scholarly journals “I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Lynn T. Matthews ◽  
Francis Bajunirwe ◽  
Jasmine Kastner ◽  
Naomi Sanyu ◽  
Cecilia Akatukwasa ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Health Workers ◽  
Child Outcomes ◽  
Safer Conception ◽  
Infected Female ◽  
Male Clients ◽  
Provider Perspectives ◽  
Hiv Serodiscordant Couples ◽  
Reproductive Counseling ◽  
Training And Support

Background.We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.Methods.We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.Results.Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.Discussion.Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.

scholarly journals Evaluating Safer Conception Options for HIV-Serodiscordant Couples (HIV-Infected Female/HIV-Uninfected Male): A Closer Look at Vaginal Insemination

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Okeoma Mmeje ◽  
Craig R. Cohen ◽  
Deborah Cohan
Keyword(s):  
Condom Use ◽  
Sexual Transmission ◽  
Safer Conception ◽  
Serodiscordant Couples ◽  
Fertile Period ◽  
Infected Female ◽  
Hiv Serodiscordant Couples ◽  
Childbearing Desires ◽  
Sexual Transmission Of Hiv

HIV serodiscordant couples represent at least half of all HIV-affected couples worldwide. Many of these couples have childbearing desires. Safer methods of conception may allow for pregnancy while minimizing the risk of sexual transmission of HIV. In serodiscordant partnerships with an HIV-infected female and HIV-uninfected male, vaginal insemination of a partner's semen during the fertile period coupled with 100% condom use may be the safest method of conception.

scholarly journals Health workers’ knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria

2019 ◽  
Vol 11 (6) ◽  
pp. 536-544
Author(s):  
Zubairu Iliyasu ◽  
Hadiza S Galadanci ◽  
Ahmad A Zubairu ◽  
Taiwo G Amole ◽  
Nadia A Sam-Agudu ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Health Workers ◽  
Reproductive Rights ◽  
Intrauterine Insemination ◽  
Tertiary Hospital ◽  
Hiv Positive ◽  
Safer Conception ◽  
Vitro Fertilization ◽  
Safer Conception Methods

Abstract Background The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers’ knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria. Methods A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude. Results Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30–39 vs <30 y) (AOR=1.33, 95% CI=1.13–2.47), married (AOR=2.15, 95% CI=1.17–5.58) and having a larger HIV-positive daily caseload (20–49 vs <20) (AOR=1.98, 95% CI=1.07–3.64) predicted positive attitude towards reproductive rights of HIV-affected couples. Conclusions Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.

scholarly journals Experiences With Safer Conception Services for HIV-Serodiscordant Couples at a Referral Hospital in Nairobi, Kenya

2021 ◽  
Vol 3 ◽  
Author(s):  
Anne Kaggiah ◽  
Grace Kimemia ◽  
Hellen Moraa ◽  
Peter Muiruri ◽  
John Kinuthia ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Referral Hospital ◽  
Safer Conception ◽  
Serodiscordant Couples ◽  
Hiv Serodiscordant Couples ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Safer Conception Methods

Human immunodeficiency virus-serodiscordant couples are an important source of new HIV infections in Africa. When trying to conceive, uninfected partners may be at high risk of infection if the infected partner is not virally suppressed. Multiple strategies targeting safer conception exist, but these services are limited. However, when services are available and used, serodiscordant couples can be protected from HIV transmission, and safe to have children if desired. To successfully introduce, integrate, promote, and optimize the service delivery of safer conception with HIV care, it is crucial to understand how HIV-serodiscordant couples perceive and experience these services. Further, viral load monitoring can be critical to safer conception, but there is limited literature on how it informs the decision of the partners about conception. This qualitative study describes the knowledge, perceptions, and experiences of both safer conception services and viral load monitoring among 26 HIV-serodiscordant couples seeking safer conception care at a referral hospital in Nairobi, Kenya. In-depth interviews of HIV-serodiscordant couples were conducted from April to July 2017, and transcripts were analyzed to identify the themes central to the experience of safer conception services of couples and viral load monitoring. Serodiscordant couples reported success in using some of the safer conception methods and had positive experiences with healthcare providers. However, despite using the services, some were concerned about HIV transmission to the seronegative partner and baby, while others faced challenges when using pre-exposure prophylaxis (PrEP) and vaginal insemination. Overall, their motivation to have children overcame their concern about HIV transmission, and they welcomed discussions on risk reduction. Moreover, supportive clinic staff was identified as key to facilitating trust in safer conception methods. Furthermore, viral load monitoring was identified as integral to safer conception methods, an emerging theme that requires further evaluation, especially where routine viral load monitoring is not performed. In conclusion, healthcare providers offering safer conception services should build trust with couples, and recognize the need for continual couple counseling to encourage the adoption of safer conception services.

