male circumcision status and time in study.ConclusionWomen had increased risk of HIV acquisition if they and/or their partner wanted a child, while men had increased risk of HIV acquisition when their partner or if both partners agreed that they wanted children. Safer-conception interventions are needed to protect HIV uninfected women and men from HIV acquisition in HIV-serodiscordant couples who want children.

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A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya

Cited by 19 publications

References 39 publications

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Implementation of a comprehensive safer conception intervention for HIV‐serodiscordant couples in Kenya: uptake, use and effectiveness

Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia

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