With HIV becoming more of a chronic disease, desires and plans for childbearing has become increasingly prominent among persons living with HIV/AIDS (PLHA), especially in sub-Saharan Africa (SSA) where fertility is a strong cultural value. Pregnancy in PLHA involves both vertical and horizontal transmission risks, yet while there are considerable resources and support for patients to prevent unwanted pregnancy or once they become pregnant (e.g., PMTCT), services aimed at promoting safer conception are rarely available. Low cost safer conception strategies include antiretroviral therapy, timed unprotected intercourse, and manual insemination, but little known about the knowledge, acceptability and use of conception risk reduction methods among PLHA in SSA. HIV and family planning (FP) providers are a critical source of information and counseling for the reproductive health options for PLHA. Yet HIV providers often convey messages to PLHA that childbearing is inappropriate, are frequently constrained by feeling inadequately trained to offer effective counseling for safe conception, and so struggle with how to counsel patients when a risk of transmission to the partner is present. Similar issues may hold for FP providers, but this is even less studied. Consequently, patients may be uncomfortable discussing their fertility intentions and/or pregnancy with their providers. This breach in provider-patient trust and communication, coupled with an already over stressed health care system and cultural beliefs, lead many PLHA to seek advice from traditional healers (TH) who are more accessible, but often unprepared to fully address the HIV disease context. Research to date has focused on prevalence and correlates of fertility desires, with very little study of the use of pre- and post-conception risk reduction methods by PLHA. The proposed study will examine the reproductive decision making and use of conception risk reduction methods of HIV patients with fertility intentions, the knowledge, attitudes and practices of health providers regarding safer conception counseling for PLHA, and structural barriers to provision of support services. Phase 1 will be a formative evaluation of fertility planning and decision making through qualitative in-depth interviews with male and female HIV clients (and their partners) who have either recently conceived a child or have an intention to conceive;we will also interview HIV, FP and TH providers to examine knowledge, attitudes and practices related to childbearing support services for PLHA. Phase 2 will be an observational, prospective cohort study of 400 PLHA with fertility intentions who will be followed for 24 months to assess determinants of use of contraception (while waiting for the preferred time to conceive, and post-conception), pre-conception risk reduction methods, and PMTCT (when pregnant). Providers will also be surveyed longitudinally to assess changes in knowledge, attitudes, practices and structural barriers regarding provision of safer conception support over time. Findings from this study will inform the development of a structural intervention aimed at helping providers and clinics to better provide support needed by PLHA to have safer, healthy pregnancies, and limit transmission.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
5R01HD072633-03
Application #
8644656
Study Section
Special Emphasis Panel (ZHD1)
Program Officer
Newcomer, Susan
Project Start
Project End
Budget Start
Budget End
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
Wagner, Glenn J; Goggin, Kathy; Mindry, Deborah et al. (2015) Correlates of Use of Timed Unprotected Intercourse to Reduce Horizontal Transmission Among Ugandan HIV Clients with Fertility Intentions. AIDS Behav 19:1078-88
Goggin, Kathy; Mindry, Deborah; Beyeza-Kashesya, Jolly et al. (2014) "Our hands are tied up": current state of safer conception services suggests the need for an integrated care model. Health Care Women Int 35:990-1009
Finocchario-Kessler, Sarah; Wanyenze, Rhoda; Mindry, Deborah et al. (2014) "I may not say we really have a method, it is gambling work": knowledge and acceptability of safer conception methods among providers and HIV clients in Uganda. Health Care Women Int 35:896-917