Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;22(6):1758-1765.
doi: 10.1007/s10461-017-1902-7.

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

Renee Heffron  1   2 , Kerry Thomson  3 , Connie Celum  4   3   5 , Jessica Haberer  6 , Kenneth Ngure  4   7 , Nelly Mugo  4   8 , Elizabeth Bukusi  4   9 , Elly Katabira  10 , Josephine Odoyo  9 , Nulu Bulya  10 , Stephen Asiimwe  11 , Edna Tindimwebwa  11 , Jared M Baeten  4   3   5 ; Partners Demonstration Project Team
Collaborators, Affiliations

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

Renee Heffron et al. AIDS Behav. 2018 Jun.

Abstract

African HIV serodiscordant couples often desire pregnancy, despite sexual HIV transmission risk during pregnancy attempts. Pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) reduce HIV risk and can be leveraged for safer conception but how well these strategies are used for safer conception is not known. We conducted an open-label demonstration project of the integrated delivery of PrEP and ART among 1013 HIV serodiscordant couples from Kenya and Uganda followed quarterly for 2 years. We evaluated fertility intentions, pregnancy incidence, the use of PrEP and ART during peri-conception, and peri-conception HIV incidence. At enrollment, 80% of couples indicated a desire for more children. Pregnancy incidence rates were 18.5 and 18.7 per 100 person years among HIV-uninfected and HIV-infected women, and higher among women who recently reported fertility intention (adjusted odds ratio 3.43, 95% CI 2.38-4.93) in multivariable GEE models. During the 6 months preceding pregnancy, 82.9% of couples used PrEP or ART and there were no HIV seroconversions. In this cohort with high pregnancy rates, integrated PrEP and ART was readily used by HIV serodiscordant couples, including during peri-conception periods. Widespread scale-up of safer conception counseling and services is warranted to respond to strong desires for pregnancy among HIV-affected men and women.

Keywords: ART; Africa; Discordant couples; PrEP; Pregnancy; Safer conception.

PubMed Disclaimer

Conflict of interest statement

Compliance with Ethical Standards: Disclosure of potential conflicts of interest: All authors declare no conflicts of interest.

Figures

Figure I
Figure I. Fertility intentions reported by a) women and b) men during quarterly follow up visits for the Partners Demonstration Project
Each line represents data from one person and line color represents the fertility intention at baseline and is carried throughout follow up time. Lines move up or down to reflect changes in fertility intentions from one quarterly visit to the next. The individual lines have been arranged to depict consistency in fertility intention so that people with the same intention throughout the study are represented in straight lines. When multiple people maintain the same fertility intention throughout the entire study, the graphic depicts individuals' lines as a thicker block of lines. Percentages in the lower table show the aggregate number of people with the designated fertility intention at each quarterly time period and do not reflect past fertility intention.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ngure K, Baeten JM, Mugo N, et al. My intention was a child but I was very afraid: fertility intentions and HIV risk perceptions among HIV-serodiscordant couples experiencing pregnancy in Kenya. AIDS care. 2014;26(10):1283–1287. - PMC - PubMed
    1. Pintye J, Ngure K, Curran K, et al. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning. AIDS patient care and STDs. 2015 Sep;29(9):510–516. - PMC - PubMed
    1. Matthews L, Mukherjee J. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS and behavior. 2009;13(Supplement 1):S5–S11. - PubMed
    1. Heffron R, Davies N, Cooke I, et al. A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings. Journal of the International AIDS Society. 2015;18(6 Suppl 5):20272. - PMC - PubMed
    1. World Health Organization. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. Geneva, Switzerland: World Health Organization; 2015. - PubMed

MeSH terms

Substances