“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

Abstract

Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…Factors affecting SCS availability from the individual or couple’s perspective included lack of awareness about safer conception services [20, 22, 33, 36–42] and limited integration of services for sexual and reproductive health into HIV care [43–45]. Few patients discussed fertility goals with providers, and discussions around pregnancy focused on maternal and child health and not on sexual HIV transmission [39–41, 46].…”

“…Thirteen studies were qualitative assessments of healthcare providers and people living with HIV or serodiscordant couples. Several studies found that providers rarely initiated discussion of fertility intentions and reproductive goals with HIV-affected clients during visits [24, 39, 41, 42, 46, 50, 58, 65]. When fertility intentions were assessed, usually only the woman’s reproductive goals were discussed and not the man’s or couples [58, 61].…”

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

“…Many recent safer conception studies and public programmes have shown good uptake of safer conception strategies, including ART and PrEP [25][26][27][28][29]. To the best of our knowledge, ours is the first study to estimate the effectiveness of a safer conception intervention on HIV transmission risk.…”

Client uptake of safer conception strategies: implementation outcomes from the Sakh'umndeni Safer Conception Clinic in South Africa

“…Consequently, provider efforts tend to be limited to maternal health and prevention of vertical transmission of HIV [10,12,14]. As a result, patients have limited knowledge of safer conception methods, which limits their uptake of safer conception strategies and their ability to reduce HIV transmission risks [15–17].…”