Abstract:
Introduction: For HIV serodiscordant couples in resource-limited settings, pregnancy is common despite the risk of
sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during
pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and
others. We sought to understand Kenyan health providers’ and HIV serodiscordant couples’ perspectives and
experiences with safer conception.
Methods: Between August 2015 and March 2016, we conducted key informant interviews (KIIs) with health providers from
public and private HIV care and fertility clinics and in-depth interviews (IDIs) and focus group discussions (FGDs) with HIV
serodiscordant couples participating in an open-label study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral
therapy (ART) for HIV prevention (the Partners Demonstration Project). An inductive analytic approach identified a number
of themes related to experiences with and perceptions of safer conception strategies.
Results: We conducted 20 KIIs with health providers, and 21 IDIs and 4 FGDs with HIV serodiscordant couples. HIV clinic
providers frequently discussed timed condomless sex and antiretroviral medications while providers at private fertility care
centres were more comfortable recommending medically assisted reproduction. Couples experienced with ART and PrEP
reported that they were comfortable using these strategies to reduce HIV risk when attempting pregnancy. Timed condomless
sex in conjunction with ART and PrEP was a preferred strategy, often owing to them being available for free in public and
research clinics, as well as most widely known; however, couples often held inaccurate knowledge of how to identify days
with peak fertility in the upcoming menstrual cycle.
Conclusions: Antiretroviral-based HIV prevention is acceptable and accessible to meet the growing demand for safer
conception services in Kenya, since medically assisted interventions are currently cost prohibitive. Cross-disciplinary training
for health providers would expand confidence in all prevention options and foster the tailoring of counselling to couples’
preferences.
