Skip to main content

Advertisement

SpringerLink
Log in

Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa’s initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The authors are prepared to make de-identified interview transcripts available upon reasonable request.

Code Availability

N/A.

Consent for Publication

N/A, this manuscript does not include identifiable individual data or images.

References

  1. Chemaitelly H, Awad SF, Shelton JD, Abu-Raddad LJ. Sources of HIV incidence among stable couples in Sub-Saharan Africa. J Int AIDS Soc. 2014;17:18765.

    Article  Google Scholar 

  2. Irungu EM, Baeten JM. PrEP rollout in Africa: status and opportunity. Nat Med. 2020;26:655–64.

    Article  CAS  Google Scholar 

  3. UNAIDS. Highly effective HIV prevention option not reaching those who need it. UNAIDS; 2020. https://www.unaids.org/en/resources/presscentre/featurestories/2020/november/20201102_prep (cited 13 March 2021).

  4. Musau A, Were D, Mutegi J, Ongwen P, Wakhutu B, Reed J. Surveillance data from public and private primary care facilities uncover implementation successes and gaps during pre-exposure prophylaxis (PrEP) scale-up: results from the Jilinde Project in Kenya. In: HIV Research for Prevention virtual conference, 2021.

  5. Acom CP. Mobile health approaches with facility-based care to improve access and adherence to pre-exposure prophylaxis (PrEP) in Lango region, Uganda. In: 20th ICASA international conference on AIDS and STI’s in Africa, 2019.

  6. Gombe MM, Mangwendeza Y, Ncube G, Zwangobani N, Prust M, Cakouros B. Integrating oral HIV pre‐exposure prophylaxis (PrEP) in a public family planning facility and youth center to inform national roll out in Zimbabwe. In: 22nd International AIDS conference, Amsterdam, 2018.

  7. Mack N, Odhiambo J, Wong CM, Agot K. Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: results of a consultation with community stakeholders. BMC Health Serv Res. 2014;14:1–12.

    Article  Google Scholar 

  8. Nakku-Joloba E, Pisarski EE, Wyatt MA, Muwonge TR, Asiimwe S, Celum CL, et al. Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples. J Int AIDS Soc. 2019;22:e25225.

    Article  Google Scholar 

  9. Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A. My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health. 2010;10:247.

    Article  Google Scholar 

  10. Beyeza-Kashesya J, Kaharuza F, Mirembe F, Neema S, Ekstrom AM, Kulane A. The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda. Afr Health Sci. 2009;9:2–12.

    PubMed  PubMed Central  Google Scholar 

  11. Martins A, Alves S, Chaves C, Canavarro MC, Pereira M. Prevalence and factors associated with fertility desires/intentions among individuals in HIV-serodiscordant relationships: a systematic review of empirical studies. J Int AIDS Soc. 2019;22:e25241.

    Article  Google Scholar 

  12. Joseph Davey D, West S, Umutoni V, Taleghani S, Klausner H, Farley E, et al. A systematic review of the current status of safer conception strategies for HIV affected heterosexual couples in Sub-Saharan Africa. AIDS Behav. 2018;22:2916–46.

    Article  CAS  Google Scholar 

  13. Agadjanian V, Hayford SR. PMTCT, HAART, and childbearing in Mozambique: an institutional perspective. AIDS Behav. 2009;13:103–12.

    Article  Google Scholar 

  14. Cooper D, Moodley J, Zweigenthal V, Bekker L-G, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav. 2009;13:38–46.

    Article  Google Scholar 

  15. Nduna M, Farlane L. Women living with HIV in South Africa and their concerns about fertility. AIDS Behav. 2009;13:62–5.

    Article  Google Scholar 

  16. Saleem HT, Surkan PJ, Kerrigan D, Kennedy CE. HIV care providers’ communication with patients about safer conception for people living with HIV in Tanzania. Int Perspect Sex Reprod Health. 2016;42(4):179–86.

