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Gitome S, Musara P, Chitukuta M, Mhlanga F, Mateveke B, Chirenda T, Mgodi N, Mutero P, Matubu A, Chareka G, Chasakara C, Murombedzi C, Makurumure T, Smith-Hughes C, Bukusi E, Cohen CR, Shiboski S, Darbes L, Rutherford GW, Chirenje ZM, Brown JM. " First was to sit down and bring our minds together". A qualitative study on safer conception decision-making among HIV sero-different couples in Zimbabwe. Sex Reprod Health Matters 2024; 32:2366587. [PMID: 39007699 PMCID: PMC11251431 DOI: 10.1080/26410397.2024.2366587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.
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Affiliation(s)
- Serah Gitome
- Clinical Research Scientist, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Petina Musara
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Miria Chitukuta
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Felix Mhlanga
- Senior Lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe; Principal Investigator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Bismark Mateveke
- Obstetrician & Gynecologist, Honorary lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe
| | - Thandiwe Chirenda
- Registered Nurse/Midwife, Clinical Research Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Nyaradzo Mgodi
- Clinical Research Site Leader, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Prisca Mutero
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Allen Matubu
- Laboratory Director, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Gift Chareka
- Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Charles Chasakara
- Community Engagement Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Caroline Murombedzi
- Research Pharmacist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Tinei Makurumure
- Laboratory Director, Mercy-Care Fertility Centre, Harare, Zimbabwe
| | - Carolyn Smith-Hughes
- Associate Director of Evidence Translation, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Elizabeth Bukusi
- Senior Principal Clinical Research Scientist, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen Shiboski
- Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lynae Darbes
- Professor, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA
| | - George W. Rutherford
- Professor, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Z. Michael Chirenje
- Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Professor, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Joelle M. Brown
- Associate Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Isehunwa OO, Jaggernath M, Kriel Y, Psaros C, Mathenjwa M, Hurwitz KE, Bennett K, Smith PM, Bangsberg DR, Marrazzo JM, Haberer JE, Smit JA, Matthews LT. Uptake and Persistence of Safer Conception Strategies Among South African Women Planning for Pregnancy. AIDS Behav 2024:10.1007/s10461-024-04475-z. [PMID: 39240299 DOI: 10.1007/s10461-024-04475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
Safer conception strategies can minimize HIV acquisition during periconception periods among women living in HIV-endemic areas. We examined uptake and predictors of persistent use of the same safer conception strategy among a cohort of HIV-uninfected South African women ages 18-35 years planning for pregnancy with a partner living with HIV or of unknown HIV-serostatus. The safer conception strategies we evaluated included oral PrEP, condomless sex limited to peak fertility, and waiting for a better time to have a child (until, for example, the risks of HIV acquisition are reduced and/or the individual is prepared to care for a child); persistence was defined as using the same safer conception strategy from the first visit through 9 months follow-up. Modified Poisson regression models were used to examine predictors of persistent use of the same strategy. The average age of 227 women in our cohort was 24.6 (range: 18.0, 35.7) years. In this cohort, 121 (74.2%) women reported persisting in the same strategy through 9 months. Employment and HIV knowledge were associated with the persistent use of any strategy. Our results highlight the need to provide safer conception services to women exposed to HIV during periconception periods. Findings also offer some insights into factors that might influence persistent use. Further research is needed to better understand how to involve male partners and how their involvement might influence women's consistent use of safer conception strategies during periconception periods.
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Affiliation(s)
- Oluwaseyi O Isehunwa
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, 703 19Th Street South, Birmingham, AL, 35233, USA.
| | - Manjeetha Jaggernath
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Yolandie Kriel
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Mxolisi Mathenjwa
- Epidemiology and Prevention Department, Centre for the AIDS Programme of South Africa (CAPRISA), Durban, South Africa
| | | | | | - Patricia M Smith
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, 703 19Th Street South, Birmingham, AL, 35233, USA
| | | | - Jeanne M Marrazzo
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, 703 19Th Street South, Birmingham, AL, 35233, USA
| | - Jessica E Haberer
- Department of Medicine, Harvard Medical School, Boston, USA
- Center for Global Health, Massachusetts General Hospital, Boston, USA
| | - Jennifer A Smit
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Lynn T Matthews
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, 703 19Th Street South, Birmingham, AL, 35233, USA
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Motaharinezhad M, Yousefi Z, Rostami S, Goli S, Keramat A. Reproductive health needs of HIV serodiscordant couples: a systematic review. Front Public Health 2024; 12:1348026. [PMID: 39267649 PMCID: PMC11390637 DOI: 10.3389/fpubh.2024.1348026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/06/2024] [Indexed: 09/15/2024] Open
Abstract
Objectives HIV is closely linked to reproductive and sexual health. HIV Serodiscordant couples face significant social, reproductive, and sexual challenges. This systematic review aimed to identify their reproductive health needs. Methods A comprehensive literature search was conducted across six databases: Scopus, PubMed, Web of Science, Google Scholar, Magiran, and Iranmedex. No date restrictions were applied, and only English-language articles published before February 21, 2023, were included. We also searched the grey literature and conducted forward/backward citation searches. Results From an initial 758 articles, 18 met the inclusion criteria. Studies were qualitative (n = 10) and quantitative (n = 8). Key reproductive health needs included (1) childbearing intention, (2) HIV serodiscordance and sexuality, (3) psychological and social support, (4) training and consultation services, (5) access to reliable information, and (6) focused training for healthcare providers. Conclusion HIV-discordant couples face various reproductive health challenges. Implementing comprehensive guidelines for reproductive and sexual health, rehabilitation, and fertility planning is crucial to improving their quality of life and health. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023393567.
