Skip to main content

Advertisement

Log in

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. UNAIDS Report on the Global AIDS Epidemic, 2013. http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf Accessed 28 July 2017.

  2. Schwartz SR, Rees H, Mehta S, Venter WD, Taha TE, Black V. High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa. PLoS ONE. 2012;7:e36039.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Myer L, Carter RJ, Katyal M, et al. Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in Sub-Saharan Africa: a cohort study. PLoS Med. 2010;7:e1000229. https://doi.org/10.1371/journal.pmed.1000229.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Taulo F, Berry M, Tsui A, et al. Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav. 2009;13(Suppl 1):20–7.

    Article  PubMed  Google Scholar 

  5. 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 

  6. Mugo NR, Heffron R, Donnell D, et al. Increased risk of HIV-1 transmission in pregnancy: a prospective study among african HIV-1 serodiscordant couples. AIDS. 2011;25:1887–95. https://doi.org/10.1097/QAD.0b013e32834a9338.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vitorino RL, Grinsztejn BG, de Andrade CAF, et al. Systematic review of the effectiveness and safety of assisted reproduction techniques in couples serodiscordant for human immunodeficiency virus where the man is positive. Fertil Steril. 2011;95:1684–90. https://doi.org/10.1016/j.fertnstert.2011.01.127.

    Article  PubMed  Google Scholar 

  8. Fiore JR, Lorusso F, Vacca M, et al. The efficiency of sperm washing in removing human immunodeficiency virus type 1 varies according to the seminal viral load. Fertil Steril. 2005;84:232–4. https://doi.org/10.1016/j.fertnstert.2004.12.060.

    Article  PubMed  Google Scholar 

  9. Bujan L, Hollander L, Coudert M, et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS. 2007;21:1909–14. https://doi.org/10.1097/QAD.0b013e3282703879.

    Article  PubMed  Google Scholar 

  10. Savasi V, Mandia L, Laoreti A, et al. Reproductive assistance in HIV serodiscordant couples. Hum Reprod Update. 2013;19:136–50. https://doi.org/10.1093/humupd/dms046.

    Article  PubMed  CAS  Google Scholar 

  11. Schwartz SR, Bassett J, Sanne I, et al. Implementation of a safer conception service for HIV-affected couples in South Africa. AIDS. 2014;28:S277–85. https://doi.org/10.1097/QAD.0000000000000330.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schwartz SR, West N, Phofa R, et al. Acceptability and preferences for safer conception HIV prevention strategies: a qualitative study. Int J STD AIDS. 2016;27:984–92. https://doi.org/10.1177/0956462415604091.

    Article  PubMed  CAS  Google Scholar 

  13. Matthews LT, Baeten JM, Celum C, et al. Periconception pre-exposure prophylaxis to prevent HIV transmission: benefits, risks, and challenges to implementation. AIDS. 2010;24:1975–82. https://doi.org/10.1097/QAD.0b013e32833bedeb.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369:643–56. https://doi.org/10.1016/S0140-6736(07)60312-2.

    Article  PubMed  Google Scholar 

  15. Mmeje O, Cohen C, Murage A, et al. Promoting reproductive options for HIV-affected couples in sub-Saharan Africa. BJOG. 2014;121:79–86. https://doi.org/10.1111/1471-0528.12876.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chemaitelly H, Cremin I, Shelton J, et al. Distinct HIV discordancy patterns by epidemic size in stable sexual partnerships in sub-Saharan Africa. Sex Transm Infect. 2012;88:51–7. https://doi.org/10.1136/sextrans-2011-050114.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brubaker SG, Bukusi EA, Odoyo J, Achando J, Okumu A, Cohen CR. Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu. Kenya. HIV Med. 2011;12(5):316–21. https://doi.org/10.1111/j.1468-1293.2010.00884.x.

    Article  PubMed  CAS  Google Scholar 

  18. Liberati A, Altman DG, Tetzlaff J, et al. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Med. 2009;6:e1000100. https://doi.org/10.1371/journal.pmed.1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schwartz SR, Bassett J, Holmes CB, et al. Client uptake of safer conception strategies: implementation outcomes from the Sakh’umndeni safer conception clinic in South Africa. J Int AIDS Society. 2017. https://doi.org/10.7448/ias.20.2.2129.

