title: 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.
abstract: Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV-serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and treatment programs in Kenya and other HIV endemic regions of sub-Saharan Africa.
authors.affiliation: a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA.|b Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , MI , USA.
authors.forename: Okeoma
authors.initials: O
authors.lastname: Mmeje
authors.affiliation: c Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research , Nairobi City , Kenya.
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.affiliation: c Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research , Nairobi City , Kenya.|d Family AIDS Care and Education Services (FACES) , Kisumu , Kenya.
authors.forename: Eliud
authors.initials: E
authors.lastname: Akama
authors.affiliation: e Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Leddy
authors.affiliation: f Department of Obstetrics and Gynecology , University of Colorado, School of Medicine , Aurora , CO , USA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Breitnauer
authors.affiliation: g Center for AIDS Prevention Studies and Global Health Sciences, University of California , San Francisco , CA , USA.
authors.forename: Lynae
authors.initials: L
authors.lastname: Darbes
authors.affiliation: h Department of Obstetrics, Gynecology, and Reproductive Science , University of California , San Francisco , CA , USA.|i Department of Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling / Q000379:methods; D005191:Family Characteristics; D005239:Fear; D005260:Female; D005306:Fertilization; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D033182:Intention; D007630:Kenya; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D036301:Qualitative Research; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology; D057545:Social Stigma
keywords: HIV prevention; HIV-affected couples; Safer conception; family planning; prevention of mother-to-child transmission