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Affiliation(s)
- Mohadese Motaharinezhad
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zahra Yousefi
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sahar Rostami
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infertility, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Goli
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Brown JM, Musara P, Gitome S, Chitukuta M, Mataveke B, Chirenda T, Mgodi N, Mutero P, Matubu A, Chareka G, Chasakara C, Murombedzi C, Makurumure T, Hughes CS, Bukusi E, Cohen CR, Shiboski S, Darbes L, Rutherford GW, Chirenje ZM, Mhlanga F. "We chose PrEP because I wanted to be sure that this child my wife was going to conceive was indeed mine." Factors influencing the choice of safer conception methods and experiences with its use: a qualitative study among HIV sero-discordant couples in Zimbabwe. BMC Public Health 2024; 24:1936. [PMID: 39030487 PMCID: PMC11264618 DOI: 10.1186/s12889-024-19155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/14/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples' actual experiences using safer conception methods, and why some couples switch safer conception methods. METHODS Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods. RESULTS We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely. CONCLUSIONS The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals.
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Affiliation(s)
- Joelle M Brown
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Petina Musara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Serah Gitome
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Miria Chitukuta
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Thandiwe Chirenda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- University of Zimbabwe, Harare, Zimbabwe
| | - Prisca Mutero
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Allen Matubu
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Gift Chareka
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- University of Zimbabwe, Harare, Zimbabwe
| | - Charles Chasakara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | - Carolyn Smith Hughes
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Shiboski
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Z Michael Chirenje
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- University of Zimbabwe, Harare, Zimbabwe
| | - Felix Mhlanga
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- University of Zimbabwe, Harare, Zimbabwe
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Guo Y, Chongsuvivatwong V, Songwathana P, Liu J, Wichaidit W. Fertility desire among HIV-positive individuals in the Chinese sociocultural context: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:156. [PMID: 37404936 PMCID: PMC10317250 DOI: 10.4103/jehp.jehp_126_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/13/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND China's recent change from a one-child policy to a two-child policy has urged many couples/families to consider having a child or an additional child. However, little is known about such fertility desire among heterosexual couples with at least one human immunodeficiency virus (HIV)-positive partner. The objective of this qualitative study was to describe fertility desire and its motivating factors and barriers among people living with HIV (PLHIV). MATERIALS AND METHODS We conducted in-depth semi-structured interviews in 31 patients at an antiretroviral therapy (ART) clinic in Kunming, China, from October to December 2020. We included only patients in a sexually active heterosexual relationship with no more than one child. Participants gave verbal informed consent before participation. Interview recordings were transcribed verbatim, translated into English, and then analyzed using thematic analysis. RESULTS Participants who reported fertility desire were mostly male, while participants who reported no fertility desire were mostly female. Study participants reported motivating factors and barriers that were identical to HIV-negative persons such as 1) social norms, 2) Chinese sociocultural factors, 3) the government's two-child policy, and 4) the financial burden of having children. However, study participants also reported motivating factors and barriers unique to human immunodeficiency virus (HIV)-positive individuals that included 1) the availability of ART and prevention of mother-to-child HIV transmission services, 2) health-related concerns, 3) stigma and discrimination against PLHIV, and 4) the additional cost of child-rearing when HIV-positive. CONCLUSIONS The study findings highlighted major areas of concern for relevant stakeholders. The development of PLHIV-specific health policy should consider the PLHIV-specific motivating factors and barriers reported in this study. However, social desirability and lack of generalizability should also be considered in the interpretation of this study's findings.
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Affiliation(s)
- Yingwu Guo
- Department of Infectious Diseases, Third People's Hospital of Kunming City, Kunming, Yunnan, People's Republic of China
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Praneed Songwathana
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jun Liu
- Department of Infectious Diseases, Third People's Hospital of Kunming City, Kunming, Yunnan, People's Republic of China
| | - Wit Wichaidit
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Brown JM, Gitome S, Mataveke B, Chirenda T, Matubu A, Chareka G, Chasakara C, Mgodi N, Murombedzi C, Musara P, Makurumure T, Hughes CS, Bukusi E, Cohen CR, Shiboski S, Darbes L, Kahn JG, Rutherford GW, Chirenje ZM, Mhlanga F. Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000796. [PMID: 36963004 PMCID: PMC10022125 DOI: 10.1371/journal.pgph.0000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program (Clintrials.gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176.
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Affiliation(s)
- Joelle M. Brown
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Serah Gitome
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Thandiwe Chirenda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Allen Matubu
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Gift Chareka
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Charles Chasakara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Petina Musara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Carolyn Smith Hughes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Stephen Shiboski
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - James G. Kahn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Z. Michael Chirenje
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Felix Mhlanga
- University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
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Pratt MC, Owembabazi M, Muyindike W, Kaida A, Marrazzo JM, Bangsberg DR, Bwana MB, Psaros C, Turan J, Atukunda EC, Matthews LT. 'I still desire to have a child': a qualitative analysis of intersectional HIV- and childlessness-related stigma in rural southwestern Uganda. CULTURE, HEALTH & SEXUALITY 2023; 25:143-158. [PMID: 35015604 PMCID: PMC9271525 DOI: 10.1080/13691058.2021.2023761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer conception strategies. This secondary analysis explored how challenges conceiving informed pregnancy plans and HIV prevention behaviours. The following themes were developed (1) partnership conflicts arise from HIV- and infertility-related forms of stigma, contributing to gender-based violence, partnership dissolution and the pursuit of new partners; (2) cultural and gender norms pressure men and women to conceive and maintain partnerships, which is complicated by the stigma directed towards serodifferent couples; (3) frustration with low partner participation in safer conception strategies led to the decreased use of these methods of HIV prevention; (4) health care provider support promotes continued hope of conception and helps overcome stigma. In HIV-affected partnerships, these intersecting forms of stigma may impact HIV prevention. Seeking to fulfil their reproductive needs, partners may increase HIV transmission opportunities as they engage in condomless sex with additional partners and decrease adherence to prevention strategies. Future research programmes should consider the integration of fertility counselling with reproductive and sexual health care.