    Article  Google Scholar 

  20. Steiner RJ, Black V, Rees H, et al. Low receipt and uptake of safer conception messages in routine HIV care: findings from a prospective cohort of women living with HIV in South Africa. JAIDS J Acquir Immune Defic Syndr. 2016;72:105–13.

    Article  PubMed  Google Scholar 

  21. Ngure K, Baeten JM, Mugo N, et al. My intention was a child but I was very afraid: fertility intentions and HIV risk perceptions among HIV-serodiscordant couples experiencing pregnancy in Kenya. AIDS Care. 2014;26:1283–7. https://doi.org/10.1080/09540121.2014.911808.

    Article  PubMed  PubMed Central  Google Scholar 

  22. van Zyl C, Visser MJ. Reproductive desires of men and women living with HIV: implications for family planning counselling. Reprod BioMed Online. 2015;31:434–42. https://doi.org/10.1016/j.rbmo.2015.06.004.

    Article  PubMed  Google Scholar 

  23. Teasdale CA, Marais BJ, Abrams EJ. HIV: prevention of mother-to-child transmission. BMJ Clin Evid 2011;2011.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217724/.

  24. Kawale P, Mindry D, Phoya A, et al. Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi. Reprod Health. 2015. https://doi.org/10.1186/s12978-015-0004-0.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wagner GJ, Woldetsadik MA, Beyeza-Kashesya J, et al. Multi-level correlates of safer conception methods awareness and attitudes among Ugandan HIV clients with fertility intentions. Afr J Reprod Health. 2016;20:40–51.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zash R, Souda S, Chen JY, et al. Reassuring birth outcomes with tenofovir/emtricitabine/efavirenz used for prevention of mother-to-child transmission of HIV in Botswana. JAIDS J Acquir Immune Defic Syndr. 2016;71:428–36.

    Article  PubMed  CAS  Google Scholar 

  27. Mmeje O, van der Poel S, Workneh M, et al. Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya. AIDS Care. 2015;27:10–6. https://doi.org/10.1080/09540121.2014.946385.

    Article  PubMed  Google Scholar 

  28. Were EO, Heffron R, Mugo NR, et al. Pre-exposure prophylaxis does not affect the fertility of HIV-1-uninfected men. AIDS. 2014;28:1977–82. https://doi.org/10.1097/QAD.0000000000000313.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Delany-Moretlwe S, Mullick S, Eakle R, et al. Planning for HIV preexposure prophylaxis introduction: lessons learned from contraception. Curr Opin HIV AIDS. 2016;11:87–93. https://doi.org/10.1097/COH.0000000000000221.

    Article  PubMed  Google Scholar 

  30. Matthews LT, Heffron R, Mugo NR, et al. High medication adherence during periconception periods among HIV-1–uninfected women participating in a clinical trial of antiretroviral pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2014;67:91–7. https://doi.org/10.1097/QAI.0000000000000246.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Taylor TN, Mantell JE, Nywagi N, et al. ‘He lacks his fatherhood’: safer conception technologies and the biological imperative for fatherhood among recently-diagnosed Xhosa-speaking men living with HIV in South Africa. Cult Health Sex. 2013;15:1101–14. https://doi.org/10.1080/13691058.2013.809147.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hancuch K, Baeten J, Ngure K, Celum C, Mugo N, Tindimwebwa E. Heffron R; Partners Demonstration Project Team. Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences. AIDS Care. 2018;17:1–9. https://doi.org/10.1080/09540121.2018.1437251.

    Article  Google Scholar 

  33. Wagner GJ, Linnemayr S, Goggin K, Mindry D, Beyeza-Kashesya J, Finocchario-Kessler S, Robinson E, Birungi J, Wanyenze RK. Prevalence and correlates of use of safer conception methods in a prospective cohort of Ugandan HIV-affected couples with fertility intentions. AIDS Behav. 2017;21(8):2479–87. https://doi.org/10.1007/s10461-017-1732-7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ezeanochie M, Olagbuji B, Ande A, et al. Fertility preferences, condom use, and concerns among HIV-infected women in serodiscordant relationships in the era of antiretroviral therapy. Int J Gynecol Obst. 2009;107:97–8. https://doi.org/10.1016/j.ijgo.2009.06.013.

