Undiagnosed HIV Infection and Couple HIV Discordance Among Household Members of HIV-Infected People Receiving Antiretroviral Therapy in Uganda

Were, Willy; Mermin, Jonathan; Wamai, Nafuna; Awor, Anna; Bechange, Stevens; Moss, Susan; Solberg, Peter; Downing, Robert; Coutinho, Alex; Bunnell, Rebecca

doi:10.1097/01.qai.0000225021.81384.28

Cited by 122 publications

(104 citation statements)

References 19 publications

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“…[1][2][3][4][5][6][7][8] Yet in sub-Saharan Africa, where approximately 50% of couples with an HIV-infected partner are HIV-serodiscordant, these ''safer conception'' strategies are often unavailable or not discussed early enough with HIV-serodiscordant couples who desire children. 9,10 These couples would benefit from education and counseling about accessible and feasible safer conception strategies that protect HIV-uninfected partners during peri-conception (i.e., pregnancy attempts without condoms). For African HIV-serodiscordant couples in low resource settings, feasible peri-conception risk reduction strategies may include limiting condomless sex to peak fertility periods, antiretroviral pre-exposure prophylaxis (PrEP) taken by the HIV-uninfected partner, antiretroviral treatment (ART) to suppress viral load of the HIV-infected partner, treatment of sexually transmitted infections, infertility screening, and/or vaginal self-insemination when the woman is HIV-infected.…”

Section: Introductionmentioning

confidence: 99%

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Pintye

Ngure

Curran

et al. 2015

AIDS Patient Care and STDs

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HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIVserodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions.

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Section: Introductionmentioning

confidence: 99%

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Pintye

Ngure

Curran

et al. 2015

AIDS Patient Care and STDs

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“…4. HIV voluntary counselling and testing (VCT) among family members of people with HIV (family VCT) effectively identifies children and adults with HIV as well as HIV-discordant couples (Were, 2006;Malamba 2005). 5.…”

Section: Introductionmentioning

confidence: 99%

Utilization of a basic care and prevention package by HIV-infected persons in Uganda

et al. 2008

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Opportunistic infections are the leading cause of mortality among HIV-infected people. Several simple interventions prevent illness, prolong life, or prevent HIV transmission from HIV-infected people in Africa. These include: cotrimoxazole prophylaxis; insecticide-treated bed nets; supplies for household water treatment and safe storage; materials promoting family voluntary counselling and testing (VCT); and condoms. We provided these interventions to adults and children with HIV who were members of the AIDS Support Organization in Uganda. To evaluate use of this basic care and prevention package, we surveyed a representative sample of 112 clients of TASO in their homes. Among respondents, 95% reported taking cotrimoxazole everyday, 89% said they had slept under a bednet the night before, 65% reported current treatment of household drinking water, 89% of sexually active respondents reported using condoms, and 96% reported family use of VCT. Household observations verified that use of cotrimoxazole, bednets, and water treatment products were consistent with reported use. This evaluation suggests successful distribution and use of basic care and prevention services at an AIDS organization in Uganda.

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“…1,4,5 Studies in sub-Saharan Africa have shown a prevalence of HIV discordance among couples of 3-20% in the general population 6-8 and 20-35% among couples with one partner seeking HIV care. [9][10][11] A multi-site HIV prevention trial at eastern and southern Africa sites found a prevalence of HIV discordance of 27% in 1,126 couples screened in South Africa and 14% in 477 couples screened in Tanzania. 12 However, with the exception of participants tested for HIV in a research context, many individuals living in resourcepoor countries are unaware of their own and their partners' HIV status.…”

mentioning

confidence: 99%

Sexual relations and childbearing decisions of HIV-discordant couples: an exploratory study in South Africa and Tanzania

Rispel

Metcalf

Moody

et al. 2011

Reproductive Health Matters

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Undiagnosed HIV Infection and Couple HIV Discordance Among Household Members of HIV-Infected People Receiving Antiretroviral Therapy in Uganda

Abstract: Provision of home-based VCT to household members of people initiating ART was well accepted and resulted in the detection of a large number of previously undiagnosed HIV infections and HIV-discordant relationships.

Cited by 122 publications

References 19 publications

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Utilization of a basic care and prevention package by HIV-infected persons in Uganda

Sexual relations and childbearing decisions of HIV-discordant couples: an exploratory study in South Africa and Tanzania

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