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Affiliation(s)
- Madeline C. Pratt
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jeanne M. Marrazzo
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David R. Bangsberg
- School of Public Health, Oregon Health Sciences University – Portland State University, Portland, OR, USA
| | | | - Christina Psaros
- Department of Psychiatry, Behavioural Medicine Program, Massachusetts General Hospital, Boston, MA, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Lynn T. Matthews
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Ukoha WC, Mtshali NG. Preconception care practices among primary health care nurses working in public health facilities in KwaZulu-Natal. Glob Health Action 2022; 15:2112395. [PMID: 36161863 PMCID: PMC9542517 DOI: 10.1080/16549716.2022.2112395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Preconception care (PCC) is necessary to identify and deal with all the risk factors before conception. Some aspects of PCC, like folic acid supplementation, would be relevant to people desiring a pregnancy. Alternatively, PCC could provide contraceptive support to those with no pregnancy intention. In South Africa, primary healthcare nurses provide a comprehensive package of essential services in public health facilities to about 90% of the population at no cost. Therefore, they are the key providers of promotive, preventive, and curative services, including PCC. OBJECTIVE This study aimed to determine the level of PCC practice among primary healthcare nurses and identify determinants of effective practice. METHODS This cross-sectional descriptive survey was conducted among 196 nurses undertaking a specialisation Primary HealthCare program in a selected higher education institution. A pretested questionnaire was used to collect data that were analysed with SPSS version 27 software. RESULTS The overall practice of PCC was 87.8%. Older participants were significantly less likely to exhibit good PCC practice than their younger counterparts. Female participants were also less likely to have good PCC practices than their male counterparts. Married participants were significantly more likely to practice PCC than their unmarried counterparts. Participants practicing in rural areas were also less likely to have good PCC practices than their urban counterparts. CONCLUSION The PCC practice of most primary healthcare nurses in the study is relatively high. The study also identified the determinants of good PCC practice that can enhance its practice. There is a need to revisit the PCC training of healthcare workers, as most indicated the need for further training.
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Affiliation(s)
- Winifred Chinyere Ukoha
- School of Nursing and Public Health, Howard College, University of KwaZulu-Natal, Durban, South Africa
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Guo Y, Wichaidit W, Du Y, Liu J, Chongsuvivatwong V. Mediation of the association between stigma and HIV status and fertility intention by fertility desire among heterosexual couples living with HIV in Kunming, China. PLoS One 2022; 17:e0278244. [PMID: 36454983 PMCID: PMC9714893 DOI: 10.1371/journal.pone.0278244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aimed to assess the influences of stigma and HIV status on reproductive intention among heterosexual couples living with HIV in China. METHODS A cross-sectional study was conducted in Kunming, China among 315 HIV-positive individuals and their spouses (n = 315 couples). An interview questionnaire was used to collect data on intention, desire, HIV Stigma Scale items, and HIV status. Dyadic fertility intention was examined using the actor-partner interdependence mediation model, based on the Traits-Desires-Intentions-Behavior framework. RESULTS The husbands' or wives' internalized stigma had significant negative effects on their own fertility desire (β = -0.149, p<0.05 and β = -0.238, p<0.01, respectively). HIV-positive status of the husbands was weakly linked to their own fertility intention (β = -0.181, p<0.05). Husbands' perceived provider stigma was associated with their own and their wives' fertility intention via the mediating effect of their fertility desire (β = -0.374, p<0.001 and β = -0.203, p<0.01, respectively). The cumulative influence of their reproductive desire mediated the husband's perceived provider stigma and the wife's internalized stigma on their fertility intention. CONCLUSIONS Stigma and HIV status were associated with fertility intention among couples living with HIV, mediated by fertility desire. The high intra-couple correlation suggested that counseling should be conducted when both spouses are present together with extensive discussions on concerns regarding HIV-related stigma, potential discrepancies between each partner's fertility desire and intention, and the influence of one partner on the other.
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Affiliation(s)
- Yingwu Guo
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, People’s Republic of China
- Faculty of Medicine, Department of Epidemiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Wit Wichaidit
- Faculty of Medicine, Department of Epidemiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yingrong Du
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, People’s Republic of China
| | - Jun Liu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, People’s Republic of China
| | - Virasakdi Chongsuvivatwong
- Faculty of Medicine, Department of Epidemiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
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10
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Guo Y, Du Y, Liu J, Bai J, Gao J, Wu L, Yang Y, Wang W, Chen J, Xu Z, Yan J, Lu N, Li C, Chongsuvivatwong V. Effects of HIV-related worries on fertility motivation moderated by living children among couples living with HIV: A dyadic analysis. Front Psychol 2022; 13:1000100. [PMID: 36438391 PMCID: PMC9685432 DOI: 10.3389/fpsyg.2022.1000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/28/2022] [Indexed: 08/31/2023] Open
Abstract
Introduction HIV-related worries are a major barrier to achieving fertility goals for couples living with HIV (CLWH). We examined the moderating role of living children in the association between HIV-related worries and fertility motivation in CLWH including happiness, well-being, identity, and continuity. Methods The data of 322 reproductive-aged CLWH were collected for this cross-sectional study from a referral antiretroviral therapy clinic in Kunming, China between October and December 2020. Intra- and interpersonal mechanisms of association between HIV-related worries and fertility motivation moderated by the number of living children in husband-wife dyads were analyzed by the actor-partner interdependence moderation model. Results The high-level HIV-related worries of the wives and husbands were associated with the spouses' fertility motivation. Having at least one child helped to ameliorate the negative association between one's own HIV-related worries and fertility motivation. However, there was no evidence of such moderation in the spouse. Conclusion Whether the CLWH has at least one living child should be taken into account in counseling. Childless families should be counseled on HIV-related worries as those worries have a greater negative effect on fertility motivation than couples who have a child.
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Affiliation(s)
- Yingwu Guo
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Yingrong Du
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jun Liu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jingsong Bai
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jianpeng Gao
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Lei Wu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Yongrui Yang
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Weibo Wang
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jie Chen
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Zhaoyuan Xu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Junfang Yan
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Nihong Lu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Chongxi Li
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
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11
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Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples. AIDS Behav 2022; 26:2397-2408. [PMID: 35064850 DOI: 10.1007/s10461-022-03584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/01/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa's initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.
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12
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Ukoha WC, Mtshali NG, Adepeju L. Current state of preconception care in sub-Saharan Africa: A systematic scoping review. Afr J Prim Health Care Fam Med 2022; 14:e1-e11. [PMID: 35532112 PMCID: PMC9082216 DOI: 10.4102/phcfm.v14i1.3096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Preconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services. Aim This study aims to review the current literature on the knowledge, utilisation and provision of PCC. Setting This included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries. Methods Arksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study. Results Out of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least. Conclusion The estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.
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Affiliation(s)
- Winifred C Ukoha
- School of Nursing and Public Health, College of Health Science, University of KwaZulu-Natal, Durban.
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13
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Carroll K, Pottinger AM, Pinkney J, Christie LR, Hamilton PI, Thompson MS. Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception? AIDS Care 2022; 35:1045-1054. [PMID: 34986729 DOI: 10.1080/09540121.2021.2023729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.
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Affiliation(s)
- Kamali Carroll
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Audrey M Pottinger
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Jodian Pinkney
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Loxley R Christie
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Pansy I Hamilton
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Monique S Thompson
- Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston, Jamaica
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14
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Mathenjwa M, Khidir H, Milford C, Mosery N, Rambally Greener L, Pratt MC, O'Neil K, Harrison A, Bangsberg DR, Safren SA, Smit JA, Psaros C, Matthews LT. Acceptability of an Intervention to Promote Viral Suppression and Serostatus Disclosure for Men Living with HIV in South Africa: Qualitative Findings. AIDS Behav 2022; 26:1-12. [PMID: 34097209 PMCID: PMC8786780 DOI: 10.1007/s10461-021-03278-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/15/2023]
Abstract
Men living with HIV (MLWH) often have reproductive goals that can increase HIV-transmission risks to their pregnancy partners. We developed a safer conception intervention for MLWH in South Africa employing cognitive behavioral skills to promote serostatus disclosure, ART uptake, and viral suppression. MLWH were recruited from an HIV clinic near Durban, South Africa, and encouraged to include partners in follow-up visits. Exit in-depth interviews were conducted with eleven men and one female partner. The emerging over-arching theme is that safer conception care mitigates internalized and community-level HIV-stigma among MLWH. Additional related sub-themes include: (1) safer conception care acceptability is high but structural barriers challenge participation; (2) communication skills trainings helped overcome barriers to disclose serostatus; (3) feasibility and perceived effectiveness of strategies informed safer conception method selection. Our findings suggest that offering safer conception care to MLWH is a novel stigma-reducing strategy for motivating HIV prevention and treatment and serostatus disclosure to partners.
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Affiliation(s)
- Mxolisi Mathenjwa
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | | | - Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Letitia Rambally Greener
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- Population Services International, South Africa, Johannesburg, South Africa
| | - Madeline C Pratt
- University of Alabama at Birmingham (UAB), Division of Infectious Disease, Birmingham, Alabama, USA
| | | | | | | | | | - Jennifer A Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | | | - Lynn T Matthews
- University of Alabama at Birmingham (UAB), Division of Infectious Disease, Birmingham, Alabama, USA.
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15
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Grant-Maidment T, Kranzer K, Ferrand RA. The Effect of Integration of Family Planning Into HIV Services on Contraceptive Use Among Women Accessing HIV Services in Low and Middle-Income Countries: A Systematic Review. Front Glob Womens Health 2022; 3:837358. [PMID: 35284908 PMCID: PMC8907733 DOI: 10.3389/fgwh.2022.837358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
There is substantial unmet need for family planning (FP) among women living with HIV (WLHIV), leading to unintended pregnancies and may contribute indirectly to increasing the risk of transmission of HIV. This review aims to determine whether integration of FP into HIV testing and care results in increased use of contraception, a reduction in unmet need for FP, improved use of safer conception methods and a reduction in unintended pregnancies in low and middle-income countries. A systematic review was undertaken incorporating studies from PubMed, EMBASE, CINAHL, Web of Science and Global Health, the International AIDS Society Abstract Archive, the World STI & HIV Congress Abstract Archive and the Conference on Retroviruses and Opportunistic Infections Abstract Archive published between 2016 and 2021, updating previous systematic reviews. After screening, 13 studies were included, 11 conducted in sub-Saharan Africa and 2 in India. The primary outcome of the review was contraceptive uptake and secondary outcomes included unmet need for FP, safer conception and unintended pregnancy. Integrated FP-HIV facilities were found to increase dual contraceptive use by at least 8% in five studies and modern contraceptive use by at least 8% in four studies. Findings from two studies suggested integration decreased the unmet need for contraception. Limited data prevented a conclusion from being drawn regarding whether integration increases safer conception. There was no evidence of integration reducing unintended pregnancies. The median quality score of studies was 3/9. Overall, integrated facilities have the potential of improving reproductive health of women accessing HIV services in LMICs. FP may be enhanced by including a safer conception component for WLHIV. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021251008, identifier: CRD42021251008.
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Affiliation(s)
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
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16
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Young CR, Gill E, Bwana M, Muyindike W, Hock RS, Pratt MC, Owembabazi M, Tukwasibwe D, Najjuma A, Kalyebara P, Natukunda S, Kaida A, Matthews LT. Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care. AIDS Behav 2022; 26:76-87. [PMID: 34152530 PMCID: PMC8688584 DOI: 10.1007/s10461-021-03343-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.
