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. 2014 Jul;28 Suppl 3(Suppl 3):S277-85.
doi: 10.1097/QAD.0000000000000330.

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

Sheree R Schwartz  1 , Jean Bassett, Ian Sanne, Rebecca Phofa, Nompumelelo Yende, Annelies Van Rie
Affiliations

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

Sheree R Schwartz et al. AIDS. 2014 Jul.

Abstract

Objective: To describe the development and implementation of a safer conception service in a resource-limited setting.

Methods: Qualitative work to inform the design of a safer conception service was conducted with clients and providers at Witkoppen Health and Welfare Centre, a primary health center in Johannesburg, South Africa. Services began in July 2013 for HIV-affected participants planning conception within 6 months and included counseling about timed unprotected intercourse and home-based self-insemination, early initiation of combined antiretroviral therapy (cART) for HIV-infected individuals, pre-exposure prophylaxis for HIV-uninfected partners and circumcision for men. Participants were enrolled into an implementation science study evaluating method uptake, acceptability, and pregnancy and HIV transmission outcomes.

Results: Findings to-date from 51 qualitative participants and 128 clinical cohort participants (82 women and 46 men, representing 82 partnerships) are presented. All men were accompanied by female partners, whereas 56% of women attended with their male partner. Fifteen of the 46 couples (33%) were in confirmed serodiscordant relationships; however, of the 36 additional women attending alone, 56% were unaware of their partners' HIV status or believed them to be HIV-uninfected. The majority of the HIV-infected women (86%) and men (71%) were on cART at enrollment; however, only 47% on cART were virally suppressed. Timed unprotected intercourse, self-insemination and cART were common choices for participants; few elected pre-exposure prophylaxis.

Conclusions: Lessons learned from early implementation demonstrate feasibility of safer conception services; however, reaching discordant couples, cART-naïve infected partners, and men remain challenges. Creating demand for safer conception services among those at highest risk for HIV transmission is necessary.

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Figures

Figure 1
Figure 1
Implementation science approach to optimizing safer conception services
Figure 2
Figure 2
Current safer conception service delivery model
See this image and copyright information in PMC

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