Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

Brubaker, Sara G.; Ea, Bukusi; Odoyo, Josephine; Achando, Jackson; Okumu, Albert; Cohen, CR

doi:10.1111/j.1468-1293.2010.00884.x

Cited by 64 publications

(60 citation statements)

References 23 publications

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“…Similar findings were reported in a study done in Kisumu where a high number of pregnancies occurred among HIV discordant couples, indicating that the need to conceive may be the reason condom use is very low among the couples. 29 Widows were significantly less likely to use a method of family planning than married women despite having sexual partners. Similar findings were reported in a study in South Western Uganda.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the utilization of family planning services among HIV infected women in a Kenyan health facility

Njuguna

Ilovi

Muiruri

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Women’s knowledge and access to reproductive health services improves their ability to safely achieve their required fertility and reduces maternal and infant morbidity and mortality. We aimed to determine the utilization of family planning (FP) among HIV Infected women visiting the HIV clinic.Methods: A cross-sectional mixed quantitative and qualitative study among HIV positive females in Nairobi, Kenya was conducted. Consenting women completed a questionnaire that assessed the utilization of FP services. Descriptive and inferential analysis was carried out on quantitative data to determine significant associations with FP utilization. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising.Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). The contraceptive prevalence was 53% with an unmet need of family planning of 38.5%. Patients were more likely to use family planning if they were married, if condoms were offered at the clinic, if they discussed contraception with the clinic staff and their partners. They were less likely to use FP if they had expressed fertility desire. Widows were less likely to use any form of FP than married couples despite having sexual partners. The main themes on the barriers of utilization of family planning services included lack of knowledge, pill burden, and adverse reactions to hormonal FP.Conclusions: The unmet need of family planning is high, and heightened measures need to be taken to improve the utilization of the service. Particular groups such as sexually active widows and single women should be targeted for these interventions.

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Section: Discussionmentioning

confidence: 99%

Factors influencing the utilization of family planning services among HIV infected women in a Kenyan health facility

Njuguna

Ilovi

Muiruri

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…An estimated 30–50% of HIV-positive people in sub-Saharan Africa (SSA) are involved in stable discordant relationships [7–9], and around 44–60% of incident HIV infections in parts of SSA occur in married or cohabiting discordant couples [10]. Because the risk of transmission is estimated to be higher in discordant couples who conceive [11], it is crucial that HIV prevention interventions focus on safer conception strategies (SCS) to reduce incident cases of HIV.…”

Section: Introductionmentioning

confidence: 99%

Community perceptions of childbearing and use of safer conception strategies among HIV‐discordant couples in Kisumu, Kenya

Breitnauer

Mmeje

Njoroge

et al. 2015

Journal of the International AIDS Society

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IntroductionSafer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings.MethodsWe conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59) of community members, including men, women, youth (age 19–25), community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed.Results and discussionAll participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their community.ConclusionsMany community members noted a need and desire for safer conception education and services in Kisumu. However, community barriers such as fear, stigma and lack of information should be addressed before safer conception interventions can be successfully implemented and delivered. Further research focused on community education, male engagement and healthcare provider training is a crucial next step in delivering safer conception in this region.

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“…Successful antiretroviral therapy (ART) has prompted HIV-infected individuals to pursue fulfillment of childbearing desires. Heterosexual HIV-sero discordant couples may account for at least 50% of new HIV infections in Kenya, and transmission nearly doubles in partnerships where pregnancy occurs (Guthrie et al, 2007; Dunkle et al, 2008; Matthews et al, 2010; Coburn et al, 2011; Brubaker et al, 2011). HIV-serodiscordant couples desiring children knowingly risk HIV transmission with unprotected intercourse.…”

Section: Introductionmentioning

confidence: 99%

Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya

et al. 2014

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In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. Timed vaginal insemination, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single sex focus group discussions comprised of 33 HIV-serodiscordant couples and healthcare providers in the Nyanza region of Kenya to assess the acceptability and feasibility of timed vaginal insemination as a safer method of conception. The transcribed data was analyzed using a grounded theory approach. We found that educating and counseling HIVserodiscordant couples on timed vaginal insemination could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by healthcare providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and healthcare providers on timed vaginal insemination combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission.

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Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

Cited by 64 publications

References 23 publications

Factors influencing the utilization of family planning services among HIV infected women in a Kenyan health facility

Factors influencing the utilization of family planning services among HIV infected women in a Kenyan health facility

Community perceptions of childbearing and use of safer conception strategies among HIV‐discordant couples in Kisumu, Kenya

Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya

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