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Affiliation(s)
- Cynthia R Young
- Division of Infectious Diseases, University of Kentucky, Lexington, KY
| | - Elizabeth Gill
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mwebesa Bwana
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rebecca S. Hock
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Madeline C Pratt
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Moran Owembabazi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deogratius Tukwasibwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Paul Kalyebara
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Silvia Natukunda
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lynn T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL,Corresponding author:
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17
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Rees H, Chersich MF, Munthali RJ, Brumskine W, Palanee-Phillips T, Nkala B, Ahmed K, Sebe M, Mabude Z, Nchabeleng M, Bekker LG, Kotze P, Mogodiri T, Naidoo I, Panchia R, Myer L, Lombard C, Doncel GF, Gray G, Delany-Moretlwe S. HIV Incidence Among Pregnant and Nonpregnant Women in the FACTS-001 Trial: Implications for HIV Prevention, Especially PrEP Use. J Acquir Immune Defic Syndr 2021; 88:376-383. [PMID: 34710071 DOI: 10.1097/qai.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission. SETTING Nine sites in 4 South African provinces. METHODS Women aged 18-30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status. RESULTS Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use. CONCLUSIONS Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings.
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Affiliation(s)
- Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Francis Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Munthali
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Zonke Mabude
- MATCH, University of the Witwatersrand, Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Centre, Ladysmith, South Africa
| | - Thembisile Mogodiri
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ishana Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa ; and
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Glenda Gray
- Setshaba Research Centre, Soshanguve, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wall KM, Karita E, Nyombayire J, Ingabire R, Mukamuyango J, Parker R, Brill I, Price M, Haddad LB, Tichacek A, Hunter E, Allen S. Genital Abnormalities, Hormonal Contraception, and Human Immunodeficiency Virus Transmission Risk in Rwandan Serodifferent Couples. J Infect Dis 2021; 224:81-91. [PMID: 33560366 PMCID: PMC8253127 DOI: 10.1093/infdis/jiab071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda. METHODS From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were followed up, and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; nonulcerative genital sexually transmitted infection (STIs), including gonorrhea, chlamydia, and trichomoniasis; and non-STI vaginal infections, including bacterial vaginosis and candida. Multivariable models evaluated associations between covariates and HIV transmission genetically linked to the index partner. RESULTS Among 877 couples in which the man was HIV positive, 37 linked transmissions occurred. Factors associated with women's HIV acquisition included genital ulceration in the female partner (adjusted hazard ratio, 14.1) and nonulcerative STI in the male partner (8.6). Among 955 couples in which the woman was HIV positive, 46 linked transmissions occurred. Factors associated with HIV acquisition in men included nonulcerative STI in the female partner (adjusted hazard ratio, 4.4), non-STI vaginal dysbiosis (7.1), and genital ulceration in the male partner (2.6). Hormonal contraception use was not associated with HIV transmission or acquisition. CONCLUSIONS Our findings underscore the need for integrating HIV services with care for genital abnormalities. Barriers (eg, cost of training, demand creation, advocacy, and client education; provider time; and clinic space) to joint HIV/STI testing need to be considered and addressed.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Etienne Karita
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Julien Nyombayire
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Rosine Ingabire
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Jeannine Mukamuyango
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ilene Brill
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matt Price
- IAVI, New York, New York, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Amanda Tichacek
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Susan Allen
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Wagner GJ, Wanyenze RK, Beyeza-Kashesya J, Gwokyalya V, Hurley E, Mindry D, Finocchario-Kessler S, Nanfuka M, Tebeka MG, Saya U, Booth M, Ghosh-Dastidar B, Linnemayr S, Staggs VS, Goggin K. "Our Choice" improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches. Implement Sci 2021; 16:41. [PMID: 33858462 PMCID: PMC8048255 DOI: 10.1186/s13012-021-01109-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and supervision would result in a more efficacious approach to implementing SCC. Methods In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until pregnancy. Results The combined intervention groups used appropriate reproductive methods more than usual care [20.8% vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR (95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]. The arms did not vary on modern contraception use among those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1, compared to $1014 in SCC2. Conclusions More intensive provider training and more frequent supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard low intensity implementation approach. Trial registration Clinicaltrials.gov, NCT03167879; date registered May 23, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01109-z.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, 91105, USA.
| | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jolly Beyeza-Kashesya
- Department of Reproductive Medicine, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Emily Hurley
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Deborah Mindry
- University of California Global Health Institute, Center for Women's Health and Empowerment, 1234 Sunny Oaks Circle, Altadena, CA, 91001, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - Mahlet G Tebeka
- Pardee RAND Graduate School, 1776 Main St., Santa Monica, CA, 91105, USA
| | - Uzaib Saya
- Pardee RAND Graduate School, 1776 Main St., Santa Monica, CA, 91105, USA
| | - Marika Booth
- RAND Corporation, 1776 Main St., Santa Monica, CA, 91105, USA
| | | | | | - Vincent S Staggs
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Kathy Goggin
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
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21
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Zia Y, Velloza J, Oluoch L, Momanyi R, Mbugua S, Njoroge J, Gakuo S, Mugo E, Thuo N, Kiptinness C, Njuguna N, Ngure K, R Mugo N, Heffron R. Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya. Reprod Health 2021; 18:73. [PMID: 33794936 PMCID: PMC8017620 DOI: 10.1186/s12978-021-01128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background For couples affected by HIV, and serodifferent couples in particular, pregnancy desire is often juxtaposed against the risk of HIV transmission between the couple and the potential neonate leading to thinking about measures to minimize risk of HIV transmission. We assess the use of fertility awareness methods [FAM] and evaluate the drivers of alignment between indicators of fertility and sexual behavior among HIV-serodifferent couples desiring pregnancy. Methods HIV-serodifferent couples from Thika, Kenya were enrolled into an open-label pilot evaluation of safer conception strategies. Women responded to daily 7-item short message service [SMS] surveys on FAM and sexual activity. Menstrual cycles were categorized as having condomless sex aligned, not aligned, or partially aligned to the predicted peak fertility. We used binomial logit models with generalized estimating equations to assess alignment between condomless sex during peak fertility days and FAM results. We used Cox proportional hazards to compare pregnancy incidence among months with sex and peak fertility aligned and mis-aligned. Results A total of 6929 SMS surveys across 252 menstrual cycles of 65 women were included. Reporting “sticky” cervical mucus (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [95% CI]: 1.30, 3.90) and positive ovulation prediction kit [OPK] result (aOR: 2.07, 95% CI: 1.11, 3.86) were associated with increased likelihood of alignment of condomless sex during peak fertility. Pregnancy incidence was statistically similar among periods with sex aligned and not aligned with peak fertility. Conclusions Among women engaged in a comprehensive safer conception program, a moderate percentage of women aligned condomless sex and predicted peak fertility days at least once. While FAM, particularly cervical mucus and OPK, are an inexpensive option for couples to consider using as a component of their safer conception strategies, antiretroviral-based strategies remain important to minimize risk.
