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

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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.

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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

  1. Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA

    D. Joseph Davey & S. Taleghani

  2. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    D. Joseph Davey & E. Farley

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    S. West

  4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    V. Umutoni, R. Shah, S. Madni, S. Orewa, V. Kottamasu, V. Rice, Z. Robbin & K. M. Wall

  5. Cornell University, Ithaca, NY, USA

    H. Klausner

Authors
  1. D. Joseph Davey
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  2. S. West
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  3. V. Umutoni
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  4. S. Taleghani
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  5. H. Klausner
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  6. E. Farley
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  7. R. Shah
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  8. S. Madni
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  9. S. Orewa
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  10. V. Kottamasu
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  11. V. Rice
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  12. Z. Robbin
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  13. K. M. Wall
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Corresponding author

Correspondence to D. Joseph Davey.

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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).

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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

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

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