Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya
Introduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Obstetrics and Gynecology International |
| Online Access: | http://dx.doi.org/10.1155/2020/1675987 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832546974411259904 |
|---|---|
| author | Nyawira Gitahi Sheila Juliet Eshiwani Kenneth Mutai Jared Ongechi Mecha James Njogu Kiarie |
| author_facet | Nyawira Gitahi Sheila Juliet Eshiwani Kenneth Mutai Jared Ongechi Mecha James Njogu Kiarie |
| author_sort | Nyawira Gitahi |
| collection | DOAJ |
| description | Introduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods. We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples’ clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results. Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion. The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention. |
| format | Article |
| id | doaj-art-d19a3c2d292b4d0496115c6d7b8c40fa |
| institution | Kabale University |
| issn | 1687-9589 1687-9597 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Obstetrics and Gynecology International |
| spelling | doaj-art-d19a3c2d292b4d0496115c6d7b8c40fa2025-02-03T06:46:29ZengWileyObstetrics and Gynecology International1687-95891687-95972020-01-01202010.1155/2020/16759871675987Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in KenyaNyawira Gitahi0Sheila Juliet Eshiwani1Kenneth Mutai2Jared Ongechi Mecha3James Njogu Kiarie4Institute of Tropical Medicine and Infectious Disease (ITROMID), Kenya Medical Research Institute, Nairobi, KenyaKenyatta National Hospital, Nairobi, KenyaKenyatta National Hospital, Nairobi, KenyaDepartment of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, KenyaDepartment of Obstetrics and Gynaecology, University of Nairobi, Nairobi, KenyaIntroduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods. We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples’ clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results. Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion. The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.http://dx.doi.org/10.1155/2020/1675987 |
| spellingShingle | Nyawira Gitahi Sheila Juliet Eshiwani Kenneth Mutai Jared Ongechi Mecha James Njogu Kiarie Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya Obstetrics and Gynecology International |
| title | Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya |
| title_full | Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya |
| title_fullStr | Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya |
| title_full_unstemmed | Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya |
| title_short | Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya |
| title_sort | preconception care uptake and immediate outcomes among discordant couples accessing routine hiv care in kenya |
| url | http://dx.doi.org/10.1155/2020/1675987 |
| work_keys_str_mv | AT nyawiragitahi preconceptioncareuptakeandimmediateoutcomesamongdiscordantcouplesaccessingroutinehivcareinkenya AT sheilajulieteshiwani preconceptioncareuptakeandimmediateoutcomesamongdiscordantcouplesaccessingroutinehivcareinkenya AT kennethmutai preconceptioncareuptakeandimmediateoutcomesamongdiscordantcouplesaccessingroutinehivcareinkenya AT jaredongechimecha preconceptioncareuptakeandimmediateoutcomesamongdiscordantcouplesaccessingroutinehivcareinkenya AT jamesnjogukiarie preconceptioncareuptakeandimmediateoutcomesamongdiscordantcouplesaccessingroutinehivcareinkenya |