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

• Published in: AIDS (London) Vol. 28 Suppl 3; no. Supplement 3; pp. S277 - S285
• Main Authors: Schwartz, Sheree R, Bassett, Jean, Sanne, Ian, Phofa, Rebecca, Yende, Nompumelelo, Van Rie, Annelies
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins, Inc 01.07.2014
• Subjects: Adult; AIDS/HIV; Cohort Studies; Family Characteristics; Female; Fertilization; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV Infections - transmission; Humans; Infant; Infant, Newborn; Lentivirus; Male; Pregnancy; Reproductive Health; Retroviridae; Sexual Partners; South Africa; South Africa
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000000330

OBJECTIVE:To describe the development and implementation of a safer conception service in a resource-limited setting. METHODS:Qualitative work to inform the design of a safer conception service was conducted with clients and providers at Witkoppen Health and Welfare Centre, a primary health center in Johannesburg, South Africa. Services began in July 2013 for HIV-affected participants planning conception within 6 months and included counseling about timed unprotected intercourse and home-based self-insemination, early initiation of combined antiretroviral therapy (cART) for HIV-infected individuals, pre-exposure prophylaxis for HIV-uninfected partners and circumcision for men. Participants were enrolled into an implementation science study evaluating method uptake, acceptability, and pregnancy and HIV transmission outcomes. RESULTS:Findings to-date from 51 qualitative participants and 128 clinical cohort participants (82 women and 46 men, representing 82 partnerships) are presented. All men were accompanied by female partners, whereas 56% of women attended with their male partner. Fifteen of the 46 couples (33%) were in confirmed serodiscordant relationships; however, of the 36 additional women attending alone, 56% were unaware of their partners’ HIV status or believed them to be HIV-uninfected. The majority of the HIV-infected women (86%) and men (71%) were on cART at enrollment; however, only 47% on cART were virally suppressed. Timed unprotected intercourse, self-insemination and cART were common choices for participants; few elected pre-exposure prophylaxis. CONCLUSIONS:Lessons learned from early implementation demonstrate feasibility of safer conception services; however, reaching discordant couples, cART-naïve infected partners, and men remain challenges. Creating demand for safer conception services among those at highest risk for HIV transmission is necessary.