Implementation of a comprehensive safer conception intervention for HIV-serodiscordant couples in Kenya: uptake, use and effectiveness
Implementation of a comprehensive safer conception intervention for HIV-serodiscordant couples in Kenya: uptake, use and effectiveness
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DOI：
10.1002/jia2.25261
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发表时间：
2019-04-01
影响因子：
6
通讯作者：
Mugo, Nelly
中科院分区：
文献类型：
--
作者：
Heffron, Renee;Ngure, Kenneth;Mugo, Nelly
介绍：更安全的受孕策略最大限度地减少艾滋病毒的风险在无避孕套的性行为成为怀孕。在了解艾滋病毒血清不一致的夫妇在有多种更安全的妊娠选择时的可接受性、可行性和选择方面仍然存在差距。方法：2016年3月至2018年4月，我们在肯尼亚为有立即生育愿望的艾滋病毒血清不一致夫妇进行了一项全面的更安全受孕包的试点研究。一揽子干预措施包括对艾滋病毒阳性伴侣的抗逆转录病毒治疗，对艾滋病毒阴性伴侣的口服暴露前预防，通过短信服务调查跟踪每日生育和性行为，自我授精咨询，以及自愿转介男性包皮环切和生育护理。夫妇在怀孕前每月进行一次检查，并在每次检查中对阴性伴侣进行艾滋病毒检测。我们在之前的PrEP临床试验中使用了一个反事实队列，从性别匹配的夫妇中模拟安慰剂组，估计了预期的HIV血清转化的数量。我们使用引导方法来比较预期的和观察到的服务器转换。结果：74对入组夫妇中，54%为hiv阴性女性/ hiv阳性男性。6月和12月累计妊娠率分别为45.3%和61.9%。在怀孕前一个月，80.9%的艾滋病毒阳性伴侣的病毒受到抑制，81.4%的艾滋病毒阴性伴侣高度遵守PrEP，短信调查显示无安全套性行为的潜在时间为生育高峰(性行为中位数= 10，四分位数间距（IQR） 7至12；无套性行为中位数= 3.5，IQR为1 ~ 7)。大多数（95.7%）孕妇采用>= 2策略；57.4%的孕妇采用高水平的PrEP和ART依从性、包皮环切术（伴或不伴定时无套性行为）；10例（21.3%）在hiv阳性伴侣和男性包皮环切伴或不伴定时无套性行为中受到病毒抑制的保护；8例（17.0%）受到高依从性PrEP和包皮环切术（伴或不伴定时无套性行为）的保护。我们观察到0例HIV血清转化（95% CI为0.0 - 6.0 / 100人年），表明HIV风险降低100% （p = 0.04）。结论：使用多种更安全的受孕策略，主要是PrEP， ART，男性包皮环切术和/或生育跟踪，对于非洲HIV血清不一致的夫妇是可接受和可行的，并显著降低了HIV传播风险。重要的是，在涉及异性传播和高生育率的艾滋病毒流行区域，增加更安全受孕服务的提供和咨询。
Introduction: Safer conception strategies minimize HIV risk during condomless sex to become pregnant. Gaps remain in understanding the acceptability, feasibility and choices HIV-serodiscordant couples make when multiple safer conception options are available.Methods: We conducted a pilot study of a comprehensive safer conception package for HIV-serodiscordant couples with immediate fertility desires in Kenya from March 2016 to April 2018. The intervention package included antiretroviral therapy (ART) for HIV-positive partners, oral pre-exposure prophylaxis (PrEP) for HIV-negative partners, daily fertility and sexual behaviour tracking via short message service (SMS) surveys, counselling on self-insemination, and referrals for voluntary medical male circumcision and fertility care. Couples attended monthly visits until pregnancy with HIV testing for negative partners at each visit. We estimated the number of expected HIV seroconversions using a counterfactual cohort simulated from gender-matched couples in the placebo arm of a previous PrEP clinical trial. We used bootstrap methods to compare expected and observed seroconversions.Results: Of the 74 enrolled couples, 54% were HIV-negative female/HIV-positive male couples. The 6 and 12-month cumulative pregnancy rates were 45.3% and 61.9% respectively. In the month preceding pregnancy, 80.9% of HIV-positive partners were virally suppressed, 81.4% of HIV-negative partners were highly adherent to PrEP, and SMS surveys indicated potential timing of condomless sex to peak fertility (median of sex acts = 10, interquartile range (IQR) 7 to 12; median condomless sex acts = 3.5, IQR 1 to 7). Most (95.7%) pregnancies were protected by >= 2 strategies: 57.4% were protected by high PrEP and ART adherence, male circumcision with or without timed condomless sex; 10 (21.3%) were protected by viral suppression in the HIV-positive partner and male circumcision with or without timed condomless sex; 8 (17.0%) were protected by high PrEP adherence and male circumcision with or without timed condomless sex. We observed 0 HIV seroconversions (95% CI 0.0 to 6.0 per 100 person years), indicating a 100% reduction in HIV risk (p = 0.04).Conclusions: The use of multiple safer conception strategies, primarily PrEP, ART, male circumcision and/or tracking fertility, was acceptable and feasible for African HIV-serodiscordant couples and significantly reduced HIV transmission risk. It is important to increase the availability of and counselling about safer conception services in regions with HIV epidemics involving heterosexual transmission and high fertility.