    Article  Google Scholar 

  35. Goggin K, Finocchario-Kessler S, Staggs V, et al. Attitudes, knowledge, and correlates of self-efficacy for the provision of safer conception counseling among ugandan HIV providers. AIDS Patient Care STDs. 2015;29:651–60. https://doi.org/10.1089/apc.2015.0089.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Matthews LT, Smit JA, Moore L, et al. Periconception HIV risk behavior among men and women reporting HIV-serodiscordant partners in KwaZulu-Natal, South Africa. AIDS Behav. 2015;19:2291–303. https://doi.org/10.1007/s10461-015-1050-x.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Fourie JM, Loskutoff N, Huyser C. Semen decontamination for the elimination of seminal HIV-1. Reprod BioMed Online. 2015;30:296–302. https://doi.org/10.1016/j.rbmo.2014.11.008.

    Article  PubMed  CAS  Google Scholar 

  38. Mmeje O, Cohen CR, Cohan D. Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): a closer look at vaginal insemination. Infec Dis Obst Gynecol. 2012;2012:1–7. https://doi.org/10.1155/2012/587651.

    Article  Google Scholar 

  39. Kawale P, Mindry D, Stramotas S, et al. Factors associated with desire for children among HIV-infected women and men: a quantitative and qualitative analysis from Malawi and implications for the delivery of safer conception counseling. AIDS Care. 2014;26:769–76. https://doi.org/10.1080/09540121.2013.855294.

    Article  PubMed  Google Scholar 

  40. Matthews LT, Crankshaw T, Giddy J, et al. Reproductive counseling by clinic healthcare workers in Durban, South Africa: perspectives from HIV-infected men and women reporting serodiscordant partners. Infec Dis in Obst Gynecol. 2012;2012:1–9. https://doi.org/10.1155/2012/146348.

    Article  Google Scholar 

  41. Matthews LT, Moore L, Milford C, et al. “If I don’t use a condom… I would be stressed in my heart that I’ve done something wrong”: routine prevention messages preclude safer conception counseling for HIV-infected men and women in South Africa. AIDS Behav. 2015;19:1666–75. https://doi.org/10.1007/s10461-015-1026-x.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Matthews LT, Bajunirwe F, Kastner J, et al. I Always worry about what might happen ahead: implementing safer conception services in the current environment of reproductive Counseling for HIV-affected men and women in Uganda. Biomed Res Int. 2016;2016:1–9. https://doi.org/10.1155/2016/4195762.

    Article  CAS  Google Scholar 

  43. Khidir H, Psaros C, Greener L, et al. Developing a safer conception intervention for men living with HIV in South Africa. AIDS Behav. 2017. https://doi.org/10.1007/s10461-017-1719-4.

    Article  PubMed Central  Google Scholar 

  44. Sturt AS, Dokubo EK, Sint TT. Antiretroviral therapy (ART) for treating HIV infection in ART-eligible pregnant women. In: The Cochrane Collaboration, ed. Cochrane database of systematic reviews. Wiley, Chichester 2010.

  45. Saleem HT, Surkan PJ, Kerrigan D, et al. Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples. AIDS Care. 2016;28:197–204. https://doi.org/10.1080/09540121.2015.1074652.

    Article  PubMed  Google Scholar 

  46. 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(2):e0192902.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Moodley J, Cooper D, Mantell JE, et al. Health care provider perspectives on pregnancy and parenting in HIV-infected individuals in South Africa. BMC Health Services Research. 2014;14:384.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ngure K, Kimemia G, Dew K, et al. Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. J Int AIDS Soc. 2017. https://doi.org/10.7448/ias.20.2.21309.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Finocchario-Kessler S, Wanyenze R, Mindry D, et al. “I may not say we really have a method, it is gambling work”: knowledge and acceptability of safer conception methods among providers and HIV clients in Uganda. Health Care Women Int. 2014;35:896–917. https://doi.org/10.1080/07399332.2014.924520.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mindry DL, Milford C, Greener L, et al. Client and provider knowledge and views on safer conception for people living with HIV (PLHIV). Sex Reprod Healthcare. 2016;10:35–40. https://doi.org/10.1016/j.srhc.2016.03.005.

    Article  Google Scholar 

  51. West N, Schwartz S, Phofa R, et al. “I don’t know if this is right…but this is what I’m offering”: healthcare provider knowledge, practice, and attitudes towards safer conception for HIV-affected couples in the context of Southern African guidelines. AIDS Care. 2016;28:390–6. https://doi.org/10.1080/09540121.2015.1093596.

