Safer Conception Among HIV-1 Sero-Discordant Couples in East Africa: Understanding Knowledge, Attitudes, and Experiences

Context: Supporting people affected by HIV-1 in achieving their reproductive goals while minimizing the risk of HIV-1 transmission is a public health imperative. Background: For HIV-1 serodiscordant couples, HIV-1 exposure and risk of transmission to the uninfected partner and unborn children is heightened during pregnancy attempts but safer conception strategies can mitigate risk. Understanding couples’ choices and experiences with safer conception can be useful for programmatic recommendations as safer conception programs are scaled up. Methods: 1013 high-risk, heterosexual HIV-1 serodiscordant couples from Kenya and Uganda were followed for two years in an open-label delivery study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), the Partners Demonstration Project. Annually, we assessed participant experience with safer conception strategies. Multivariate logistic regression was used to characterize women who reported ever having used a safer conception strategy during their first annual visit. Results: 859 couples were included in analysis. 66% of couples had HIV-infected women and 86% desired future children. The median age for women was 27 (interquartile range: 23-32). At the first annual visit, 32% of women reported use of a safer conception strategy ever in their life: 14% reported using ART, 16% PrEP, 3% self-insemination, and 2% STI treatment. Women who reported discussing their fertility desires with their male partners (adjusted odds ratio (aOR) = 1.91, 95% confidence interval (CI) 1.26-2.589), had no living children at the time of study enrollment (aOR = 1.71, 95% CI 1.14-2.57), and were HIV-uninfected (aOR = 1.56, 95% CI 1.11-2.20) were more likely to report having used at least one safer conception strategy. Conclusions: HIV-1 prevention counseling for serodiscordant couples should integrate opportunities for couples to share their fertility desires and discuss preferences for safer conception strategies.