    Article  Google Scholar 

  17. Kawale P, Mindry D, Phoya A, Jansen P, Hoffman RM. Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi. Reprod Health. 2015;12:17.

    Article  Google Scholar 

  18. Kimemia G, Ngure K, Baeten JM, Celum C, Dew K, Njuguna N, et al. Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya. Reprod Health. 2019;16:85.

    Article  Google Scholar 

  19. Rütten A, Gelius P. The interplay of structure and agency in health promotion: integrating a concept of structural change and the policy dimension into a multi-level model and applying it to health promotion principles and practice. Soc Sci Med. 2011;73:953–9.

    Article  Google Scholar 

  20. Gutin SA, Harper GW, Amico KR, Bitsang C, Moshashane N, Harries J, et al. ‘I’m waiting for that’: interest in the use of PrEP for safer conception in Botswana. Glob Public Health. 2020;15:1200–11.

    Article  Google Scholar 

  21. Ngure K, Heffron R, Curran K, Vusha S, Ngutu M, Mugo N, et al. I knew I would be safer. Experiences of Kenyan HIV serodiscordant couples soon after pre-exposure prophylaxis (PrEP) initiation. AIDS Patient Care STDS. 2016;30:78–83.

    Article  Google Scholar 

  22. Wabwire-Mangen F, Odiit M, Kirungi W, Kisitu DK, Wanyama JO. Uganda HIV prevention response and modes of transmission analysis. UNAIDS; 2009.

  23. Goggin K, Hurley EA, Beyeza-Kashesya J, Gwokyalya V, Finocchario-Kessler S, Birungi J, et al. Study protocol of “Our Choice”: a randomized controlled trial of the integration of safer conception counseling to transform HIV family planning services in Uganda. Implement Sci. 2018;13:1–12.

    Article  Google Scholar 

  24. Wagner GJ, Wanyenze RK, Beyeza-Kashesya J, Gwokyalya V, Hurley E, Mindry D, et al. “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches. Implement Sci. 2021;16:1–13.

    Article  Google Scholar 

  25. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  26. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349–57.

    Article  Google Scholar 

  27. Ugandan Ministry of Health. Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda. Kampala: Ugandan Ministry of Health; 2020. https://uac.go.ug/sites/default/files/ConsolidatedHIVGuidelines2020.pdf.

  28. Ugandan Ministry of Health. Addendum to the HIV testing services policy and implementation guidelines: HIV self-testing and assisted partner notification services. Kampala: Ugandan Ministry of Health; 2018.

    Google Scholar 

  29. Wall KM, Inambao M, Kilembe W, Karita E, Chomba E, Vwalika B, et al. Cost-effectiveness of couples’ voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework. J Int AIDS Soc. 2020;23(53):e25522.

    PubMed  PubMed Central  Google Scholar 

  30. UNAIDS. Global HIV/AIDS statistics: 2020 fact sheet. UNAIDS; 2020. https://www.unaids.org/en/resources/fact-sheet (cited 6 May 2021).

  31. Nannozi V, Wobudeya E, Gahagan J. Fear of an HIV positive test result: an exploration of the low uptake of couples HIV counselling and testing (CHCT) in a rural setting in Mukono District, Uganda. Glob Health Promot. 2017;24:33–42.

    Article  Google Scholar 

  32. Monroe-Wise A, Maingi Mutiti P, Kimani H, Moraa H, Bukusi DE, Farquhar C. Assisted partner notification services for patients receiving HIV care and treatment in an HIV clinic in Nairobi, Kenya: a qualitative assessment of barriers and opportunities for scale-up. J Int AIDS Soc. 2019;22:e25315.

    Article  Google Scholar 

  33. Goggin K, Hurley EA, Wagner GJ, Staggs V, Finocchario-Kessler S, Beyeza-Kashesya J, et al. Changes in providers’ self-efficacy and intentions to provide safer conception counseling over 24 months. AIDS Behav. 2018;22(9):1–11.