    Article  PubMed  Google Scholar 

  52. Matthews LT, Milford C, Kaida A, et al. Lost opportunities to reduce periconception HIV transmission: safer conception counseling by south african providers addresses perinatal but not sexual HIV transmission. J Acquir Immune Defic Syndr. 2014;67:S210–7. https://doi.org/10.1097/QAI.0000000000000374(B).

    Article  PubMed  PubMed Central  Google Scholar 

  53. Mindry DL, Crankshaw TL, Maharaj P, et al. “We have to try and have this child before it is too late”: missed opportunities in client-provider communication on reproductive intentions of people living with HIV. AIDS Care. 2015;27:25–30. https://doi.org/10.1080/09540121.2014.951311.

    Article  PubMed  CAS  Google Scholar 

  54. Mmeje O, Njoroge B, Akama E, et al. Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a safer conception counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services. AIDS Care. 2016;28:750–7. https://doi.org/10.1080/09540121.2016.1153592.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Mantell JE, Cooper D, Exner TM, et al. Emtonjeni-A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: results of a Phase II Study. AIDS Behav. 2017;21:905–22. https://doi.org/10.1007/s10461-016-1562-z.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  56. Matthews LT, Smit JA, Cu-Uvin S, et al. Antiretrovirals and safer conception for HIV-serodiscordant couples. Curr Opin HIV AIDS. 2012;7:569–78. https://doi.org/10.1097/COH.0b013e328358bac9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Breitnauer BT, Mmeje O, Njoroge B, et al. Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya. J Int AIDS Soc. 2015. https://doi.org/10.7448/ias.18.1.19972.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Matthews LT, Ribaudo HB, Kaida A, et al. HIV-infected Ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods. JAIDS J Acquir Immune Defic Syndr. 2016;71:399–406.

    Article  PubMed  CAS  Google Scholar 

  59. Matthews LT, Crankshaw T, Giddy J, et al. Reproductive decision-making and periconception practices among HIV-infected men and women attending HIV services in Durban, South Africa. AIDS Behav. 2013;17:461–70. https://doi.org/10.1007/s10461-011-0068-y.

    Article  PubMed  Google Scholar 

  60. Wagner GJ, Goggin K, Mindry D, et al. Correlates of Use of timed unprotected intercourse to reduce horizontal transmission among Ugandan HIV clients with fertility intentions. AIDS Behav. 2015;19:1078–88. https://doi.org/10.1007/s10461-014-0906-9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Crankshaw TL, Mindry D, Munthree C, et al. Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa. J Int AIDS Soc. 2014. https://doi.org/10.7448/ias.17.1.18832.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Kaida A, Matthews LT, Kanters S, et al. Incidence and predictors of pregnancy among a cohort of HIV-infected women initiating antiretroviral therapy in Mbarara, Uganda. PLoS ONE. 2013;8:e63411. https://doi.org/10.1371/journal.pone.0063411.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Pintye J, Ngure K, Curran K, et al. Fertility decision-making among Kenyan HIV-serodiscordant couples who recently conceived: implications for safer conception planning. AIDS Patient Care STDs. 2015;29:510–6. https://doi.org/10.1089/apc.2015.0063.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Matthews LT, Burns BF, Bajunirwe F, Kabakyenga J, Bwana M, Ng C, et al. Beyond HIV-serodiscordance: partnership communication dynamics that affect engagement in safer conception care. PLoS ONE. 2017;12(9):e0183131.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Nosarka S, Hoogendijk CF, Siebert TI, et al. Assisted reproduction in the HIV-serodiscordant couple. S Afr Med J. 2007;97:24–6.

    PubMed  CAS  Google Scholar 

  66. Kuete M, Yuan H, Tchoua Kemayou AL, et al. Scale up use of family planning services to prevent maternal transmission of HIV among discordant couples: a cross-sectional study within a resource-limited setting. Patient Prefer Adher. 2016;10:1967–77. https://doi.org/10.2147/PPA.S105624.

    Article  Google Scholar 

  67. Rao A, Baral S, Phaswana-Mafuya N, et al. Pregnancy intentions and safer pregnancy knowledge among female sex workers in Port Elizabeth, South Africa. Obst Gynecol. 2016;128:15–21. https://doi.org/10.1097/AOG.0000000000001471.

    Article  Google Scholar 

  68. Saleem HT, Surkan PJ, Kerrigan D, et al. Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples. AIDS Care. 2016;28:197–204. https://doi.org/10.1080/09540121.2015.1074652.

