AIDS and Behavior

, Volume 22, Issue 6, pp 1758–1765 | Cite as

Fertility Intentions, Pregnancy, and Use of PrEP and ART for Safer Conception Among East African HIV Serodiscordant Couples

  • Renee Heffron
  • Kerry Thomson
  • Connie Celum
  • Jessica Haberer
  • Kenneth Ngure
  • Nelly Mugo
  • Elizabeth Bukusi
  • Elly Katabira
  • Josephine Odoyo
  • Nulu Bulya
  • Stephen Asiimwe
  • Edna Tindimwebwa
  • Jared M. Baeten
  • Partners Demonstration Project Team
Original Paper

Abstract

African HIV serodiscordant couples often desire pregnancy, despite sexual HIV transmission risk during pregnancy attempts. Pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) reduce HIV risk and can be leveraged for safer conception but how well these strategies are used for safer conception is not known. We conducted an open-label demonstration project of the integrated delivery of PrEP and ART among 1013 HIV serodiscordant couples from Kenya and Uganda followed quarterly for 2 years. We evaluated fertility intentions, pregnancy incidence, the use of PrEP and ART during peri-conception, and peri-conception HIV incidence. At enrollment, 80% of couples indicated a desire for more children. Pregnancy incidence rates were 18.5 and 18.7 per 100 person years among HIV-uninfected and HIV-infected women, and higher among women who recently reported fertility intention (adjusted odds ratio 3.43, 95% CI 2.38–4.93) in multivariable GEE models. During the 6 months preceding pregnancy, 82.9% of couples used PrEP or ART and there were no HIV seroconversions. In this cohort with high pregnancy rates, integrated PrEP and ART was readily used by HIV serodiscordant couples, including during peri-conception periods. Widespread scale-up of safer conception counseling and services is warranted to respond to strong desires for pregnancy among HIV-affected men and women.

Keywords

Discordant couples Safer conception PrEP ART Pregnancy Africa 

Notes

Acknowledgements

We thank the couples who participated in this study for their motivation and dedication and the referral partners, community advisory groups, institutions, and communities that supported this work.

Partners Demonstration Project Team

Coordinating Center (University of Washington) and collaborating investigators (Harvard Medical School, Johns Hopkins University, Massachusetts General Hospital) Jared Baeten (protocol chair), Connie Celum (protocol co-chair), Renee Heffron (project director), Deborah Donnell (statistician), Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware, Monique Wyatt. Project sites Kabwohe, Uganda (Kabwohe Clinical Research Centre): Stephen Asiimwe, Edna Tindimwebwa. Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya. Kisumu, Kenya (Kenya Medical Research Institute): Elizabeth Bukusi, Josephine Odoyo. Thika, Kenya (Kenya Medical Research Institute, University of Washington): Nelly Rwamba Mugo, Kenneth Ngure. Data Management was provided by DF/Net Research, Inc. (Seattle, WA). PrEP medication was donated by Gilead Sciences.

Funding

This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R00HD076679). The Partners Demonstration Project was funded by the Bill & Melinda Gates Foundation (OPP1056051), the National Institute of Mental Health of the US National Institutes of Health (R01 MH095507) and the United States Agency for International Development (AID-OAA-A-12-00023). This work is made possible by the generous support of the American people through USAID; the contents are the responsibility of the authors and do not necessarily reflect the views of USAID, NIH, or the United States Government.

Compliance with Ethical Standards

Conflicts of interest

All authors declare no conflicts of interest.