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Affiliation(s)
- Yasaman Zia
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jennifer Velloza
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA
| | - Lynda Oluoch
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Sarah Mbugua
- Kenya Medical Research Institute, Nairobi, Kenya
| | - John Njoroge
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Edwin Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Njambi Njuguna
- Kenya Medical Research Institute, Nairobi, Kenya.,KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.,Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nelly R Mugo
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA.,Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
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22
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Mandell LN, Rodriguez VJ, Jones DL. Safer Conception and Family Planning Knowledge, Attitudes, and Practices Among Postpartum Women with HIV in Rural South Africa. Open Access J Contracept 2021; 12:17-25. [PMID: 33603508 PMCID: PMC7882456 DOI: 10.2147/oajc.s288569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction With the help of safer conception strategies (SCS), women with HIV (WHIV) can achieve their reproductive goals while minimizing the risk of transmission to their partners or infants. However, interpregnancy intervals of at least 24 months are recommended to optimize maternal and infant health outcomes, so postpartum WHIV need to use contraception to delay subsequent pregnancies. Understanding safer conception and family planning knowledge, attitudes, and practices among WHIV is key to tailoring family planning policy and intervention development in regions with high HIV prevalence. Methods This study described the safer conception and family planning knowledge, attitudes, and practices of postpartum WHIV (N = 956) in rural Mpumalanga province, South Africa, 12 months after delivery. Results Almost all women understood the importance of condom use, but most overestimated the risk of sexual transmission. A majority of women reported that their partner’s desires (53%) and the risk of perinatal transmission (58%) were very important factors when making childbearing decisions. Most women (81%) used condoms for HIV prevention and most (83%) used contraception for pregnancy prevention. Many women (33% of contraceptive users) used condoms for both HIV prevention and contraception without using another contraceptive method as well. Only 43% of contraceptive users endorsed dual method use of condoms with hormones, intrauterine devices, or sterilization. Discussion Results highlight the prominence of condom-based pregnancy and HIV transmission prevention, the influence of male partners in fertility decision-making, and the opportunity for further education and promotion of long acting methods in this setting.
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Affiliation(s)
- Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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23
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Gutin SA, Harper GW, Moshashane N, Ramontshonyana K, Mompe A, Fleming PJ, Harries J, Ramogola-Masire D, Morroni C. "I did not know about all these": Perceptions regarding safer conception methods by women living with HIV in Gaborone, Botswana. PLoS One 2020; 15:e0242992. [PMID: 33259505 PMCID: PMC7707558 DOI: 10.1371/journal.pone.0242992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
Various safer conception methods to limit HIV transmission risks can be offered in resource-constrained settings. However, implementation of safer conception services remains limited in many countries, including Botswana. Understanding perceptions about safer conception methods and the benefits and challenges to use can help with the development of policies, interventions, and service delivery models. Forty-five women living with HIV in the greater Gaborone, Botswana area participated in focus group discussions. Themes were analyzed using interpretive phenomenology. Despite low knowledge of specific safer conception methods that can be used to prevent transmission of HIV when trying to achieve pregnancy, there was noted interest in pre-exposure prophylaxis and vaginal insemination. Challenges to greater uptake were noted including a lack of knowledge about a range of SC methods, limited partner support and communication, provider stigma, health systems barriers, current policies, and the cultural acceptability of methods. Interventions will need to address these challenges and be responsive to the needs and reflect the realities of WLHIV who desire pregnancy in order for safer conception uptake to become a common practice.
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Affiliation(s)
- Sarah A. Gutin
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Gary W. Harper
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Neo Moshashane
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Kehumile Ramontshonyana
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Atlang Mompe
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Paul J. Fleming
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jane Harries
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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24
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Arikawa S, Dumazert P, Messou E, Burgos-Soto J, Tiendrebeogo T, Zahui A, Horo A, Minga A, Becquet R. Childbearing desire and reproductive behaviors among women living with HIV: A cross-sectional study in Abidjan, Côte d'Ivoire. PLoS One 2020; 15:e0239859. [PMID: 33085671 PMCID: PMC7577483 DOI: 10.1371/journal.pone.0239859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Evidence on childbearing desire and reproductive behaviors in women living with HIV on antiretroviral therapy (ART) is scarce, particularly in West Africa. We investigated the prevalence and associated factors of childbearing desire in HIV-infected women in care in Abidjan, Côte d’Ivoire and explored whether such desires were translated into behaviors related to contraceptive use and communication with health personnel. Methods A cross-sectional survey was conducted in two HIV-care facilities in Abidjan, Côte d’Ivoire in 2015. Eligible women were non-pregnant, non-menopausal, aged 18–49 years and diagnosed as HIV-infected. The outcomes were childbearing desire, prevalence of modern contraceptive use, unmet needs for family planning and intention of the last pregnancy since HIV diagnosis. Women wishing to conceive immediately were asked whether they had discussed their desire with HIV healthcare workers. Logistic regression models were used to assess the associations between the outcomes and women’s characteristics. Results Of 1,631 women, 80% declared having childbearing desire. No association was found between women’s childbearing desire and ART status or its duration. In multivariate models, younger age, being in a stable relationship and having no or only one child were significantly associated with increased childbearing desire. Of the women wishing to conceive immediately (n = 713), only 43% reported having had fertility-related dialogue with healthcare provider. Among sexually active women wanting to avoid or delay pregnancy (n = 650), unmet needs for family planning was 40%. Regarding the last pregnancy since HIV diagnosis, one in three women reported not having wanted a baby at that time. Conclusions Pregnancy desire in women living with HIV in Abidjan was extremely high. Integration of safe conception strategies as well as improvement of contraceptive uptake among women in need of family planning are of utmost importance to ensure optimal conception and to avoid transmission of HIV to the male partner or to the forthcoming child.
