Delivering Safer Conception Services to HIV Serodiscordant Couples in Kenya: Perspectives From Healthcare Providers and HIV Serodiscordant Couples

May 2017 - Combination Prevention

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Ngure, K., Kimemia, G., Dew, K., et al. Journal of the International AIDS Society (March 2017), 20(Suppl 1): 52–58, doi:10.7448/IAS.20.2.21309.

The authors of this qualitative study examined the views and experiences of providers and serodiscordant couples in Thika, Kenya, to inform strategies for safer contraception among mixed-status couples. Between August 2015 and March 2016, they interviewed 20 providers from public and private clinics providing HIV or fertility care; and they conducted 20 interviews and four focus group discussions with serodiscordant couples who were participating in the Partners Demonstration Project assessing antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for serodiscordant couples. Findings showed that participants often favored methods they were familiar with and revealed gaps in knowledge among both providers and clients. Providers from HIV clinics frequently discussed timed condomless sex and ART; providers from fertility centers favored medically assisted reproduction and were often uninformed about ART. Couples experienced with ART and PrEP were willing to use these strategies to reduce HIV risk when attempting pregnancy. Couples also found condomless sex, combined with ART and PrEP, an acceptable strategy; but they often revealed insufficient knowledge of fertility cycles. The authors concluded that strategies based on ART, PrEP, and timed condomless sex were acceptable to serodiscordant couples. They recommended cross-training for medical providers to strengthen services for safe conception, and they endorsed frequent discussions of the fertility desires of serodiscordant couples.

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