Receipt and uptake of safer conception messages among a prospective cohort of HIV-positive women on antiretroviral therapy in South Africa

Background:  Safer conception strategies may be used by people living with HIV (PLWH) to reduce HIV transmission risks to infants and partners during attempted conception. The extent to which PLWH receive safer conception messages and employ risk reduction strategies is largely unknown.

Methods:  We use prospective data from a clinic-based cohort study in Johannesburg, South Africa. HIV-positive women aged 18-35 on antiretroviral therapy (n=831) completed a baseline survey and ≥1 follow-up visits assessing fertility intentions, pregnancy incidence and clinical characteristics; an endline survey was administered one year post-enrollment. Chi-squared statistics compared receipt of safer conception messages by pregnancy status and fertility intentions, as well risk reduction indicators by partner serostatus.

Results:  Over one-third of the cohort had a pregnancy or was trying to conceive at endline (n=291). About half of participants either trying to conceive or who had conceived during follow-up had never received safer conception advice, regardless of fertility intentions (p=0.600). Only 13.5% of those trying and 3.6% of those not trying received information about timed unprotected intercourse (p=0.041). Among women trying to conceive (n=169), the use of timed unprotected intercourse was low overall (17.1%) and even lower among those in a serodiscordant versus concordant partnership (8.5% vs 26.9%, p=0.010). ART adherence, viral suppression, and CD4 cell count were similar across both groups, with nearly one-quarter reporting <100% adherence and 40% having a CD4 count ≤ 350 cells/ml.

Conclusions:  These findings suggest that clinic and patient-level interventions are needed to ensure that PLWH receive and employ safer conception strategies.