Prevalence and Correlates of Use of Safer Conception Methods in a Prospective Cohort of Ugandan HIV-Affected Couples with Fertility Intentions

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.

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Fertility intentions of women living with HIV and their male partners during the perinatal period in rural South Africa

International Journal of STD & AIDS ◽

10.1177/0956462420987447 ◽

2021 ◽

pp. 095646242098744

Author(s):

Lissa N Mandell ◽

Violeta J Rodriguez ◽

Karl Peltzer ◽

Stephen M Weiss ◽

Deborah L Jones

Keyword(s):

South Africa ◽

Perinatal Care ◽

Healthcare Providers ◽

Male Involvement ◽

Fertility Intentions ◽

People Living With Hiv ◽

Male Partners ◽

Safer Conception ◽

Women Living With Hiv ◽

Living With Hiv

Understanding the fertility intentions of people living with HIV can guide safer conception planning and prevention of mother-to-child transmission (PMTCT). Most research has addressed fertility intentions among women, rather than couples, at a single time point. This clinical trial of a PMTCT intervention in rural Mpumalanga province, South Africa, examined longitudinal fertility intentions among perinatal women living with HIV and their male partners. Study assessments and intervention and control sessions were conducted prenatally and postpartum. Longitudinal predictors of participants’ ( n = 360 men, n = 917 women) fertility intentions were similar between sexes. Younger age and male involvement in perinatal care were associated with reporting fertility intentions at both baseline and 12 months postpartum. Having an HIV-positive infant and discussing pregnancy plans with a healthcare provider by 12 months postpartum were associated with incident fertility intentions after reporting no plans for further children at baseline. Results highlight the important role of healthcare providers to educate men and women on issues surrounding conception, as well as the potential for incorporating PMTCT and safer conception education into HIV clinical services.

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Provider Beliefs Related to Safer Conception Methods Questionnaire

PsycTESTS Dataset ◽

10.1037/t57164-000 ◽

2016 ◽

Author(s):

Mahlet Atakilt Woldetsadik ◽

Kathy Goggin ◽

Vincent S. Staggs ◽

Rhoda K. Wanyenze ◽

Jolly Beyeza-Kashesya ◽

...

Keyword(s):

Safer Conception ◽

Safer Conception Methods ◽

Provider Beliefs

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Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda

Reproductive Health ◽

10.1186/s12978-019-0717-6 ◽

2019 ◽

Vol 16 (S1) ◽

Cited By ~ 2

Author(s):

Violet Gwokyalya ◽

Jolly Beyeza-Kashesya ◽

John Baptist Bwanika ◽

Joseph K. B. Matovu ◽

Shaban Mugerwa ◽

...

Keyword(s):

Hiv Care ◽

Safer Conception ◽

Safer Conception Methods

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Our Choice Improves Use of Safer Conception Methods Among HIV Serodiscordant Couples in Uganda: A Cluster Randomized Controlled Trial Evaluating Two Implementation Approaches

10.21203/rs.3.rs-143444/v1 ◽

2021 ◽

Author(s):

Glenn Wagner ◽

Rhoda Wanyenze ◽

Jolly Beyeza-Kashesya ◽

Violet Gwokyalya ◽

Emily Hurley ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Family Planning ◽

Usual Care ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Hiv Care ◽

Safer Conception ◽

Randomized Controlled ◽

Safer Conception Methods ◽

Cluster Randomized

Abstract Background: Safer conception counseling (SCC) to promote safer conception methods (SCM) is not yet part of routine family planning or HIV care, and to date there are no published controlled evaluations of SCC.Methods: In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach, or existing family planning services (usual care). 389 HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until pregnancy. Results: The combined intervention groups used appropriate reproductive methods more than usual care [20.8% vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR (95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]; the arms did not vary on modern contraception use among those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1, compared to $1014 in SCC2. Conclusions: More intensive training and supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard implementation approach.Trial registration: Clinicaltrials.gov, NCT03167879; date registered May 23, 2017; https://clinicaltrials.gov/ct2/show/NCT03167879.

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“Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches

Implementation Science ◽

10.1186/s13012-021-01109-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Glenn J. Wagner ◽

Rhoda K. Wanyenze ◽

Jolly Beyeza-Kashesya ◽

Violet Gwokyalya ◽

Emily Hurley ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Family Planning ◽

Usual Care ◽

Controlled Trial ◽

Safer Conception ◽

Low Intensity ◽

Randomized Controlled ◽

Training And Supervision ◽

Safer Conception Methods ◽

Cluster Randomized

Abstract Background Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and supervision would result in a more efficacious approach to implementing SCC. Methods In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until pregnancy. Results The combined intervention groups used appropriate reproductive methods more than usual care [20.8% vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR (95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]. The arms did not vary on modern contraception use among those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1, compared to $1014 in SCC2. Conclusions More intensive provider training and more frequent supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard low intensity implementation approach. Trial registration Clinicaltrials.gov, NCT03167879; date registered May 23, 2017.

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