Research Involving Human Participants and/or Animals

All procedures performed were in accordance with the ethical standards of the University of Washington institutional review board, national research ethics committees for each study site, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ngure K, Baeten JM, Mugo N, et al. My intention was a child but I was very afraid: fertility intentions and HIV risk perceptions among HIV-serodiscordant couples experiencing pregnancy in Kenya. AIDS Care. 2014;26(10):1283–7.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pintye J, Ngure K, Curran K, et al. Fertility decision-making among Kenyan HIV-serodiscordant couples who recently conceived: implications for safer conception planning. AIDS Patient Care STDs. 2015;29(9):510–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Matthews L, Mukherjee J. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Supplement 1):S5–11.CrossRefGoogle Scholar
  4. 4.
    Heffron R, Davies N, Cooke I, et al. A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings. J Int AIDS Soc. 2015;18(6 Suppl 5):20272.PubMedPubMedCentralGoogle Scholar
  5. 5.
    World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, Switzerland: World Health Organization; 2015.Google Scholar
  6. 6.
    Baeten JM, Heffron R, Kidoguchi L, et al. Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1-serodiscordant couples: a prospective implementation study in Kenya and Uganda. PLoS Med. 2016;13(8):e1002099.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kahle EM, Hughes JP, Lingappa JR. An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention. J Acquir Immune Defic Syndr (1999). 2013;62(3):339–47.CrossRefGoogle Scholar
  8. 8.
    Morton JF, Celum C, Njoroge J. Counseling framework for HIV-serodiscordant couples on the integrated use of antiretroviral therapy and pre-exposure prophylaxis for HIV prevention. J Acquir Immune Defic Syndr (1999). 2017;74(Suppl 1:):S15–22.CrossRefGoogle Scholar
  9. 9.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Semprini AE, Levi-Setti P, Bozzo M, et al. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet. 1992;340(8831):1317–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Semprini AE, Macaluso M, Hollander L, et al. Safe conception for HIV-discordant couples: insemination with processed semen from the HIV-infected partner. Am J Obstet Gynecol. 2013;208(5):e401–9.CrossRefGoogle Scholar
  12. 12.
    De Carli G, Palummieri A, Liuzzi G, Puro V. Safe conception for human immunodeficiency virus-discordant couples: the preexposure prophylaxis for conception alternative. Am J Obstet Gynecol. 2014;210(1):90.CrossRefPubMedGoogle Scholar
  13. 13.
    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):52–8.Google Scholar
  14. 14.
    Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: a systematic review. Matern Child Health J. 2002;6(2):75–88.CrossRefPubMedGoogle Scholar
  15. 15.
    Davies N. Uptake and clinical outcomes from a primary healthcare based safer conception service in Johannesburg, South Africa: findings at 7 months. Abstract #THPDC0105. AIDS 2016. Durban, South Africa 2016.Google Scholar
  16. 16.
    Kaida A. High planned partner pregnancy incidence among HIV-positive men in rural Uganda: implications for comprehensive safer conception services for men. Abstract #THPDC0106. AIDS 2016. Durban, South Africa 2016.Google Scholar
  17. 17.
    Yende N. Clinical outcomes and lessons learned from a safer conception clinic for HIV-affected couples trying to conceive. Abstract #THPDC0104. AIDS 2016. Durban, South Africa 2016.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Renee Heffron
    • 1
    • 2
  • Kerry Thomson
    • 2
  • Connie Celum
    • 1
    • 2
    • 3
  • Jessica Haberer
    • 4
  • Kenneth Ngure
    • 1
    • 5
  • Nelly Mugo
    • 1
    • 6
  • Elizabeth Bukusi
    • 1
    • 7
  • Elly Katabira
    • 8
  • Josephine Odoyo
    • 7
  • Nulu Bulya
    • 8
  • Stephen Asiimwe
    • 9
  • Edna Tindimwebwa
    • 9
  • Jared M. Baeten
    • 1
    • 2
    • 3
  • Partners Demonstration Project Team
  1. 1.Department of Global HealthUniversity of WashingtonSeattleUSA
  2. 2.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  3. 3.Department of MedicineUniversity of WashingtonSeattleUSA
  4. 4.Massachusetts General Hospital and Harvard Medical SchoolBostonUSA
  5. 5.Centre for Clinical Research, College of Health SciencesJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
  6. 6.Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
  7. 7.Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
  8. 8.Infectious Disease InstituteMakerere UniversityKampalaUganda
  9. 9.Kabwohe Clinical Research CenterKabwoheUganda

Personalised recommendations