Preventing HIV and achieving pregnancy among HIV sero-different couples

Pilot study of a safer conception intervention in Zimbabwe

Bibliographic Data

ID19590686
AuthorsJoelle Brown (0000-0002-6044-2906, University of California, San Francisco, corresponding author), Serah Gitome (0009-0002-3371-4213, Kenya Medical Research Institute, corresponding author), Bismark Mataveke (University of Zimbabwe, corresponding author), Thandiwe Chirenda (University of Zimbabwe, corresponding author), Allen Matubu (0000-0001-5361-7686, University of Zimbabwe, corresponding author), Gift Chareka (0000-0002-0529-877X, University of Zimbabwe, corresponding author), Charles Chasakara (0000-0002-3717-8617, University of Zimbabwe, corresponding author), Nyaradzo M Mgodi (0000-0002-3085-5259, University of Zimbabwe, corresponding author), Nyaradzo Mgodi, Caroline Murombedzi (0000-0002-7032-2318, University of Zimbabwe, corresponding author), Petina Musara (0000-0001-9668-4344, University of Zimbabwe, corresponding author), Tinei Makurumure (corresponding author), Carolyn Smith Hughes (0000-0002-8216-7634, University of California, San Francisco, corresponding author), Elizabeth A Bukusi (0000-0002-2031-2808, Kenya Medical Research Institute, corresponding author), Elizabeth Bukusi, Craig R Cohen (0000-0001-8654-6634, University of California, San Francisco, corresponding author), Stephen Shiboski (0000-0002-9257-2609, University of California, San Francisco, corresponding author), Lynae A Darbes (0000-0003-4738-6812, University of Michigan, corresponding author), Lynae Darbes, James G Kahn (0000-0002-1259-7233, University of California, San Francisco, corresponding author), Geddes W Rutherford (0000-0002-0707-8287, University of California, San Francisco, corresponding author), George W Rutherford (0000-0002-1789-734X), Zvavahera M Chirenje (0000-0003-3538-5150, University of Zimbabwe, corresponding author), Felix Mhlanga (0000-0003-3294-3567, University of Zimbabwe, corresponding author)
EditorsMadhukar Pai (0000-0003-3667-4536)
Year2023
Volume3
Issue2
Pagese0000796
Publication date2023-02-24
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000796
PMID36963004
OpenAlexW4321780561
LanguageEN
Citations received6
References cited47

Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program ( Clintrials . gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176

Family medicine · Gynecology · Obstetrics · Pregnancy · SAFER · Viral load · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Medicine · Nursing · Sex work and related issues