Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya

Abstract

Introduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods. We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples’ clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results. Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion. The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

Host CCR5 and HIV-1 env/pol polymorphisms: Role in transmission and virulence in the Kenyan population

“…However, there is no clear explanation for this observation. Some studies have also reported a relatively high serodiscordant rate among couples [65] and increased use of ARVs. Regular and concurrent characterization of HIV-1 genetic/antigenic variants and mutations that encode resistance in HIV-1 subtypes circulating in the whole country is necessary.…”

“…Regular periodic molecular analysis of HIV-1 strains is important, especially now that subtype-specific vaccines are under consideration. Regular resistance mutation analyses are required to monitor ARV resistance and determine the association between HIV-1 strain variation(s) and high infection discordance seen among some couples in Kenya [65]. Characterization of genetic/antigenic variants circulating in a given population is essential for more effective patient management.…”

Modeled estimates of HIV-serodifferent couples in tuberculosis-affected households in four sub-Saharan African countries

“…With the scale-up of HHC evaluation, there is an opportunity to increase the value of this service by integrating HIV screening to identify SDCs in TB-affected households (i.e., households in which at least one family member has been diagnosed with TB). Past studies have shown high PrEP uptake, adherence [18][19][20][21][22] and acceptability [18,23] among SDCs, reporting that couple-focused ART and PrEP services were perceived to strengthen couples' relationships [24] and could help support safer conception among couples desiring pregnancy [21,22]. Thus, HHC evaluation may provide an excellent opportunity to improve linkage to HIV care and PrEP among SDCs and prevent HIV acquisition and adverse health effects.…”