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Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples.
J Int AIDS Soc. 2017 03 08; 20(Suppl 1):21309.JI

Abstract

INTRODUCTION

For HIV serodiscordant couples in resource-limited settings, pregnancy is common despite the risk of sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and others. We sought to understand Kenyan health providers' and HIV serodiscordant couples' perspectives and experiences with safer conception.

METHODS

Between August 2015 and March 2016, we conducted key informant interviews (KIIs) with health providers from public and private HIV care and fertility clinics and in-depth interviews (IDIs) and focus group discussions (FGDs) with HIV serodiscordant couples participating in an open-label study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) for HIV prevention (the Partners Demonstration Project). An inductive analytic approach identified a number of themes related to experiences with and perceptions of safer conception strategies.

RESULTS

We conducted 20 KIIs with health providers, and 21 IDIs and 4 FGDs with HIV serodiscordant couples. HIV clinic providers frequently discussed timed condomless sex and antiretroviral medications while providers at private fertility care centres were more comfortable recommending medically assisted reproduction. Couples experienced with ART and PrEP reported that they were comfortable using these strategies to reduce HIV risk when attempting pregnancy. Timed condomless sex in conjunction with ART and PrEP was a preferred strategy, often owing to them being available for free in public and research clinics, as well as most widely known; however, couples often held inaccurate knowledge of how to identify days with peak fertility in the upcoming menstrual cycle.

CONCLUSIONS

Antiretroviral-based HIV prevention is acceptable and accessible to meet the growing demand for safer conception services in Kenya, since medically assisted interventions are currently cost prohibitive. Cross-disciplinary training for health providers would expand confidence in all prevention options and foster the tailoring of counselling to couples' preferences.

Authors+Show Affiliations

Department of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.Department of Behavioral Sciences, Partners in Research Health and Development, Thika, Kenya.Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA.Department of Clinical Sciences, Partners in Research Health and Development, Thika, Kenya.Department of Behavioral Sciences, Partners in Research Health and Development, Thika, Kenya. Center for Clinical Research, Kenya Medical Research Institute, Kenya.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA. Department of Medicine, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA. Department of Medicine, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28361508

Citation

Ngure, Kenneth, et al. "Delivering Safer Conception Services to HIV Serodiscordant Couples in Kenya: Perspectives From Healthcare Providers and HIV Serodiscordant Couples." Journal of the International AIDS Society, vol. 20, no. Suppl 1, 2017, p. 21309.
Ngure K, Kimemia G, Dew K, et al. Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. J Int AIDS Soc. 2017;20(Suppl 1):21309.
Ngure, K., Kimemia, G., Dew, K., Njuguna, N., Mugo, N., Celum, C., Baeten, J. M., & Heffron, R. (2017). Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. Journal of the International AIDS Society, 20(Suppl 1), 21309. https://doi.org/10.7448/IAS.20.2.21309
Ngure K, et al. Delivering Safer Conception Services to HIV Serodiscordant Couples in Kenya: Perspectives From Healthcare Providers and HIV Serodiscordant Couples. J Int AIDS Soc. 2017 03 8;20(Suppl 1):21309. PubMed PMID: 28361508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. AU - Ngure,Kenneth, AU - Kimemia,Grace, AU - Dew,Kristin, AU - Njuguna,Njambi, AU - Mugo,Nelly, AU - Celum,Connie, AU - Baeten,Jared M, AU - Heffron,Renee, PY - 2017/4/1/entrez PY - 2017/4/1/pubmed PY - 2017/9/14/medline KW - HIV prevention KW - Kenya KW - pregnancy KW - safer conception KW - serodiscordant couples SP - 21309 EP - 21309 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 20 IS - Suppl 1 N2 - INTRODUCTION: For HIV serodiscordant couples in resource-limited settings, pregnancy is common despite the risk of sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and others. We sought to understand Kenyan health providers' and HIV serodiscordant couples' perspectives and experiences with safer conception. METHODS: Between August 2015 and March 2016, we conducted key informant interviews (KIIs) with health providers from public and private HIV care and fertility clinics and in-depth interviews (IDIs) and focus group discussions (FGDs) with HIV serodiscordant couples participating in an open-label study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) for HIV prevention (the Partners Demonstration Project). An inductive analytic approach identified a number of themes related to experiences with and perceptions of safer conception strategies. RESULTS: We conducted 20 KIIs with health providers, and 21 IDIs and 4 FGDs with HIV serodiscordant couples. HIV clinic providers frequently discussed timed condomless sex and antiretroviral medications while providers at private fertility care centres were more comfortable recommending medically assisted reproduction. Couples experienced with ART and PrEP reported that they were comfortable using these strategies to reduce HIV risk when attempting pregnancy. Timed condomless sex in conjunction with ART and PrEP was a preferred strategy, often owing to them being available for free in public and research clinics, as well as most widely known; however, couples often held inaccurate knowledge of how to identify days with peak fertility in the upcoming menstrual cycle. CONCLUSIONS: Antiretroviral-based HIV prevention is acceptable and accessible to meet the growing demand for safer conception services in Kenya, since medically assisted interventions are currently cost prohibitive. Cross-disciplinary training for health providers would expand confidence in all prevention options and foster the tailoring of counselling to couples' preferences. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/28361508/Delivering_safer_conception_services_to_HIV_serodiscordant_couples_in_Kenya:_perspectives_from_healthcare_providers_and_HIV_serodiscordant_couples_ L2 - https://doi.org/10.7448/IAS.20.2.21309 DB - PRIME DP - Unbound Medicine ER -