Implementation of a safer conception service for HIV-affected couples in South Africa

Schwartz, Sheree R.; Bassett, Jean; Sanne, Ian; Phofa, Rebecca; Yende, Nompumelelo; Van Rie, Annelies

doi:10.1097/QAD.0000000000000330

Title

Implementation of a safer conception service for HIV-affected couples in South Africa

Author

Schwartz, Sheree R.

Bassett, Jean

Sanne, Ian

Phofa, Rebecca

Yende, Nompumelelo

Van Rie, Annelies

Abstract

Objective:To describe the development and implementation of a safer conception service in a resource-limited setting.Methods:Qualitative work to inform the design of a safer conception service was conducted with clients and providers at Witkoppen Health and Welfare Centre, a primary health center in Johannesburg, South Africa. Services began in July 2013 for HIV-affected participants planning conception within 6 months and included counseling about timed unprotected intercourse and home-based self-insemination, early initiation of combined antiretroviral therapy (cART) for HIV-infected individuals, pre-exposure prophylaxis for HIV-uninfected partners and circumcision for men. Participants were enrolled into an implementation science study evaluating method uptake, acceptability, and pregnancy and HIV transmission outcomes.Results:Findings to-date from 51 qualitative participants and 128 clinical cohort participants (82 women and 46 men, representing 82 partnerships) are presented. All men were accompanied by female partners, whereas 56% of women attended with their male partner. Fifteen of the 46 couples (33%) were in confirmed serodiscordant relationships; however, of the 36 additional women attending alone, 56% were unaware of their partners' HIV status or believed them to be HIV-uninfected. The majority of the HIV-infected women (86%) and men (71%) were on cART at enrollment; however, only 47% on cART were virally suppressed. Timed unprotected intercourse, self-insemination and cART were common choices for participants; few elected pre-exposure prophylaxis.Conclusions:Lessons learned from early implementation demonstrate feasibility of safer conception services; however, reaching discordant couples, cART-naive infected partners, and men remain challenges. Creating demand for safer conception services among those at highest risk for HIV transmission is necessary.

Language

English

Source (journal)

AIDS. - London

Publication

London : 2014

ISSN

0269-9370

DOI

10.1097/QAD.0000000000000330

Volume/pages

28 :s:[3] (2014) , p. S277-S285