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

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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Low Receipt and Uptake of Safer Conception Messages in Routine HIV Care

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000945 ◽

2016 ◽

Vol 72 (1) ◽

pp. 105-113 ◽

Cited By ~ 16

Author(s):

Riley J. Steiner ◽

Vivian Black ◽

Helen Rees ◽

Sheree R. Schwartz

Keyword(s):

Hiv Care ◽

Safer Conception

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HIV Care Providers’ Communication with Patients About Safer Conception for People Living with HIV in Tanzania

International Perspectives on Sexual and Reproductive Health ◽

10.1363/42e2916 ◽

2016 ◽

Vol 42 (4) ◽

pp. 179 ◽

Cited By ~ 5

Author(s):

Saleem ◽

Surkan ◽

Kerrigan ◽

Kennedy

Keyword(s):

Hiv Care ◽

People Living With Hiv ◽

Care Providers ◽

Safer Conception ◽

Living With Hiv

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Safer Conception Methods and Counseling: Psychometric Evaluation of New Measures of Attitudes and Beliefs Among HIV Clients and Providers

AIDS and Behavior ◽

10.1007/s10461-015-1199-3 ◽

2015 ◽

Vol 20 (6) ◽

pp. 1370-1381 ◽

Cited By ~ 5

Author(s):

Mahlet Atakilt Woldetsadik ◽

Kathy Goggin ◽

Vincent S. Staggs ◽

Rhoda K. Wanyenze ◽

Jolly Beyeza-Kashesya ◽

...

Keyword(s):

Psychometric Evaluation ◽

Attitudes And Beliefs ◽

Safer Conception ◽

Safer Conception Methods

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“I May Not Say We Really Have a Method, It Is Gambling Work”: Knowledge and Acceptability of Safer Conception Methods Among Providers and HIV Clients in Uganda

Health Care For Women International ◽

10.1080/07399332.2014.924520 ◽

2014 ◽

Vol 35 (7-9) ◽

pp. 896-917 ◽

Cited By ~ 30

Author(s):

Sarah Finocchario-Kessler ◽

Rhoda Wanyenze ◽

Deborah Mindry ◽

Jolly Beyeza-Kashesya ◽

Kathy Goggin ◽

...

Keyword(s):

Safer Conception ◽

Safer Conception Methods ◽

Work Knowledge

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

AIDS and Behavior ◽

10.1007/s10461-017-1732-7 ◽

2017 ◽

Vol 21 (8) ◽

pp. 2479-2487 ◽

Cited By ~ 8

Author(s):

Glenn J. Wagner ◽

Sebastian Linnemayr ◽

Kathy Goggin ◽

Deborah Mindry ◽

Jolly Beyeza-Kashesya ◽

...

Keyword(s):

Prospective Cohort ◽

Fertility Intentions ◽

Safer Conception ◽

Safer Conception Methods

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

International Health ◽

10.1093/inthealth/ihz016 ◽

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.

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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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“It really proves to us that we are still valuable”: Qualitative research to inform a safer conception intervention for men living with HIV in South Africa

PLoS ONE ◽

10.1371/journal.pone.0240990 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0240990

Author(s):

Lynn T. Matthews ◽

Letitia Greener ◽

Hazar Khidir ◽

Christina Psaros ◽

Abigail Harrison ◽

...

Keyword(s):

South Africa ◽

Risk Reduction ◽

Hiv Transmission ◽

Hiv Care ◽

Safer Conception ◽

Serostatus Disclosure ◽

Condomless Sex ◽

Hiv Serostatus ◽

Exposure Prophylaxis ◽

Living With Hiv

Objective Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. Methods We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25–45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the “desired pregnancy partner”). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. Results Twelve participants from three FGDs had a median age of 37 (range 23–45) years, reported a median of 2 (range 1–4) sexual partners, and 1 (range 1–3) desired pregnancy partner(s). A third (N = 4) had disclosed HIV-serostatus to the pregnancy partner. Emergent themes included opportunities for and challenges to engaging men in safer conception services. Opportunities included enthusiasm for a clinic-based safer conception intervention and acceptance of some safer conception strategies. Challenges included poor understanding of safer conception strategies, unfamiliarity with risk reduction [versus “safe” (condoms) and “unsafe” (condomless) sex], mixed acceptability of safer conception strategies, and concerns about disclosing HIV-serostatus to a partner. Conclusions Men living with HIV expressed interest in safer conception and willingness to attend clinic programs. Imprecise prevention counseling messages make it difficult for men to conceptualize risk reduction. Effective safer conception programs should embrace clear language, e.g. undetectable = untransmittable (U = U), and support multiple approaches to serostatus disclosure to pregnancy partners.

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