Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

Abstract

Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV–serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and treatment programs in Kenya and other HIV endemic regions of sub-Saharan Africa.

A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya

“…In addition, we previously reported that the majority of HIV-affected individuals and couples in this study indicated that they would prefer delivery of safer conception counseling in individualized sessions (Mmeje et al, 2016), which allows them to ask questions they would not ask if there are many people. However, it is possible that group-level counseling may be more feasible than individual or couple-level counseling in some settings.…”

“…The Toolkit materials can be found at http://www.hiveonline.org/safer-conception-toolkit-for-hiv-affected-individuals-and-couples-and-healthcare-providers. The Toolkit components were modeled after existing patient resources available in the United States (HIVE, 2015; Rutgers Francois-Xavier Bagnoud Center, 2015) and adapted and refined prior to the initiation of this study through an iterative process with key stakeholders (i.e., HIV-affected individuals and couples, local leaders, and health care providers) in the urban communities of Kisumu (Mmeje et al, 2016). The provider training is designed to be delivered in 4 hours: 2 hours of didactic lecture and 2 hours of facilitated interactive case studies and role-playing.…”

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…Studies found that providers faced challenges when discussing SCS when one partner was HIV-infected but had not yet disclosed his or her serostatus to their partner due to confidentiality issues, lack of couple’s HIV counseling and testing, one partner being more involved than the other [40, 54, 61], and differences in acceptability of SCS given prior HIV disclosure [43]. Many studies identified provider level barriers to SCS acceptability including providers being indifferent or opposed to people living with HIV having children [22, 39, 47, 51–53] or providers expressing discomfort discussing sex, especially condomless sex in patients living with HIV, thus limiting SCS discussions [20, 50, 51].…”

Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples

“…Potential risk reduction strategies include antiretroviral therapy (ART) use by HIV-infected partners to suppress HIV viral levels, pre-exposure prophylaxis (PrEP) use by HIV-uninfected partners, condom use except during days with peak fertility, vaginal self-insemination when the female is the HIV-infected partner, medically assisted reproduction, screening and treatment of sexually transmitted infections, voluntary medical male circumcision when the male is the HIV-uninfected partner, and fertility screening to prevent unnecessary HIV exposure during pregnancy attempts in the face of infertility [3]. Current efforts to integrate HIV and reproductive health services provide opportunities to identify HIV serodiscordant couples with fertility intentions and promote safer conception when pregnancy is desired [15]. …”