Clients' experiences utilizing a safer conception service for HIV affected individuals: Implications for differentiated care service delivery models

Sheree Schwartz, Natasha Davies, Nicolette Naidoo, Diantha Pillay, Nokuthula Makhoba, Saiqa Mullick

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Safer conception services promote the reproductive health and rights of families, while minimizing HIV transmission risks between partners trying to conceive, as well vertical transmission risks. Implementation data, including clients' experiences utilizing safer conception services in sub-Saharan Africa are limited. Methods: Hillbrow Community Health Centre began offering safer conception services for individuals and couples affected by HIV in Johannesburg, South Africa in June 2015. A stratified sub-sample of safer conception clients were consecutively recruited from April 2016-August 2017 for a cross-sectional interview assessing clients' perceptions of service acceptability and value, as well as perceived safer conception knowledge and self-efficacy. Visual analog scales from 0 to 100 were used to measure clients' experiences; scores were classified as low, moderate and high acceptance/value/knowledge/self-efficacy if they were < 50, 50-79 and ≥ 80 respectively. Comparisons of scores were made across safer conception visits attended. Results: Among 692 clients utilizing safer conception services, 120 (17%) were sampled for the process evaluation; sub-sample participant characteristics were similar to the overall cohort. Clients gave a mean score of ≥90-points for each question assessing service acceptability and 96% (114/119) indicated a high perceived value (scores ≥80) for regular safer conception attendance until conception. Fifty-eight percent (n = 70) of clients reported learning something new during the visit completed the day of the survey, though acquisition of new information tended to decrease as visits increased (p = 0.09). In terms of safer conception strategies, 80% of clients reported high levels of knowledge on the impact of antiretroviral treatment (ART) and viral suppression on HIV transmission, 67% reported high levels of knowledge of the importance of STI screening and 56% regarding limiting condomless sex to days of peak fertility; 34% in sero-different relationships reported high pre-exposure prophylaxis (PrEP) knowledge. Self-efficacy varied by safer conception methods and was similar across study visits. Conclusions: Clients perceived high value from their safer conception visits and preferred regular attendance until conception, however we observed a plateau in knowledge and self-efficacy across subsequent visits after initially attending safer conception care. More intensive services may be appropriate for certain clients based on clinical circumstances, but many couples may potentially receive a 'lighter touch' approach while still minimizing HIV transmission risks.

Original languageEnglish (US)
Article number65
JournalReproductive health
Volume16
DOIs
StatePublished - May 29 2019

Keywords

  • Differentiated care
  • Discordant couples
  • HIV
  • HIV prevention
  • Implementation
  • Safer conception

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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