Schwartz Sheree R, Bassett Jean, Sanne Ian, Phofa Rebecca, Yende Nompumelelo, Van Rie Annelies
aDivision of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA bWitkoppen Health and Welfare Centre cClinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa dRight to Care, Johannesburg, South Africa eDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
AIDS. 2014 Jul;28 Suppl 3(Suppl 3):S277-85. doi: 10.1097/QAD.0000000000000330.
To describe the development and implementation of a safer conception service in a resource-limited setting.
Qualitative work to inform the design of a safer conception service was conducted with clients and providers at Witkoppen Health and Welfare Centre, a primary health center in Johannesburg, South Africa. Services began in July 2013 for HIV-affected participants planning conception within 6 months and included counseling about timed unprotected intercourse and home-based self-insemination, early initiation of combined antiretroviral therapy (cART) for HIV-infected individuals, pre-exposure prophylaxis for HIV-uninfected partners and circumcision for men. Participants were enrolled into an implementation science study evaluating method uptake, acceptability, and pregnancy and HIV transmission outcomes.
Findings to-date from 51 qualitative participants and 128 clinical cohort participants (82 women and 46 men, representing 82 partnerships) are presented. All men were accompanied by female partners, whereas 56% of women attended with their male partner. Fifteen of the 46 couples (33%) were in confirmed serodiscordant relationships; however, of the 36 additional women attending alone, 56% were unaware of their partners' HIV status or believed them to be HIV-uninfected. The majority of the HIV-infected women (86%) and men (71%) were on cART at enrollment; however, only 47% on cART were virally suppressed. Timed unprotected intercourse, self-insemination and cART were common choices for participants; few elected pre-exposure prophylaxis.
Lessons learned from early implementation demonstrate feasibility of safer conception services; however, reaching discordant couples, cART-naïve infected partners, and men remain challenges. Creating demand for safer conception services among those at highest risk for HIV transmission is necessary.
描述在资源有限的环境中开展更安全受孕服务的过程及实施情况。
在南非约翰内斯堡的一家初级卫生保健中心——维特科普恩健康与福利中心，对客户和服务提供者开展了定性研究，以指导更安全受孕服务的设计。2013年7月开始为计划在6个月内受孕的受艾滋病病毒影响的参与者提供服务，包括关于定时无保护性交和家庭自我授精的咨询、为感染艾滋病病毒的个体尽早启动联合抗逆转录病毒治疗（cART）、为未感染艾滋病病毒的伴侣提供暴露前预防以及为男性进行包皮环切术。参与者被纳入一项实施科学研究，以评估方法的采用情况、可接受性以及妊娠和艾滋病病毒传播结果。
呈现了来自51名定性研究参与者和128名临床队列参与者（82名女性和46名男性，代表82对伴侣）的迄今研究结果。所有男性均由女性伴侣陪同，而56%的女性由男性伴侣陪同。46对夫妇中有15对（33%）为确诊的血清学不一致关系；然而，在另外36名独自前来的女性中，56%不知道其伴侣的艾滋病病毒感染状况，或者认为其伴侣未感染艾滋病病毒。大多数感染艾滋病病毒的女性（86%）和男性（71%）在入组时正在接受cART治疗；然而，接受cART治疗的人中只有47%实现了病毒抑制。定时无保护性交、自我授精和cART是参与者常用的选择；很少有人选择暴露前预防。
早期实施中吸取的经验教训表明更安全受孕服务是可行的；然而，接触血清学不一致的夫妇、未接受过cART治疗的感染伴侣以及男性仍然是挑战。有必要在艾滋病病毒传播风险最高的人群中提高对更安全受孕服务的需求。
