Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe.
Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive s...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0000796 |
| _version_ | 1827832198613434368 |
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| author | Joelle M Brown Serah Gitome Bismark Mataveke Thandiwe Chirenda Allen Matubu Gift Chareka Charles Chasakara Nyaradzo Mgodi Caroline Murombedzi Petina Musara Tinei Makurumure Carolyn Smith Hughes Elizabeth Bukusi Craig R Cohen Stephen Shiboski Lynae Darbes James G Kahn George W Rutherford Z Michael Chirenje Felix Mhlanga |
| author_facet | Joelle M Brown Serah Gitome Bismark Mataveke Thandiwe Chirenda Allen Matubu Gift Chareka Charles Chasakara Nyaradzo Mgodi Caroline Murombedzi Petina Musara Tinei Makurumure Carolyn Smith Hughes Elizabeth Bukusi Craig R Cohen Stephen Shiboski Lynae Darbes James G Kahn George W Rutherford Z Michael Chirenje Felix Mhlanga |
| author_sort | Joelle M Brown |
| collection | DOAJ |
| description | Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program (Clintrials.gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176. |
| first_indexed | 2024-03-12T05:07:43Z |
| format | Article |
| id | doaj.art-67e2931ce2dc4548998b962ff515f177 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T05:07:43Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-67e2931ce2dc4548998b962ff515f1772023-09-03T08:50:29ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0132e000079610.1371/journal.pgph.0000796Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe.Joelle M BrownSerah GitomeBismark MatavekeThandiwe ChirendaAllen MatubuGift CharekaCharles ChasakaraNyaradzo MgodiCaroline MurombedziPetina MusaraTinei MakurumureCarolyn Smith HughesElizabeth BukusiCraig R CohenStephen ShiboskiLynae DarbesJames G KahnGeorge W RutherfordZ Michael ChirenjeFelix MhlangaSafer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program (Clintrials.gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176.https://doi.org/10.1371/journal.pgph.0000796 |
| spellingShingle | Joelle M Brown Serah Gitome Bismark Mataveke Thandiwe Chirenda Allen Matubu Gift Chareka Charles Chasakara Nyaradzo Mgodi Caroline Murombedzi Petina Musara Tinei Makurumure Carolyn Smith Hughes Elizabeth Bukusi Craig R Cohen Stephen Shiboski Lynae Darbes James G Kahn George W Rutherford Z Michael Chirenje Felix Mhlanga Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. PLOS Global Public Health |
| title | Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. |
| title_full | Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. |
| title_fullStr | Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. |
| title_full_unstemmed | Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. |
| title_short | Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. |
| title_sort | preventing hiv and achieving pregnancy among hiv sero different couples pilot study of a safer conception intervention in zimbabwe |
| url | https://doi.org/10.1371/journal.pgph.0000796 |
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