Kaggiah Anne, Kimemia Grace, Moraa Hellen, Muiruri Peter, Kinuthia John, Roxby Alison C
Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
African Population and Health Research Center, Nairobi, Kenya.
Front Reprod Health. 2021 Nov 4;3:693429. doi: 10.3389/frph.2021.693429. eCollection 2021.
Human immunodeficiency virus-serodiscordant couples are an important source of new HIV infections in Africa. When trying to conceive, uninfected partners may be at high risk of infection if the infected partner is not virally suppressed. Multiple strategies targeting safer conception exist, but these services are limited. However, when services are available and used, serodiscordant couples can be protected from HIV transmission, and safe to have children if desired. To successfully introduce, integrate, promote, and optimize the service delivery of safer conception with HIV care, it is crucial to understand how HIV-serodiscordant couples perceive and experience these services. Further, viral load monitoring can be critical to safer conception, but there is limited literature on how it informs the decision of the partners about conception. This qualitative study describes the knowledge, perceptions, and experiences of both safer conception services and viral load monitoring among 26 HIV-serodiscordant couples seeking safer conception care at a referral hospital in Nairobi, Kenya. In-depth interviews of HIV-serodiscordant couples were conducted from April to July 2017, and transcripts were analyzed to identify the themes central to the experience of safer conception services of couples and viral load monitoring. Serodiscordant couples reported success in using some of the safer conception methods and had positive experiences with healthcare providers. However, despite using the services, some were concerned about HIV transmission to the seronegative partner and baby, while others faced challenges when using pre-exposure prophylaxis (PrEP) and vaginal insemination. Overall, their motivation to have children overcame their concern about HIV transmission, and they welcomed discussions on risk reduction. Moreover, supportive clinic staff was identified as key to facilitating trust in safer conception methods. Furthermore, viral load monitoring was identified as integral to safer conception methods, an emerging theme that requires further evaluation, especially where routine viral load monitoring is not performed. In conclusion, healthcare providers offering safer conception services should build trust with couples, and recognize the need for continual couple counseling to encourage the adoption of safer conception services.
在非洲，艾滋病毒血清学不一致的夫妇是新的艾滋病毒感染的一个重要来源。在尝试受孕时，如果感染的伴侣病毒未得到抑制，未感染的伴侣可能面临高感染风险。针对更安全受孕的多种策略已经存在，但这些服务有限。然而，当这些服务可用并得到利用时，血清学不一致的夫妇可以预防艾滋病毒传播，并且如果有意愿，可以安全地生育孩子。为了成功引入、整合、推广和优化更安全受孕服务与艾滋病毒护理的服务提供，了解艾滋病毒血清学不一致的夫妇如何看待和体验这些服务至关重要。此外，病毒载量监测对于更安全受孕可能至关重要，但关于它如何影响伴侣受孕决策的文献有限。这项定性研究描述了在肯尼亚内罗毕一家转诊医院寻求更安全受孕护理的26对艾滋病毒血清学不一致夫妇对更安全受孕服务和病毒载量监测的知识、看法和体验。2017年4月至 July 对艾滋病毒血清学不一致的夫妇进行了深入访谈，并对访谈记录进行了分析，以确定夫妇更安全受孕服务体验和病毒载量监测的核心主题。血清学不一致的夫妇报告在使用一些更安全受孕方法方面取得了成功，并对医疗服务提供者有积极的体验。然而，尽管使用了这些服务，一些人担心艾滋病毒会传播给血清学阴性的伴侣和婴儿，而另一些人在使用暴露前预防（PrEP）和阴道授精时面临挑战。总体而言，他们生育孩子的动机克服了他们对艾滋病毒传播的担忧，并且他们欢迎关于降低风险的讨论。此外，支持性的诊所工作人员被认为是促进对更安全受孕方法信任的关键。此外，病毒载量监测被确定为更安全受孕方法不可或缺的一部分，这是一个需要进一步评估的新出现的主题，特别是在未进行常规病毒载量监测的地方。总之，提供更安全受孕服务的医疗服务提供者应该与夫妇建立信任，并认识到持续进行夫妇咨询以鼓励采用更安全受孕服务的必要性。
