Demonstration and acceptability of a safer conception intervention for men with HIV in South Africa (Preprint)

Abstract

Many men with HIV (MWH) want to have children and may thus expose partners to HIV. HIV-RNA suppression can minimize sexual HIV transmission risks while allowing for conception and optimizing the health of men, their partners, and their infants.

To develop and evaluate feasibility and acceptability of an intervention to promote serostatus disclosure, ART uptake and adherence, and HIV-RNA suppression among MWH who want to have children in South Africa.

We developed a Safer Conception Intervention (“Sinikithemba Kwabesilisa”, or, ”We give hope to men”) to promote HIV-RNA suppression via ART uptake and adherence, HIV-serostatus disclosure, and other safer conception strategies for MWH in South Africa. Through 3 counseling and 2 booster sessions over 12 weeks, we offered education on safer conception strategies, and aided participants to develop a safer conception plan. We recruited MWH (HIV diagnosis known for >1 month), not yet accessing or accessing ART for <3 months, in a stable partnership with an HIV-uninfected or unknown-serostatus woman and wanting to have a child in the next year. We conducted an open pilot to evaluate acceptability based on patient participation and exit interviews, and feasibility based on recruitment and retention. In depth exit interviews were conducted with 11 men to explore intervention acceptability including affective attitudes towards the intervention, perceived efficacy, self-efficacy to benefit from the intervention. Questionnaires collected at baseline and exit assessed disclosure outcomes; CD4 and HIV-RNA data were abstracted from clinical charts to evaluate preliminary impacts on clinical outcomes of interest.

Among 31 eligible men, 16 enrolled in the study with a median age of 29 years (range 27-44), and a median time since diagnosis being 7 months prior to enrollment (range 1 month – 9 years). All identified as black South African with nine (56%) reporting secondary school completion, 7 (43%) reporting full-time employment. Seven (44%) reported an HIV-negative (vs. unknown-serostatus) partner. Fourteen men (88%) completed the 3 primary counseling sessions. In exit interviews, men reported personal satisfaction with session content and structure, while also suggesting they would refer peers to the program. They also described perceived effectiveness of the intervention and self-efficacy to benefit by reporting that the sessions provided new knowledge, instilled hope, and were perceived as helpful overall. Though significance testing was not conducted, quantitative outcomes were that thirteen men (81%) were taking ART at exit with 100% of those on ART with HIV-RNA suppressed at 12 weeks. Twelve men (75%) reported disclosure to pregnancy partner.

These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence among women and their children while supporting men’s health. However, only approximately half of those who met screening eligibility enrolled. Accordingly, refinement to optimize uptake is needed. Providing safer conception care and peer support at the community level may help to reach men.

ClinicalTrials.gov NCT03818984

RR2-https://doi.org/10.1007/s10461-017-1719-4