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

Heffron, R., Thomson, K., Celum, C., et al. AIDS and Behavior (September 2017), doi: 10.1007/s10461-017-1902-7.

This study examined fertility desires, pregnancy incidence, use of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), and HIV transmission during pregnancy among 1,013 serodiscordant couples in Kenya and Uganda. The majority of couples (80 percent) reported wanting to have children in the future and 9 percent reported actively trying to become pregnant; 50 percent of women were not using any form of contraception. Couples reported having sex a median of five times monthly; 64 percent reported having sex without a condom at least once in the past month. Pregnancy incidence was 18.5/100 person-years for HIV-negative women, and 18.7/100 person-years for HIV-positive women. Ninety percent of women on ART had high adherence. In the six months prior to conception, 82.9 percent of couples used ART or PrEP consistently, 14.5 percent used ART or PrEP irregularly, and 2.6 percent did not use anything. Among consistent users, 31.7 percent used both PrEP and ART, 21.7 percent only used PrEP, and 46.6 percent only used ART. There were no seroconversions in the six months prior to pregnancy; during pregnancy, three women and one man were diagnosed with HIV. One of the women reported the pregnancy as unplanned and had no detectable tenofovir levels. The authors concluded that integrating sexual and reproductive health and HIV prevention services can meet the needs of serodiscordant couples who wish to conceive.

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