Abstract
Introduction A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.
Highlights
A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa
The use of pre-exposure prophylaxis, artificial vaginal insemination, timed unprotected intercourse, and sperm wash have been described in the literature [8,9,10,11,12]. e recommended World Health Organization (WHO) preconception care package for all couples [6] includes among others, vaccination against preventable diseases, assessment for sexually transmitted infections (STIs), and nutritional and genetic assessment. ere is existing data that persons living with HIV (PLWHIV) who are adherent to highly active antiretroviral therapy (HAART) and maintaining an undetectable viral load have effectively no risk of sexually transmitting HIV [7, 13,14,15]
All HIV-positive partners within the discordant couples’ clinic received HAART. e prevention strategy with the highest uptake among the couples was the use of pre-exposure prophylaxis (PrEP) alongside HAART at 38.5%, followed by HAART and artificial vaginal insemination (AVI) at 29.7%
Summary
A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Ere is existing data that PLWHIV who are adherent to highly active antiretroviral therapy (HAART) and maintaining an undetectable viral load have effectively no risk of sexually transmitting HIV [7, 13,14,15]. Maternal viral suppression to undetectable levels before conception, during pregnancy, and at the time of delivery makes perinatal HIV transmission almost entirely preventable [17, 18]. Given these apparent benefits, the WHO recommends preconception care as a standard component of primary care for HIV discordant couples [6]
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