    Article  Google Scholar 

  34. Beyeza-Kashesya J, Wanyenze RK, Goggin K, Finocchario-Kessler S, Woldetsadik MA, Mindry D, et al. Stigma gets in my way: factors affecting client–provider communication regarding childbearing among people living with HIV in Uganda. PLoS ONE. 2018;13:e0192902.

    Article  Google Scholar 

  35. Mindry D, Wanyenze RK, Beyeza-Kashesya J, Woldetsadik MA, Finocchario-Kessler S, Goggin K, et al. Safer conception for couples affected by HIV: structural and cultural considerations in the delivery of safer conception care in Uganda. AIDS Behav. 2017;21(8):2488–96.

    Article  Google Scholar 

  36. Rivet Amico K, Bekker LG. Global PrEP roll-out: recommendations for programmatic success. Lancet HIV. 2019;6:e137–40.

    Article  CAS  Google Scholar 

  37. Crankshaw TL, Matthews LT, Giddy J, Kaida A, Ware NC, Smit JA, et al. A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples. Reprod Health Matters. 2012;20(Suppl 39):50–60.

    Article  Google Scholar 

  38. Matthews L, Jaggernath M, Kriel Y, Smith P, O’Neil K, Haberer J, et al. Protocol for a longitudinal study to evaluate the use of tenofovir-based PrEP for safer conception and pregnancy among women in South Africa. BMJ Open. 2019;9(7):e027227.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all of the participants who contributed their valuable time and perspectives to this research. We also thank Christopher Gordon of the National Institute of Mental Health for his partnership.

Funding

This project was funded by the National Institute of Mental Health (NIMH) in collaboration with the Office of the U. S. Global AIDS Coordinator as a supplement to an Existing Grant supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number R01HD090981. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Office of the U.S. Global AIDS Coordinator. The funders had neither role in the design of the study, the collection, analysis and interpretation of the data, nor the writing of the manuscript.

Author information

Authors and Affiliations

  1. Division of Health Services and Outcomes Research, Children’s Mercy Research Institute, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Emily A. Hurley & Kathy Goggin

  2. Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Emily A. Hurley & Kathy Goggin

  3. Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA

    Emily A. Hurley

  4. School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

    Rhoda K. Wanyenze, Jimmy Mayatsa & Simpson Nuwamanya

  5. Pardee RAND Graduate School, Santa Monica, CA, USA

    Mahlet Gizaw

  6. Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

    Violet Gwokyalya

  7. Department of Reproductive Medicine, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda

    Jolly Beyeza-Kashesya

  8. RAND Corporation, Santa Monica, CA, USA

    Glenn J. Wagner

  9. UC GlobalHealth Institute, Center for Women’s Health Gender and Empowerment, Los Angeles, CA, USA

    Deborah Mindry

  10. Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Sarah Finocchario-Kessler

  11. University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA

    Kathy Goggin

Authors
  1. Emily A. Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rhoda K. Wanyenze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahlet Gizaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Violet Gwokyalya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jolly Beyeza-Kashesya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Glenn J. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jimmy Mayatsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Simpson Nuwamanya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Deborah Mindry
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sarah Finocchario-Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kathy Goggin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EAH, RW, GW and KG designed the study, VG, JBK, JM and SN acquired data. EAH, MT, VG, JBK, JM and SN contributed to analysis and GJW, RW, KG, DM and SFK to interpretation of data. EAH drafted the manuscript, and RW, MT, VG, JBZ, GJW, JM, SN, DM, SFK and KG revised for important content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Emily A. Hurley.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interests/ competing interests.

Ethical Approval

All methods were approved by Institutional Review Boards at TASO and RAND Corporation.

Informed Consent

All participants gave written informed consent prior to participating in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hurley, E.A., Wanyenze, R.K., Gizaw, M. et al. Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples. AIDS Behav 26, 2397–2408 (2022). https://doi.org/10.1007/s10461-022-03584-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-022-03584-x

Keywords

Search

Navigation