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

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.

Prevalence of Consistent Condom Use and Associated Factors among Serodiscordant Couples in Ethiopia, 2020: A Mixed-Method Study

Background. Heterosexual transmission within serodiscordant relationships is the core source of new HIV infections. Although consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples, it has not been extensively studied in Ethiopia. Consequently, the current study looked at the proportion of serodiscordant couples in Ethiopia who used condoms consistently and the factors associated with that. Methods. A cross-sectional was conducted from October 2019 to June 2020. For the quantitative findings to be more robust and reliable, a qualitative design was incorporated. An interviewer-administered questionnaire was used to collect the data. Qualitative data were collected using gender-matched four focus group discussions. Multivariable logistic regression was conducted to identify factors associated with consistent condom use. The statistical significance of the variables was declared at a P value of less than 0.05. Results. This study confirmed that the proportion of consistent condom use was 58.4% [95% CI: 53.1-63.1%]. After controlling for all other variables, unmarried partners, adjusted odds ratio AOR = 0.44 [95% CI: 0.229-0.877] and students and employees, AOR = 0.33 [95% CI: 0.130-0.846] and AOR = 0.39 [95% CI: 0.165-0.939], respectively, were less likely consistently use condoms, whereas couples living together, AOR = 1.86 [95% CI: 1.197-2.195], receiving counseling about condom use, AOR = 1.90 [95% CI: 1.182-3.076], and having more knowledge about HIV, AOR = 1.61 [95% CI: 1.031-2.525] were more likely to use condoms consistently. Conclusion. Despite its importance, the proportion of consistent condom use among serodiscordant couples was significantly low. To improve condom use consistently, planners, policymakers, and health care practitioners should consider the factors listed above when making decisions. There should be an increased focus on student and employee intervention as well.

Oral Pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations

BackgroundThe objective of this study was to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) of the effectiveness and safety of oral Pre-Exposure Prophylaxis (PrEP) to prevent HIV.MethodsDatabases (PubMed, Embase and the Cochrane Register of Controlled Trials) were searched up to 5/7/2020. RCTs were included that compared oral tenofovir-containing PrEP to placebo, no treatment or alternative medication/dosing schedule. The primary outcome was the rate ratio (RR) of HIV infection using a modified intention-to-treat analysis. All analyses were stratified a priori by population: men who have sex with men (MSM), serodiscordant couples, heterosexuals and people who inject drugs (PWID).The quality of individual studies was assessed using the Cochrane Risk-of-Bias tool and the certainty of evidence was assessed using GRADE.ResultsOf 2,803 unique records, 15 RCTs met our inclusion criteria. Over 25,000 participants were included, encompassing 38,289 person-years of follow-up data.PrEP was found to be effective in MSM (Rate Ratio [RR] 0.25, 95% CI: 0.1-0.61; Absolute Rate Difference [ARD] -0.03, 95% CI: -0.01 to -0.05), serodiscordant couples (RR 0.25, 95% CI: 0.14-0.46; ARD -0.01, 95% CI: -0.01 to -0.02) and PWID (RR 0.51, 95% CI: 0.29-0.92; ARD - 0.00, 95% CI: -0.00 to -0.01), but not in heterosexuals (RR 0.77, 95% CI: 0.46-1.29).Efficacy was strongly associated with adherence (p<0.01). PrEP was found to be safe, however unrecognised HIV at enrolment increased the risk of viral drug mutations. Evidence for risk compensation or an increase in STIs was not found.DiscussionPrEP is safe and effective in MSM, serodiscordant couples and PWID. Additional research is needed prior to recommending PrEP in heterosexuals. Data were limited by poor adherence in several studies. No RCTs were identified for other high-risk groups, such as trangender women and sex workers.PROSPERO IDCRD42017065937Article SummaryStrengths and limitations of this studyA systematic review and meta-analysis of RCTs was conducted of the efficacy and safety of oral PrEP to prevent HIV following best practice guidelines (PRISMA guidelines and GRADE framework)Observational studies were excluded from this review, and as such, PrEP effectiveness may be lower in real-world settingsChange in sexual behaviour, or ‘risk compensation’, is difficult to ascertain based on RCT evidence aloneDue to substantial variation in adherence across studies, findings should be interpreted with caution.

Effect of semen washing methods on diminishing the transmission of viral infections in artificial reproductive technology

Seminal infections were considered to be an etiologic factor of male infertility. Semen washing is used as an appropriate technique in artificial reproductive technology (ART) for serodiscordant couples when the partner of male is contaminated. The aim of this study was to investigate the role of semen washing methods in reducing the transmission of viral infections in ART. In this narrative review we investigated accessible information from Google Scholar, PubMed, Scopus, Web of Science, IranMedex, Irandoc, Magiran, SID, MEDLIB and Scientific Information Database until 2019. The MeSH terms of semen washing, HIV, assisted reproduction, serodiscordant, and virus transmission were used. According to the search strategy, 89 articles were discovered. After checking the titles, abstracts and manuscripts, a collection of 45 papers were chosen pursuant to the suitability indexes. The studies were performed around different categories of semen washing (swim up, density gradient) in serodiscordant couples. Some studies highlighted that semen washings can completely prevent viral transmission, but a few do not believe this claim. However, scientific researchers have revealed that sperm washing may diminish the possibility of infection in serodiscordant couples where the male partner is infected. Swim up in combination with density gradient is a suitable method to diminish the transmission of infections.

HLA Class I and Plasma Viral Load of HIV-1 in Sexually Transmitted and Reproductive Tract Infections among Heterosexual Serodiscordant couples in Nigeria

ABSTRACTBackgroundThis study investigated HLA Class I in Long Term Non-progressors (LTNPs) and plasma viral load in Sexually Transmitted and Reproductive Tract Infections (STIs/RTIs) associated with Heterosexual HIV-1 transmission among serodiscordant couples in Nigeria.MethodsA total of 271 serodiscordant and concordant couples (HIV positive and negative) were enrolled, blood samples were collected from the subjects by venipuncture. HLA class I (with specific primers), plasma viral load, CD4+ analysis was done. Endocervical/urethral swabs and early morning urine samples were collected by standard microbiological methods. These were screened by microscopy, culture, antibiogram, and biochemical tests with a view to identify aetiologic agents of co-infections with HIV.ResultsThe Participants age ranged from ≥ 21- < 50years. The index whose plasma viral loads were 10,001-100,000 copies/ml had STIs/RTIs 32(60.9% p=0.059). Staphylococcus aureus and Escherichia coli (22.1%) were isolated from the index (HIV positive subject) while 14.5% of Staphylococcus aureus and 27.2% of E coli were isolated from their partners (HIV negative subject). Staphylococcus aureus and E coli are normal flora but because the patients are Immunocompromised as a result of positivity to HIV, Staphylococcus aureus and E. coli in this context becomes opportunistic thereby, causing genital tract infections. Staphylococcus from the index showed more sensitivity to Amoxicillin/clavulanate (95.4%/90.4%) compared to the partners (55.1%/73.5%) and more resistant to Ceftazidime (81.4%) compared to the partners (68.9%). LTNPs were 28(8.51%) among the index. HLA-B alleles: B*5701 (9.2%), B*5703 (4.6%) and B*5801(12.5%) were identified for viral control at late stage of HIV infection while A*1 (4.6%), and C*0701 (29.1%) were protective alleles observed. HLA-B*0702 (33.3%), B*4201/A*2301(4.6%) respectively were susceptible alleles associated with seroconversion among LTNPs.ConclusionThe microorganisms isolated from the index were associated with high viral loads and are independent makers to HIV-1 transmission among serodiscordant couples. Individuals associated with HLA class I alleles identified among LTNPs were those significantly associated with resistance and susceptible to HIV-1 infections.

Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples

Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. We aimed to evaluate health economics of antiretroviral-based strategies for HIV-serodiscordant couples in the China context. A deterministic model of HIV evolution and transmission within a cohort of serodiscordant couples was parameterized using the real-world database of Zhoukou city and published literature. We evaluated the mid-ART (a historical strategy, initiating ART with CD4 < 500 cells/mm3), early-ART (the current strategy, offering ART regardless of CD4 cell counts) and a hypothetical strategy (early-ART combined short-term daily PrEP) versus the late-ART (the baseline strategy, initiating ART with CD4 < 350 cells/mm3) offered by 2008 national guidelines. We estimated the incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) from a societal perspective, derived by clinical benefits and HIV-caused life quality respectively, and portrayed their changes over a 0–30 year’s timeframe. The model projections indicated that the antiretroviral-based interventions were more likely to obtain clinical benefits but difficult to improve quality of life, and cumulative ICER and ICUR were generally decreasing without achieving cost-saving. Scale-up access to ART for the HIV-positive among serodiscordant couples was easily fallen within the range of paying for incremental life-years and quality adjusted life years by the societal willingness. The hypothetical strategy had the potential to prevent most seroconversion events within marriages but required enormous upfront costs, thus it took a long time to reach established thresholds. The current strategy of early-ART is the most cost-effective. Clarifying the obstacles of high cost of PrEP and improving life quality for HIV-serodiscordant couples have emerged as an urgent requisition.

Human Leukocyte Antigen-C and Haplotypes: Associations with Resistance and Susceptibility to HIV-1 Infection among Serodiscordant Couples in Nigeria

ABSTRACTINTRODUCTIONThe Human Leucocyte Antigen (HLA) class-1 is known to play a significant role in mediating resistance or susceptibility to HIV infection in the clinical course of AIDS. Recent studies have identified HLA-C as a key molecule that affects HIV disease progression. However, the role of HLA class 1 in heterosexual HIV-1 susceptibility or resistance in serodiscordant couples is not known in Nigeria. Therefore, this study evaluated the association between HLA-C susceptibility and resistance in HIV-1 transmission amongst heterosexual serodiscordant couples in Nigeria.METHODSA total of 271 serodiscordant, concordant HIV positive and negative couples who gave informed consent were enrolled into this study. Extracted genomic DNA was sequenced for high resolution HLA-C class 1 genotypes using allele-specific primers (on exons 2 and 3) for HLA-C sequencing and typing.RESULTSThe highest frequency distribution of high-resolution HLA-C alleles observed in the HIV positive subjects were: HLA-C*040101 178 (35.0%) followed by C*0701 124 (24.9%) compared with HIV negative subjects: C*040101 108(39.0%) followed by C*0701 64(24.7%). Alleles C*070201 (OR = 4.19, P<0.05) and C*0804 (OR = 3, P<0.045) were found to be independently associated with HIV-1 susceptibility in the cohort of serodiscordant couples. HLA-C*0802 (OR=0.5. P<0.005) and C*0304 (OR=0.34. P<0.002) were significantly associated with HIV-1 resistance to HIV-1 infection among the cohort.CONCLUSIONThe result has contributed to the importance of how host HLA-C genetic factors can influence HIV-1 disease susceptibility (HLA-C*070201; C*0804) and resistance (HLA-C*0802; C*0304) in serodiscordant couples. This information may contribute to the development of future effective HIV vaccine in Nigeria.

“We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

Background A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. Methods This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples’ HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples’ decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. Results Three major themes were identified: (1) HIV as “two people’s secret” and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. Conclusions The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

Protective effect of the combination of wild-type genotypes (G/G and G/G) of CCR2-64V and SDF1-3A' genes in serodiscordant couples in Yaounde-Cameroon

Background: There is growing evidence that polymorphisms in chemokine and chemokine receptor genes influence susceptibility to HIV infection and disease progression. However, not much is documented about the influence of these polymorphisms in HIV serodiscordant couples in Cameroon. Objective: The objective of this study therefore was to determine the prevalence and the effect of the polymorphisms of CCR5-Δ32, CCR5 promoter 59029 A/G, CCR2-64I and SDF1-3′A gene in HIV serodiscordant couples in comparison to HIV negative seroconcordant and HIV positive seroconcordant couples in Yaoundé-Cameroon. Method: A total of 96 couples were recruited from five hospitals, of which 60 couples were HIV serodiscordant (test group), 18 HIV negative seroconcordant and 18 HIV positive seroconcordant couples were used as controls. Their genotypes for CCR5-Δ32, CCR5 promoter, CCR2and SDF1-were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism. Results: The allelic frequencies of these genes in the studied population were: 0%, 26.30%, 15.30% and 1.62% respectively for CCR5-Δ32, CCR5 promoter, CCR2and SDF1. The frequency of the combination of CCR5 promoter and SDF1- (A/A+ G/G) wild-type genotype was higher in HIV-infected partners (82.92%) compared to uninfected partners (56.1%) in HIV serodiscordant couples (p= 0.0001). The combination of wild-type CCR2and SDF1genotypes (G/G + G/G) was higher among uninfected partners (80.48%) in HIV serodiscordant couples compared to the infected partners (60.97) (p= 0.005). Conclusion: HIV negative partner protection against HIV/AIDS infection may be attributed to the combination of wild-typegenotypes (G/G and G/G) of CCR2and SDF1genes in HIV serodiscordant couples.