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Affiliation(s)
- Shino Arikawa
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Patricia Dumazert
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre de Prise en charge de Recherche et de Formation (CePReF-Aconda-VS), Abidjan, Côte d'Ivoire
| | - Juan Burgos-Soto
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Thierry Tiendrebeogo
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
| | - Angèle Zahui
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Albert Minga
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d’Ivoire
| | - Renaud Becquet
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
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25
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Yam EA, Kahabuka C, Mbita G, Winani K, Apicella L, Casalini C, Mbuguni Z. Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services. PLoS One 2020; 15:e0235739. [PMID: 32692777 PMCID: PMC7373272 DOI: 10.1371/journal.pone.0235739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire. Conclusions Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
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Affiliation(s)
- Eileen A. Yam
- Population Council, Washington, DC, United States of America
- * E-mail:
| | | | | | - Koheleth Winani
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Zuhura Mbuguni
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Larki M, Bahri N, Moghri J, Latifnejad Roudsari R. Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:103-115. [PMID: 32309452 PMCID: PMC7153425 DOI: 10.30476/ijcbnm.2020.82845.1093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives.
The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions.
The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships. Methods: This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative
women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected
using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman.
MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered. Results: The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories
along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions
and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family. Conclusion: This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also,
our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.
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Affiliation(s)
- Mona Larki
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjes Bahri
- Department of Midwifery, School of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Javad Moghri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Kyaw KWY, Mon AA, Phyo KH, Kyaw NTT, Kumar AMV, Lwin TT, Aung ZZ, Aung TK, Oo MM, Htun T, Ya SST, Satyanarayana S, Oo HN. Initiation of antiretroviral therapy or antiretroviral prophylaxis in pregnant women living with HIV registered in five townships of Mandalay, Myanmar: A cross sectional study. BMC Pregnancy Childbirth 2019; 19:475. [PMID: 31805892 PMCID: PMC6896496 DOI: 10.1186/s12884-019-2627-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A series of interventions are required to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) starting from HIV testing of pregnant women, initiating antiretroviral therapy (ART) or antiretroviral prophylaxis to HIV-positive pregnant women to providing HIV prophylaxis to newborn babies. Gaps in each step can significantly affect the effectiveness of PMTCT interventions. We aimed to determine the gap in initiation of ART/antiretroviral prophylaxis for pregnant women living with HIV, delay in initiation of ART/antiretroviral prophylaxis and factors associated with the delay. METHODS This is a cross sectional study using routinely collected programme data from five health facilities providing PMTCT services located at Township Health Departments (THD) of Mandalay, Myanmar. RESULTS There were 363 pregnant women living with HIV enrolled between January 2012 and December 2017. Sixty (16%) women were excluded from the study due to missing data on dates of HIV diagnosis. Of 303 (84%) women included in the study, 89/303 (29%) and 214/303 (71%) were diagnosed with HIV before and during current pregnancy respectively. Among 214 women, 180 (84%) women were started on ART by the censor date (31st March 2018). Among those who started ART, 109 (61%) women had a delay of starting ART > 2 weeks from diagnosis. Women residing in township 4 had a significantly higher risk of delay in initiation of ART/antiretroviral prophylaxis compared to women residing in township 1 [adjusted prevalence ratio 4.2 (95% confidence interval 1.2-14.8]. CONCLUSIONS We found that one in four women living with HIV knew their HIV status before current pregnancy. Although the rate of ART/antiretroviral prophylaxis initiation was high among pregnant women living with HIV, there was a delay. Early initiation of ART/antiretroviral prophylaxis among newly HIV diagnosed pregnant women needs to be strengthened.
