Background- HIV transmission in stable, serodiscordant couples may account for up to 60% of new HIV infections in sub-Saharan Africa. Many HIV-discordant couples'desire children, yet current prevention programs do not accommodate fertility desire. Advances in biomedical prevention create opportunities to dramatically reduce the risk of HIV transmission for individuals who choose to conceive. The proposed work focuses on discussions of fertility intention between healthcare workers (HCWs) and their HIV-positive patients, a critical first step to any reproductive counseling intervention. Little is known about how often or effectively HCWs and patients discuss fertility plans or the barriers to successful discussions. Approach- We will conduct in-depth interviews to explore views and practices of HCWs (counselors, nurses, doctors) providing reproductive counseling to HIV+ men and women in public sector clinics near Durban, South Africa. We will interview HIV+ men and women seeking care from these clinics to explore their experiences with reproductive counseling. Qualitative data and a conceptual framework for patient-provider communication will inform a survey instrument;120 HCWs will be surveyed to assess frequency and predictors of fertility intention assessment with HIV+ patients. Innovation- Minimizing HIV transmission in the context of desired conception among HIV- discordant couples is a public health priority to reduce horizontal and vertical HIV transmission. Data from CAPRISA004, iPrEX, HPTN 052, Partners PrEP, and CDC TDF2 studies demonstrate that a prevention intervention for HIV-discordant couples will include topical or systemic ARVs. A better understanding of HCWs'current views and practices of conception counseling is necessary in order to design effective pharmaco-behavioral interventions. Our team of experts in behavioral science (Bangsberg, Safren), HIV-reproductive health (Harrison, Smit), intervention development (Psaros, Safren), and patient-provider communication (Wilson) will support Dr. Matthews, a junior investigator with an excellent track record of carrying out research in this setting to understand periconception risk behavior and strategies for periconception risk reduction for HIV-discordant couples. Significance- Behavioral strategies, circumcision, antiretroviral therapy, and pre-exposure antiretroviral prophylaxis create opportunities for HIV-discordant couples to realize fertility goals while minimizing periconception HIV transmission risk. The proposed work will result in a nuanced understanding of the experiences of patients and HCWs and will inform design of interventions to optimize HCW assessment of fertility goals and implementation of future reproductive counseling interventions.
Many HIV-discordant couples (one partner is HIV-infected, the other is not) take great risks to have children, as established prevention strategies do not account for fertility desires. Recent advances in HIV prevention offer potential strategies to reduce the risk of sexual HIV transmission while allowing for conception. We propose to study healthcare worker views towards, and knowledge and practices of providing reproductive counseling to HIV+ patients in South Africa in order to inform future intervention studies to improve healthcare worker skills for offering reproductive counseling strategies to HIV-affected patients.