PrEP as Peri-Conception HIV Prevention for Women and Men

Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. 

The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. 

Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. 

As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. 

The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men, and children during the peri-conception period.

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By:  Heffron R1, Pintye J2, Matthews LT3, Weber S4, Mugo N5.

• 1Departments of Global Health and Epidemiology, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA. rheffron@uw.edu.
• 2School of Nursing, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
• 3Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA.
• 4University of California San Francisco, 1001 Potrero Ave, 6D-33, San Francisco, CA, 94110, USA.
• 5Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. 
• Curr HIV/AIDS Rep. 2016 Mar 18. 

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Acceptability & Preferences for Safer Conception HIV Prevention Strategies: A Qualitative Study

Safer conception strategies to reduce the HIV transmission risk include antiretroviral therapy for HIV-positive partners, pre-exposure prophylaxis for HIV-negative partners, condomless sex limited to fertile periods, and home-based self-insemination. Resistance to taking treatment or cultural concerns may limit uptake of strategies and intervention success. Understanding the acceptability and preferences between different approaches is important to optimise service delivery. 

Between February and July 2013, 42 adults (21 HIV-positive and 21 HIV-negative) receiving primary care at Witkoppen Health and Welfare Centre in Johannesburg, South Africa, participated in focus group discussions or in-depth interviews. Themes were analysed using a grounded theory approach. 

Acceptability of antiretroviral-based strategies varied. 

• Concerns over side effects, antiretroviral treatment duration 
• and beliefs that treatment is only for the sick were common barriers; 
• however, desperation for a child was noted as a facilitator for uptake. 
• HIV-negative men and HIV-positive women had favourable attitudes towards self-insemination, though paternity and safety concerns were raised. 
• Self-insemination was generally preferred over pre-exposure prophylaxis by HIV-negative men, 
• and antiretroviral-based strategies were preferred by couples with HIV-negative female partners, despite concerns raised about condomless sex while virally suppressed. Knowledge about the fertile window was low. 

A strong counselling component will be required for effective uptake and adherence to safer conception services.

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By: Schwartz SR1, West N2, Phofa R2, Yende N2, Sanne I3, Bassett J2, Van Rie A4.

• 1Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA sschwartz@jhu.edu.
• 2Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
• 3Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa Right to Care, Johannesburg, South Africa.
• 4Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

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Correlates of Use of Timed Unprotected Intercourse to Reduce Horizontal Transmission among Ugandan HIV Clients with Fertility Intentions

We examined the correlates of use of safer conception methods (SCM) in a sample of 400 Ugandan HIV clients (75 % female; 61 % on antiretroviral therapy; 61 % with HIV-negative or unknown status partners) in heterosexual relationships with fertility intentions. SCM assessed included timed unprotected intercourse, manual self-insemination, sperm washing, and pre-exposure prophylaxis (PrEP). 

In the 6 months prior to baseline, 47 (12 %) reported using timed unprotected intercourse to reduce risk of HIV infection (or re-infection), none had used manual self-insemination or sperm washing, and two had used PrEP. 

In multiple regression analysis, correlates of use of timed unprotected intercourse included greater perceptions of partner's willingness to use SCM and providers' stigma of childbearing among people living with HIV, higher SCM knowledge, and desire for a child within the next 6 months. 

These findings highlight the need for policy and provider training regarding integration of couples' safer conception counselling into HIV care.

Via: http://ht.ly/S9Wob 

By: Wagner GJ1, Goggin K, Mindry D, Beyeza-Kashesya J, Finocchario-Kessler S, Woldetsadik MA, Khanakwa S, Wanyenze RK.
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