Promoting reproductive options for <scp>HIV</scp>‐affected couples in sub‐Saharan Africa

Mmeje, Okeoma; Cohen, CR; Murage, Alfred; Ong’ech, John; Kiarie, James; Poel, Sheryl van der

doi:10.1111/1471-0528.12876

Cited by 13 publications

(19 citation statements)

References 41 publications

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“…Our work in Kenya, along with similar findings from other studies, suggests that many HCPs and most HIV-affected individuals and couples are unaware of safer conception strategies that are currently available (Finocchario-Kessler et al, 2014; Matthews et al, 2014; Mmeje, Cohen, et al, 2014). HCP attitudes toward HIV-affected couples and their lack of knowledge about safer reproductive methods are barriers to the availability, provision, and uptake of safer conception services by HIV-affected couples desiring children (Breitnauer et al, 2015; Matthews et al, 2014).…”

Section: Delivery Of Safer Conception Services In Kenyasupporting

confidence: 81%

“…According to the World Health Organization, all individuals have the basic reproductive right to information and the ability to decide and control their reproductive decision-making (United Nations Populations Fund [UNFPA], 1994). In an effort to promote reproductive autonomy and curb HIV incidence, HIV-affected individuals and couples need access to information on safer methods of conception (Mmeje, Titler, & Dalton, 2014; Mmeje et al, 2014; Schwartz et al, 2014). Safer conception strategies are harm-reduction techniques intended to help HIV-infected individuals and their partners achieve pregnancy, while limiting the risk of HIV transmission to the uninfected partner and unborn child (Bekker et al, 2011; Crankshaw et al, 2012; Matthews & Mukherjee, 2009).…”

Section: Delivery Of Safer Conception Services In Kenyamentioning

confidence: 99%

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Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

et al. 2016

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Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV–serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and treatment programs in Kenya and other HIV endemic regions of sub-Saharan Africa.

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Section: Delivery Of Safer Conception Services In Kenyasupporting

confidence: 81%

Section: Delivery Of Safer Conception Services In Kenyamentioning

confidence: 99%

Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

et al. 2016

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“…at least two‐thirds of couples living with HIV are in five sub‐Saharan African countries) . At the beginning of the HIV epidemic, as indicated by the Centers for Disease Control and Prevention, couples with an partner living with HIV were discouraged from considering childbearing because of the poor prognosis of those infected and the few options to reduce the risk of HIV transmission . Currently, these couples are planning their futures together, which may include the desire and intention to have biological children .…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

et al. 2019

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Introduction Better knowledge about fertility desires/intentions among HIV ‐serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the prevalence of fertility desires/intentions and its associated factors among individuals in HIV ‐serodiscordant relationships while distinguishing low‐ and middle‐income countries ( LMIC ) from high‐income countries ( HIC ). Methods A systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/ MEDLINE , Psyc INFO , Web of Science and Cochrane Library). Empirical studies published in peer‐reviewed journals with individuals in HIV ‐serodiscordant relationships assessing the prevalence of fertility desires/intentions and/or the associated factors were included in this systematic review. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses ( PRISMA ) guidelines. Results and discussion After screening 1852 references, 29 studies were included, of which 21 were conducted in LMIC and eight in HIC . A great variability in the prevalence of fertility desires/intentions was observed in LMIC (8% to 84% (one member of the dyad included)). In HIC , the results showed a smaller discrepancy between in the prevalence (32% to 58% (one member of the dyad included)); the prevalence was higher when the couple was the unit of analysis (64% to 73%), which may be related to the fact that all these studies were conducted in the context of assisted reproduction. Few studies examined the factors associated with fertility desires/intentions, and all except one were conducted in LMIC . Individuals (e.g. number of children), couple‐level (e.g. belief that the partner wanted children) and structural factors (e.g. discussions with health workers) were found to be associated. Conclusions The results of this systematic review suggest that many individuals in HIV ‐serodiscordant relationships have fertility desires/intentions, although the prevalence is particularly heterogeneous in LMIC in comparison to HIC . Well‐known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions. Different couple‐level factors emerged, reflecting the importance of considering both the individual and the couple. However, further stu...

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“…While some of these strategies are generally available (including ART and VMMC), most interventions and counseling focused on safer conception may be unavailable in sub-Saharan Africa, where the majority of HIV affected couples reside [15]. Women living in sub-Saharan Africa comprise 58% of the total number of people living with HIV (PLWH) globally [1], and it is estimated that 75% of HIV-affected partnerships are serodiscordant in countries with low HIV prevalence and 37% are serodiscordant in countries with high HIV prevalence [16].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.

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Promoting reproductive options for HIV‐affected couples in sub‐Saharan Africa

Cited by 13 publications

References 41 publications

Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

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

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