scholarly journals Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Yasaman Zia ◽  
Jennifer Velloza ◽  
Lynda Oluoch ◽  
Richard Momanyi ◽  
Sarah Mbugua ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cervical Mucus ◽  
Safer Conception ◽  
Open Label ◽  
Fertility Awareness ◽  
Menstrual Cycles ◽  
Condomless Sex ◽  
Message Service

Abstract Background For couples affected by HIV, and serodifferent couples in particular, pregnancy desire is often juxtaposed against the risk of HIV transmission between the couple and the potential neonate leading to thinking about measures to minimize risk of HIV transmission. We assess the use of fertility awareness methods [FAM] and evaluate the drivers of alignment between indicators of fertility and sexual behavior among HIV-serodifferent couples desiring pregnancy. Methods HIV-serodifferent couples from Thika, Kenya were enrolled into an open-label pilot evaluation of safer conception strategies. Women responded to daily 7-item short message service [SMS] surveys on FAM and sexual activity. Menstrual cycles were categorized as having condomless sex aligned, not aligned, or partially aligned to the predicted peak fertility. We used binomial logit models with generalized estimating equations to assess alignment between condomless sex during peak fertility days and FAM results. We used Cox proportional hazards to compare pregnancy incidence among months with sex and peak fertility aligned and mis-aligned. Results A total of 6929 SMS surveys across 252 menstrual cycles of 65 women were included. Reporting “sticky” cervical mucus (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [95% CI]: 1.30, 3.90) and positive ovulation prediction kit [OPK] result (aOR: 2.07, 95% CI: 1.11, 3.86) were associated with increased likelihood of alignment of condomless sex during peak fertility. Pregnancy incidence was statistically similar among periods with sex aligned and not aligned with peak fertility. Conclusions Among women engaged in a comprehensive safer conception program, a moderate percentage of women aligned condomless sex and predicted peak fertility days at least once. While FAM, particularly cervical mucus and OPK, are an inexpensive option for couples to consider using as a component of their safer conception strategies, antiretroviral-based strategies remain important to minimize risk.

Safer conception options for HIV-serodiscordant couples

2012 ◽  
Vol 206 (1) ◽  
pp. e21 ◽  
Author(s):  
Deborah Cohan ◽  
Shannon Weber ◽  
Ronald Goldschmidt
Keyword(s):  
Safer Conception ◽  
Serodiscordant Couples ◽  
Hiv Serodiscordant Couples

scholarly journals Couples Living with HIV

2016 ◽  
Vol 16 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Violeta J. Rodriguez ◽  
Andrew Spence ◽  
Mallory Monda ◽  
JoNell Potter ◽  
Deborah Jones
Keyword(s):  
Perceived Risk ◽  
Hiv Transmission ◽  
Horizontal Transmission ◽  
Hiv Status ◽  
Safer Conception ◽  
Reproductive Intentions ◽  
Hiv Prevention Strategies ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Men’S Involvement

Background: Desires to have children are not lessened by a woman’s HIV status. Couples may lack information to conceive safely, and men may be especially uninformed. This study examined reproductive intentions, practices, and attitudes among men in HIV-infected couples, including attitudes regarding the perceived risk of vertical and horizontal transmission, safer conception, and preconception planning. Methods: Men ( n = 12) in HIV-infected couples were interviewed regarding reproductive intentions, attitudes, and knowledge and qualitative assessments were coded for dominant themes. Results: Themes primarily addressed concerns about the health of the baby, men’s involvement in pregnancy, safer conception, concerns about HIV transmission and antiretroviral therapy, and HIV infection. Men lacked information on safer conception and newer HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). Discussion: Gaps in knowledge regarding preconception practices among men in HIV-infected couples were identified. Results highlight men’s desire for involvement in preconception planning, and opportunities for providers to facilitate this practice and to increase patient education and the use of PrEP are discussed.

scholarly journals User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala

2021 ◽  
Vol 21 (1) ◽  
pp. 248-53
Author(s):  
Jane Namakula Katende ◽  
Kizito Omona
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Service Integration ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Hiv Services ◽  
Provider Perspectives ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. Objectives: To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital. Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services. Keywords: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.

scholarly journals Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe

2006 ◽  
Vol 9 (5) ◽  
pp. 563-569 ◽  
Author(s):  
J Orne-Gliemann ◽  
T Mukotekwa ◽  
A Miller ◽  
F Perez ◽  
M Glenshaw ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Hiv Transmission ◽  
Health Workers ◽  
Feeding Practices ◽  
Cross Sectional Study ◽  
Infant Feeding Practices ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Mother To Child ◽  
Hiv Negative

AbstractObjectiveTo describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.DesignA cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.SettingThe study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.SubjectsThe interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.ResultsOverall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.ConclusionThe HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.

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