Provider Attitudes toward Discussing Fertility Intentions with HIV-Infected Women and Serodiscordant Couples in the USA

Rahangdale, Lisa

doi:10.4172/2155-6113.1000307

Cited by 9 publications

(5 citation statements)

References 31 publications

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“…A recent qualitative study found that clinical and non-clinical providers in substance abuse treatment centers in New York City had limited awareness of PrEP’s effectiveness for PWID [ 3 ] (11% of respondents) but when it was explained to them, identified challenges to incorporating it into their services, as well as receptivity to learning about its delivery to clients they identified as likely to benefit from it [ 25 ]. A recent survey of women’s health clinicians attending a regional HIV conference found that 66–72% (depending on the sex of the uninfected partners) had discussed PrEP with an HIV-discordant couple interested in pregnancy conception [ 26 ]. For primary care clinicians to successfully incorporate PrEP into their practices, it will be important to learn applicable lessons from adoption of other preventive innovations in clinical settings [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States, 2009–2015

et al. 2016

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ObjectivesAs trials were assessing the safety and efficacy of daily oral antiretroviral preexposure prophylaxis (PrEP) for the prevention of HIV infection, there was a clear need to understand the evolution of knowledge of, and attitudes toward, PrEP among primary care clinicians.MethodsPhysicians and nurse practitioners were surveyed in 2009 (n = 1500), 2010 (n = 1504), 2012 (n = 1503), 2013 (n = 1507), 2014 (n = 1508) and 2015 (n = 1501) to assess their awareness of PrEP, willingness to prescribe PrEP, and whether they support use of public funds to pay for PrEP. Pharmacists (n = 251) were surveyed about PrEP in 2012 only. Descriptive statistics were computed for physician demographics and PrEP-related questions. Prevalence ratios for willingness to prescribe PrEP were computed using Poisson regression analysis.ResultsAwareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 66%). Following a description of PrEP with an estimated effectiveness of 75%, across 6 of the study years 91% of clinicians indicated a willingness to prescribe PrEP to at least one group at high risk of HIV acquisition. A smaller majority of clinicians indicated support for public funding of PrEP in 2009: 59%, 2010: 53%, and 2013: 63%.ConclusionsIn surveys conducted before and after the release of PrEP trial results, primary care clinicians were largely unaware of PrEP. They indicated high levels of willingness to prescribe it for patients at high risk of HIV acquisition and expressed interest in education about how to deliver this new clinical HIV prevention method. It will be important to continue monitoring clinician knowledge, attitudes, and practices as the use of PrEP increases in the US.

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Section: Resultsmentioning

confidence: 99%

PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States, 2009–2015

et al. 2016

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“…Initiating clinician counseling could be accomplished with a simple question about fertility desires, as was done in this study, or could be part of a more in-depth assessment. Studies have shown that major barriers to safer conception counseling include: clinicians not routinely initiating discussions with patients around fertility desires, a reluctance to provide safer conception knowledge to patients perceived as not being prepared for conception, and gaps in knowledge of safer conception strategies (Rahangdale, Richardson, Carda-Auten, Adams, & Grodensky, 2014; West et al, 2015). A more recent study in Uganda showed that even when those barriers are removed, a lack of training on how to counsel patients about safer conception can be a barrier (Matthews et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences

et al. 2018

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For HIV-1 serodiscordant couples, HIV-1 exposure and risk of transmission is heightened during pregnancy attempts, but safer conception strategies can reduce risk. As safer conception programs are scaled up, understanding couples' preferences and experiences can be useful for programmatic recommendations. We followed 1013 high-risk, heterosexual HIV-1 serodiscordant couples from Kenya and Uganda for two years in an open-label delivery study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), the Partners Demonstration Project. We used descriptive statistics to describe the cohort and multivariate logistic regression to characterize women who reported use of a safer conception strategy by their first annual visit. 66% (569/859) of women in the study were HIV-infected and 73% (627/859) desired children in the future. At the first annual visit, 59% of women recognized PrEP, 58% ART, 50% timed condomless sex, 23% self-insemination, and fewer than 10% recognized male circumcision, STI treatment, artificial insemination, and sperm washing as safer conception strategies. Among those recognizing these strategies and desiring pregnancy, 37% reported using PrEP, 14% ART, and 30% timed condomless sex. Women who reported discussing their fertility desires with their male partners were more likely to report having used at least one strategy for safer conception (adjusted odds ratio = 1.91, 95% confidence interval:1.26-2.89). Recognition of use of safer conception strategies among women who expressed fertility desires was low, with ARV-based strategies and self-insemination the more commonly recognized and used strategies. Programs supporting HIV-1 serodiscordant couples can provide opportunities for couples to talk about their fertility desires and foster communication around safer conception practices.

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“…The application of the 'expanding range of behavioral and pharmacological strategies [that] may reduce HIV transmission risk for serodiscordant couples who wish to have a child' (Crankshaw et al 2012: .1) requires that people deliberately take cognisance of, and respond to, multiple avenues for reducing transmission opportunities that include 'the use of ART, male circumcision, timed unprotected intercourse, PrEP, and assisted reproductive technology as safer methods of conception for serodiscordant couples' (Mmeje et al 2012: 5, also see Rahangdale et al 2014) -as well as taking cognisance of environmental factors that facilitate co-infections (King et al 2013).…”

Section: Descriptive and Dynamic Preventionmentioning

confidence: 99%

Reducing the overall HIV-burden in South Africa: is ‘reviving ABC’ an appropriate fit for a complex, adaptive epidemiological HIV landscape?

Burman

Aphane

Delobelle

2015

African Journal of AIDS Research

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This article questions the recommendations to 'revive ABC (abstain, be faithful, condomise)' as a mechanism to 'educate' people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, 'descriptive' prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of 'dynamic prevention' at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the 'descriptive prevention' parameters can facilitate. The parameters of the 'descriptive prevention' paradigm, that maintain - and partially reinforce - the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the 'descriptive paradigm', and ABC, represents an historically dislocated form of prevention - with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.

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Provider Attitudes toward Discussing Fertility Intentions with HIV-Infected Women and Serodiscordant Couples in the USA

Cited by 9 publications

References 31 publications

PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States, 2009–2015

PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States, 2009–2015

Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences

Reducing the overall HIV-burden in South Africa: is ‘reviving ABC’ an appropriate fit for a complex, adaptive epidemiological HIV landscape?

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