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Affiliation(s)
- Khine Wut Yee Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Aye Aye Mon
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Khaing Hnin Phyo
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Nang Thu Thu Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Ajay M. V. Kumar
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Than Than Lwin
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Zaw Zaw Aung
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thet Ko Aung
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Myo Minn Oo
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Thurain Htun
- Monitoring, Evaluation, Accountability and Learning Unit (HIV), International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Sai Soe Thu Ya
- Monitoring, Evaluation, Accountability and Learning Unit (HIV), International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Htun Nyunt Oo
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Schwartz SR, Bassett J, Mutunga L, Yende N, Mudavanhu M, Phofa R, Sanne I, Van Rie A. HIV incidence, pregnancy, and implementation outcomes from the Sakh'umndeni safer conception project in South Africa: a prospective cohort study. Lancet HIV 2019; 6:e438-e446. [PMID: 31160268 DOI: 10.1016/s2352-3018(19)30144-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Safer conception strategies empower individuals trying to conceive to minimise HIV transmission risk to partners and potential children; however, effectiveness data are scarce. We aimed to assess adoption of safer conception methods and HIV and pregnancy outcomes from Sakh'umndeni, a novel safer conception service in South Africa. METHODS In this prospective cohort study, the Sakh'umndeni clinical cohort at Witkoppen Cinic in Johannesburg (South Africa) enrolled adults aged at least 18 years who were trying to conceive and in relationships with an HIV-positive partner. Couples who were pregnant at enrolment or had been previously diagnosed as infertile were excluded. Participants received safer conception care by a nurse, including antiretroviral therapy (ART) for HIV-positive partners, pre-exposure prophylaxis (PrEP) for HIV-negative partners, counselling around timed condomless sex, or syringes for self-insemination. Primary outcomes were pregnancy incidence and HIV transmission to partners and infants. We estimated time to first pregnancy using Kaplan-Meier curves; pregnancy and HIV incidence were estimated as events per person-years of risk. FINDINGS Between July 16, 2013, and April 5, 2017, 526 individuals (334 women and 192 men) from 334 partnerships enrolled. 162 (48%) of 334 couples were serodifferent, 149 (45%) were HIV-positive seroconcordant, and 23 (7%) were an HIV-positive woman and an unknown status male partner. At enrolment, 176 (61%) of 287 HIV-positive women and 60 (46%) of 131 HIV-positive men were virally suppressed (<50 copies per mL). Among the safer conception strategies, ART was initiated by 73 (91%) of 80 HIV-positive participants not on ART and PrEP was initiated by 28 (28%) of 101 HIV-negative participants. 2719 follow-up visits were completed, and 99 pregnancies were observed in 89 women. Pregnancy incidence was 41·2 per 100 person-years (95% CI 33·4-50·7); 25 (28%) of 89 pregnancies with a known outcome were miscarried or terminated because of risk to the mother. Pregnancy incidence was 79·0 per 100 person-years (95% CI 49·8-125·4) among HIV-negative women and 36·7 per 100 person-years (29·1-46·3) among HIV-positive women. At the time of pregnancy, viral suppression among women was high (68 [87%] of 78 women had viral loads of <50 copies per mL and 77 [99%] had viral loads of <1000 copies per mL). No horizontal or vertical HIV transmission events were observed. INTERPRETATION Safer conception strategies empowered couples to safely conceive. Pregnancy incidence among service users was high. Integration of safer conception counselling could promote HIV prevention and linkage to care. FUNDING US Agency for International Development; UJMT Consortium/Fogarty International Center, US National Institutes of Health (NIH); and Johns Hopkins University Center for AIDS Research (NIH).
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Affiliation(s)
- Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Jean Bassett
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Lillian Mutunga
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Nompumelelo Yende
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mutsa Mudavanhu
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Rebecca Phofa
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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Heffron R, Ngure K, Velloza J, Kiptinness C, Quame‐Amalgo J, Oluch L, Thuo N, Njoroge J, Momanyi R, Gakuo S, Mbugua S, Morrison S, Haugen H, Chohan B, Celum C, Baeten JM, Mugo N. Implementation of a comprehensive safer conception intervention for HIV-serodiscordant couples in Kenya: uptake, use and effectiveness. J Int AIDS Soc 2019; 22:e25261. [PMID: 30957420 PMCID: PMC6452026 DOI: 10.1002/jia2.25261] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/04/2019] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Safer conception strategies minimize HIV risk during condomless sex to become pregnant. Gaps remain in understanding the acceptability, feasibility and choices HIV-serodiscordant couples make when multiple safer conception options are available. METHODS We conducted a pilot study of a comprehensive safer conception package for HIV-serodiscordant couples with immediate fertility desires in Kenya from March 2016 to April 2018. The intervention package included antiretroviral therapy (ART) for HIV-positive partners, oral pre-exposure prophylaxis (PrEP) for HIV-negative partners, daily fertility and sexual behaviour tracking via short message service (SMS) surveys, counselling on self-insemination, and referrals for voluntary medical male circumcision and fertility care. Couples attended monthly visits until pregnancy with HIV testing for negative partners at each visit. We estimated the number of expected HIV seroconversions using a counterfactual cohort simulated from gender-matched couples in the placebo arm of a previous PrEP clinical trial. We used bootstrap methods to compare expected and observed seroconversions. RESULTS Of the 74 enrolled couples, 54% were HIV-negative female/HIV-positive male couples. The 6 and 12-month cumulative pregnancy rates were 45.3% and 61.9% respectively. In the month preceding pregnancy, 80.9% of HIV-positive partners were virally suppressed, 81.4% of HIV-negative partners were highly adherent to PrEP, and SMS surveys indicated potential timing of condomless sex to peak fertility (median of sex acts = 10, interquartile range (IQR) 7 to 12; median condomless sex acts = 3.5, IQR 1 to 7). Most (95.7%) pregnancies were protected by ≥2 strategies: 57.4% were protected by high PrEP and ART adherence, male circumcision with or without timed condomless sex; 10 (21.3%) were protected by viral suppression in the HIV-positive partner and male circumcision with or without timed condomless sex; 8 (17.0%) were protected by high PrEP adherence and male circumcision with or without timed condomless sex. We observed 0 HIV seroconversions (95% CI 0.0 to 6.0 per 100 person years), indicating a 100% reduction in HIV risk (p = 0.04). CONCLUSIONS The use of multiple safer conception strategies, primarily PrEP, ART, male circumcision and/or tracking fertility, was acceptable and feasible for African HIV-serodiscordant couples and significantly reduced HIV transmission risk. It is important to increase the availability of and counselling about safer conception services in regions with HIV epidemics involving heterosexual transmission and high fertility.
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Affiliation(s)
- Renee Heffron
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Jomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Jennifer Velloza
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Catherine Kiptinness
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Lynda Oluch
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Nicholas Thuo
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - John Njoroge
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Richard Momanyi
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Stephen Gakuo
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Sarah Mbugua
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Susan Morrison
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Harald Haugen
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Bhavna Chohan
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Connie Celum
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Nelly Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Partners in Health and Research DevelopmentCentre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
- Center for Clinical ResearchKenya Medical Research InstituteNairobiKenya
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