Implementation of a safer conception service for HIV-affected couples in South Africa
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 i...
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Published in | AIDS (London) Vol. 28 Suppl 3; no. Supplement 3; pp. S277 - S285 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Lippincott Williams & Wilkins, Inc
01.07.2014
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Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0269-9370 1473-5571 |
DOI: | 10.1097/QAD.0000000000000330 |