Preconception care for people living with HIV

Abstract

Globally, research has documented high fertility desires and intentions among HIV-positive women. Improving implementation of preconception care (PCC) for people living with HIV is critical, given estimates that the majority of HIV-positive women who want future biological children have not received reproductive counseling, largely due to a lack of provider-initiated conversations. This article offers initial recommendations and outlines key considerations for a research agenda to advance PCC implementation efforts in both high-resource and low-resource settings. We consider who should provide PCC; where it can be effectively delivered; when it should be offered; and two potential implementation models depending on available resources. We conclude with a call for PCC-specific implementation science and research translation to help people living with HIV achieve their reproductive goals.

“If I don’t use a condom … I would be stressed in my heart that I’ve done something wrong”: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa

“…Thus, although all providers should be trained to counsel clients on basic safer conception principles (e.g. delay conception attempts until the infected partner is on ART), subsequent referral system to a designated, available provider who can offer in-depth advice may be acceptable to clients (66). Public health campaigns to improve awareness of safer conception strategies for the general population are also needed.…”

Providers’ perspectives on preconception counseling and safer conception for HIV-infected women

“…There is limited data published on physician attitudes regarding childbearing in HIV-infected women (Steiner, Dariotisa et al, 2013, Steiner, Finocchario-Kessler, & Dariotis, 2013; Yudin et al, 2012). Based on this study, we recommend that additional strategies are identified to enhance the dissemination and implementation of PCC protocols for HIV-infected women across the specialties of HIV medicine, OB/GYN, and primary care.…”

“…PCC is also recommended when there is a change in a woman’s relationship status, or she is taking medications with potential reproductive toxicity or interaction with hormonal contraceptives (Panel on Treatment, 2014). Despite recommendations, protocols, and brochures to guide PCC in HIV care, counseling appears to be infrequently or cursorily addressed by health-care providers (Nattabi, Li, Thompson, Orach, & Earnest, 2009; Steiner, Dariotisa, Anderson, & Finocchario-Kessler, 2013). As few as 31% of HIV-infected women may receive a personalized discussion with their HIV provider regarding their own fertility desires and intentions, the majority of whom (64%) may have to initiate the conversation themselves (Finocchario-Kessler et al, 2010).…”

Implementation of a safer conception service for HIV-affected couples in South Africa

“…The extent to which safer conception services are being offered in high-burden, resource-limited settings is unknown, and the outcomes of such services remain unreported [23]. Building an evidence base for safer conception strategies will be necessary before services can be rolled out across Sub-Saharan African (SSA) countries.…”