Abstract
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.
Original language | English (US) |
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Pages (from-to) | S277-S285 |
Journal | AIDS |
Volume | 28 |
Issue number | SUPPL. 3 |
DOIs | |
State | Published - Jul 2014 |
Externally published | Yes |
Keywords
- HIV-1
- discordant couples
- fertility
- prevention of mother-to-child transmission
- safer conception
- treatment as prevention
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases