727. Predictors of Depressive Symptoms in Pregnant Partners in Seroconcordant Couples Living with HIV in Zambézia Province, Mozambique

Background Depression contributes to HIV treatment outcomes in sub-Saharan Africa, where approximately 15% of people living with HIV have comorbid depression. HoPS+, a cluster randomized trial among seroconcordant couples living with HIV, assesses male partner involvement during antenatal HIV care and HIV outcomes. We describe predictors of depressive symptoms among pregnant partners living with HIV in Zambézia Province, Mozambique. Methods This baseline cross-sectional analysis includes 1079 female HoPS+ participants. We show demographic (age, enrollment date, relationship status, education, and occupation) and clinical (WHO HIV stage, body mass index [BMI], and antiretroviral therapy [ART] use history) factors. We model females’ depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models with continuous covariates as restricted cubic splines (enrollment date, age, BMI, partner’s PHQ-9 score), categorical covariates (district, relationship status, education, occupation, WHO stage), and ART use history. Missing covariates were imputed 20 times. Results Participants’ median age was 23 (interquartile range [IQR] 20-28). Most women reported no or < 7 years of education (84.1%), were farmers (61.3%), and were WHO stage I (81.9%). They had a median PHQ-9 score of 3 (IQR 0-5) and 47 (43.6%) had moderately severe or severe depressive symptoms, with 19.6% missing PHQ-9 scores. Among 867 pregnant partners with PHQ-9s, demographic and clinical covariates were not meaningful predictors of PHQ-9 score. Male partner’s PHQ-9 score, however, was associated with (covariate-adjusted Spearman’s rho 0.58, 95% Confidence Interval [CI]: 0.51-0.65) and strongly predictive of a pregnant partner’s score (Figure). An increase in a male partner’s PHQ-9 score from 9 to 10 was associated with 1.47 times increased odds (95% CI: 1.37-1.58) of a ≥1-point increase in a woman’s PHQ-9 score Figure: Female Partner's Depressive Symptoms Conclusion Depressive symptoms are highly correlated among pregnant people and their partners, which may have implications for pregnancy care. Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy may have greater success when focused on addressing both partners’ depressive symptoms. Disclosures All Authors: No reported disclosures

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.

Gambaran Perilaku Pencegahan HIV Pada Pasangan Serodiskordan dan Serokonkordan Di Yayasan Grapiks Bekasi Tahun 2020

ABSTRAKLatar Belakang. Pencegahan HIV pada pasangan serodiskordan dan serokonkordan berkaitan dengan perilaku yang berfokus pada pandangan dan keyakinan individu. Penelitian tentang HIV menemukan bahwa sebanyak 25% ditularkan oleh pasangannya yang positif HIV.Tujuan. Tujuan penelitian ini adalah mengetahui gambaran perilaku pencegahan HIV pada pasangan serodiskordan dan serokonkordan di Yayasan Grapiks Bekasi.Metode. Penelitian ini menggunakan desain studi kasus dengan pendekatan kualitatif. Pengumpulan data dengan wawancara mendalam melalui WhatsApp call.Hasil. Sebagian besar pasangan serodiskordan dan semua pasangan serokonkordan konsisten menggunakan kondom dan keduanya patuh mengkonsumsi obat ARV. Semua ODHA mengungkapkan status kepada pasangannya tetapi hanya sebagian yang mengungkapkan kepada keluarganya. Pola relasi suami istri pada pasangan serodiskordan adalah head complement, sedangkan pasangan serokonkordan yaitu head complement dan senior junior partner. Pasangan serodiskordan menerima konsekuensi, sedangkan pasangan serokonkordan berharap tidak parah. Pasangan serodiskordan memiliki persepsi manfaat yang rendah dan persepsi hambatan yang tinggi daripada pasangan serokonkordan. Kedua pasangan mendapatkan informasi kurang mendalam tentang penyakit HIV/AIDS dari tenaga kesehatan.Kesimpulan. Terdapat perbedaan perilaku pencegahan HIV pada pasangan serodiskordan dan serokonkordan di Yayasan Grapiks Bekasi. ABSTRACTBackground. HIV prevention in serodiscordant and seroconcordant couples are concerned with behaviors that focus on individual views and beliefs. Studies found that 25% were transmitted by partners who were HIV positive. Objective. This research aims to determine the description of HIV prevention behavior in serodiscordant and seroconcordant couples at the Bekasi Grapiks Foundation.Methods. This study used a case study design with a qualitative approach. Data collection by in-depth interviews via WhatsApp call.Results. Most serodiscordant and all seroconcordant partners consistently used condoms and both partners adhered to taking ARV drugs. All PLWHA disclose their status to their partners but, some disclose to their families. The relationship pattern in serodiscordant couples is the head complement, while seroconcordant couples are head complement and senior junior partner. The serodiscordant partner accepted the consequences, whereas the seroconcordant partner hoped not to be severe. Serodiscordant couples have less benefit and high resistance than seroconcordant couples. Both partners received less in-depth information about HIV/AIDS from health workers.Conclusion. There are differences in HIV prevention behavior between serodiscordant and seroconcordant couples at the Bekasi Grapiks Foundation

HIV Serodiscordance among Couples in Cameroon: Effects on Sexual and Reproductive Health

Background and Objectives: One of the main reasons for risky sexual behavior observed in HIV serodiscordant couples despite the knowledge of the partner’s status and counselling is childbearing. In Cameroon, there are few reports on HIV serodiscordant couples. This paper describes the influence of HIV on sexual relationships and decision to procreate. Methods: This cross-sectional study was conducted in five health centers. Self-administered questionnaire was used to collect social and demographic information, while semi-structured in-depth individual and couple interviews were used to explore sexual relationships and decisions about fatherhood/motherhood. Blood samples were collected from the couples and tested for HIV to confirm serodiscordance. The data were analyzed using the GraphPad Prism Version 6 software. Results: A total of 53/192 (27.6%) HIV serodiscordant couples participated in the study, and 18/74 (24.32%) HIV positive seroconcordant couples and 32/80 HIV negative seroconcordant couples were used as controls. The majority of HIV-positive partners in serodiscordant couples were women (30/53), of whom 25/30 were on antiretroviral therapy. Nearly half of the respondents (23 /53) reported tensions related to serodiscordance, shown by reduced sex frequency. The use of condoms was not systematically observed among seroconcordant and serodiscordant couples with respective proportions of 55.55% and 20.75% (p = 0.0086). Thirty seven out of 53 HIV serodiscordant couples wanted children, among them, seven couples did not have any and expressed their aspiration for parenthood despite fear of infecting one’s partner. Conclusion and Global Health Implications: Sexuality of serodiscordant couples as well as of HIV positive seroconcordant couples was affected by the presence of HIV/AIDS. The desire to procreate may lead couples to adopt risky sexual behaviors. It is important to define specific guidelines for serodiscordant couples in order to improve their sexual life and consequently enable them to procreate with minimal risk of infecting their partner and or to transmit the virus to their baby. Key words: • HIV • Serodiscordance • Sexual health • Childbearing • Cameroon • Reproductive health Copyright © 2020 Tchakounté et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Pregnancy planning preferences among people and couples affected by human immunodeficiency virus: Piloting a discrete choice experiment

Decision-making related to pregnancy planning is complex and human immunodeficiency virus (HIV) may further complicate the process. With increasing rates of pregnancy among individuals affected by HIV, the need to understand decision-making is imperative. The primary objectives of this pilot study were to confirm the feasibility of using discrete choice experimentation (DCE) to elicit an understanding of this process and to determine the acceptability of the choice factors that were included in two novel DCEs, while gathering a preliminary understanding of preference. The choice attributes were risk of vertical HIV transmission, risk of horizontal HIV transmission, cost, probability of conception, method of conception, and travel time. Thirteen respondents completed a DCE for serodiscordant couples in which the female partner was HIV-positive, and 12 respondents completed a DCE for seroconcordant couples. All respondents’ utility for an increased chance of a successful pregnancy was positive and statistically significant. In the serodiscordant dyads, the attributes of risk of horizontal transmission, risk of vertical transmission, a 5-h travel time to clinic, and cost were significantly associated with decreased utility. In the seroconcordant dyads, only the attributes of chance of risk of vertical transmission and cost were significantly associated with decreased utility. The serodiscordant dyads preferred home insemination with a syringe and the seroconcordant couples preferred conception methods within fertility clinics, over condomless sex with timed ovulation. On average, participants were willing to pay more for greater chance of conception and less willing to pay for increased risk of transmission. Couples affected by HIV are willing to participate in a DCE and the attributes that were included all seem relevant except risk of vertical transmission. There are various real-life trade-offs that are made during pregnancy planning with HIV and better understanding of these can be useful for clinicians during preconception counseling.