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

Abstract

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...

“They haven’t asked me. I haven’t told them either”: fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

“…Although safer conception strategies are required to optimize health outcomes of WLHIV, their infants and their partners [39], our findings highlighted that safer conception discussions were mainly reported by HCPs. This included clinical readiness, such as a higher CD4 count, a lower viral load, and not being at AIDS stage 3 or 4.…”

Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya

“…Women were recruited from August 2017 -March 2018 at an HIV prevention and care clinic in Thika, Kenya. They were participants in a larger trial, the Safer Conception Intervention for Partners (SCIP) study (clinicaltrials.gov #NCT03030768), which included 74 mutually-disclosed HIV serodiscordant couples with immediate fertility intentions [30]. SCIP was a pilot intervention study of a comprehensive safer conception package, including integrated antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), menstrual cycle tracking, and referral for other safer conception services [30].…”

“…They were participants in a larger trial, the Safer Conception Intervention for Partners (SCIP) study (clinicaltrials.gov #NCT03030768), which included 74 mutually-disclosed HIV serodiscordant couples with immediate fertility intentions [30]. SCIP was a pilot intervention study of a comprehensive safer conception package, including integrated antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), menstrual cycle tracking, and referral for other safer conception services [30]. The SCIP parent study screened a total of 119 women in HIV serodiscordant couples, of whom 83 were eligible for SCIP study participation and 74 were enrolled [30].…”

“…SCIP was a pilot intervention study of a comprehensive safer conception package, including integrated antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), menstrual cycle tracking, and referral for other safer conception services [30]. The SCIP parent study screened a total of 119 women in HIV serodiscordant couples, of whom 83 were eligible for SCIP study participation and 74 were enrolled [30]. Participants were eligible for the SCIP parent study if they were over 18 years of age and less than 50 years of age, expressed a desire for pregnancy in the next 3 years, were sexually active, were willing to enter the study as a couple with their male partner, and intended to remain a couple for the study duration.…”

“…Participants were initially recommended for cognitive interviews by the counselor who administered their PHQ-9. The study coordinator and counselors kept track of participant demographic factors after completion of Phase 1 and then referred individuals for Phase 2 in similar proportions to the overall SCIP parent study sample (e.g., 46% of SCIP parent study participants were women living with HIV and we sought to also interview approximately 40% of women living with HIV) [30]. The counselor brought the completed PHQ-9 and debriefing report to the psychologist, who approached potential participants, explained the purpose of the interviews, and reminded participants that interview participation would not affect their participation in the SCIP study or their clinical care.…”