title: Implementation of a safer conception service for HIV-affected couples in South Africa.
abstract: OBJECTIVE
  To describe the development and implementation of a safer conception service in a resource-limited setting.
  
  
  METHODS
  Qualitative work to inform the design of a safer conception service was conducted with clients and providers at Witkoppen Health and Welfare Centre, a primary health center in Johannesburg, South Africa. Services began in July 2013 for HIV-affected participants planning conception within 6 months and included counseling about timed unprotected intercourse and home-based self-insemination, early initiation of combined antiretroviral therapy (cART) for HIV-infected individuals, pre-exposure prophylaxis for HIV-uninfected partners and circumcision for men. Participants were enrolled into an implementation science study evaluating method uptake, acceptability, and pregnancy and HIV transmission outcomes.
  
  
  RESULTS
  Findings to-date from 51 qualitative participants and 128 clinical cohort participants (82 women and 46 men, representing 82 partnerships) are presented. All men were accompanied by female partners, whereas 56% of women attended with their male partner. Fifteen of the 46 couples (33%) were in confirmed serodiscordant relationships; however, of the 36 additional women attending alone, 56% were unaware of their partners' HIV status or believed them to be HIV-uninfected. The majority of the HIV-infected women (86%) and men (71%) were on cART at enrollment; however, only 47% on cART were virally suppressed. Timed unprotected intercourse, self-insemination and cART were common choices for participants; few elected pre-exposure prophylaxis.
  
  
  CONCLUSIONS
  Lessons learned from early implementation demonstrate feasibility of safer conception services; however, reaching discordant couples, cART-naïve infected partners, and men remain challenges. Creating demand for safer conception services among those at highest risk for HIV transmission is necessary.
authors.affiliation: aDivision of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA bWitkoppen Health and Welfare Centre cClinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa dRight to Care, Johannesburg, South Africa eDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Sheree R
authors.initials: SR
authors.lastname: Schwartz
authors.forename: Jean
authors.initials: J
authors.lastname: Bassett
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Rebecca
authors.initials: R
authors.lastname: Phofa
authors.forename: Nompumelelo
authors.initials: N
authors.lastname: Yende
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005191:Family Characteristics; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D060728:Reproductive Health; D012747:Sexual Partners; D013019:South Africa