    Article  PubMed  Google Scholar 

  69. Zafer M, Horvath H, Mmeje O, et al. Effectiveness of semen washing to prevent HIV transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil steril. 2016;105(3):645–645.e2. https://doi.org/10.1016/j.fertnstert.2015.11.028.

    Article  PubMed  Google Scholar 

  70. Ddumba-Nyanzi I, Kaawa-Mafigiri D, Johannessen H. Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: a qualitative study. Patient Educ Couns. 2016;99:754–9. https://doi.org/10.1016/j.pec.2015.11.023.

    Article  PubMed  Google Scholar 

  71. Noreh LJ, Tucs O, Sekadde-Kigondu CB, et al. Outcomes of assisted reproductive technologies at the Nairobi In Vitro Fertilisation Centre. East Afr Med J 2009; https://www.ajol.info/index.php/eamj/article/view/46944 Accessed 30 Jun 2017.

  72. Dyer SJ, Kruger TF. Assisted reproductive technology in South Africa: first results generated from the South African Register of Assisted Reproductive Techniques. S Afr Med J. 2012;102:167–70.

    Article  PubMed  Google Scholar 

  73. Guthrie BL, Choi RY, Bosire R, et al. Predicting pregnancy in HIV-1-discordant couples. AIDS Behav. 2010;14:1066–71. https://doi.org/10.1007/s10461-010-9716-x.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Hayford SR, Agadjanian V, Luz L. Now or never: perceived HIV status and fertility intentions in rural Mozambique. Stud Fam Plann. 2012;43:191–9.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Matthews LT, Beyeza-Kashesya J, Cooke I, Davies N, Heffron R, Kaida A, Kinuthia J, Mmeje O, Semprini AE, Weber S. Consensus statement: supporting safer conception and pregnancy for men and women living with and affected by hiv. AIDS Behav. 2017. https://doi.org/10.1007/s10461-017-1777-7.

    Article  PubMed Central  Google Scholar 

  76. Asiimwe S, Ross JM, Arinaitwe A, et al. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc. 2017;20(Suppl 4):21633. https://doi.org/10.7448/IAS.20.5.21633.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Suthar AB, Ford N, Bachanas PJ, Towards Universal Voluntary HIV, et al. Testing and counselling: a systematic review and meta-analysis of community-based approaches. Sansom SL, ed. PLoS Med. 2013;10(8):e1001496. https://doi.org/10.1371/journal.pmed.1001496.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Wall K, Karita E, Nizam A, et al. Influence network agent effectiveness in promoting couples’ Hiv counseling and testing in Kigali, Rwanda. AIDS (London, England). 2012;26(2):217–27. https://doi.org/10.1097/qad.0b013e32834dc593.

    Article  Google Scholar 

  79. Wall KM, Kilembe W, Nizam A, et al. Promotion of couples’ voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents. BMJ Open. 2012;2(5):e001171. https://doi.org/10.1136/bmjopen-2012-001171.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Kelley AL, Hagaman AK, Wall KM, et al. Promotion of couples’ voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia. BMC Public Health. 2016;16:744. https://doi.org/10.1186/s12889-016-3424-z.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Wall KM, Kilembe W, Vwalika B, et al. Sustained effect of couples’ HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples. Sex Trans Infect. 2017;93(4):259–66. https://doi.org/10.1136/sextrans-2016-052743.

    Article  Google Scholar 

  82. Joseph Davey DL, Wall KM. Need to include couples’ HIV counselling and testing as a strategy to improve HIV partner notification services. AIDS. 2017;31(17):2435–6. https://doi.org/10.1097/QAD.0000000000001632.

    Article  PubMed  Google Scholar 

  83. Dalal S, Johnson C, Fonner V, et al. Improving HIV test uptake and case finding with assisted partner notification services. AIDS. 2017;31(13):1867–76. https://doi.org/10.1097/qad.0000000000001555.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the students, interns and fellows who worked on this review. We would also like to acknowledge all of the researchers and study participants who were included in our review.

Funding

We received funding from NIH-NIAID-T32DA023356 and NIH/FIC R25TW009340.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Joseph Davey.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

N/A (this is a systematic review of existing literature).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joseph Davey, D., West, S., Umutoni, V. et al. A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa. AIDS Behav 22, 2916–2946 (2018). https://doi.org/10.1007/s10461-018-2170-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-018-2170-x

Keywords

Navigation