title: Client uptake of safer conception strategies: implementation outcomes from the Sakh'umndeni Safer Conception Clinic in South Africa.
abstract: Implementation of safer conception services for HIV-affected couples within primary healthcare clinics in resource-limited settings remains limited. We review service utilization and safer conception strategy uptake during the first three years ofSakh'umndeni, which is a safer conception clinic in South Africa.
  
  
  
  Sakh'umndeniis located at Witkoppen Health and Welfare Centre, a high-volume primary healthcare clinic in northern Johannesburg. Men and women desiring to conceive in less than or equal to six months and in relationships in which one or both partners are living with HIV are eligible for safer conception services. Clients receive a baseline health assessment and counselling around periconception HIV risk reduction strategies and choose which strategies they plan to use. Clients are followed-up monthly. We describe client service utilization and uptake and continuation of safer conception methods. Factors associated with male partner attendance are assessed using robust Poisson regression.
  
  
  
  Overall 440 individuals utilized the service including 157 couples in which both partners attended (55%) and 126 unaccompanied female partners. Over half of the couples (55%) represented were in serodiscordant/unknown status relationships. Higher economic status and HIV-negative status of the women increased male partner involvement, while HIV-negative status of the men decreased male involvement. Regarding safer conception strategies, uptake of antiretroviral therapy initiation (90%), vaginal self-insemination among partnerships with HIV-negative men (75%) and timed condomless intercourse strategies (48%) were variable, but generally high. Overall uptake of pre-exposure prophylaxis (PrEP) was 23% and was lower among HIV-negative men than women (7% vs. 44%,p< 0.001). Male medical circumcision (MMC) was used by 28% of HIV-negative men. Over 80% of clients took up at least one recommended safer conception strategy. Continuation of selected strategies over attempted conception attempts was >60%.
  
  
  
  Safer conception strategies are generally used by clients per recommendations. High uptake of strategies suggests that the proposed combination prevention methods are acceptable to clients and appropriate for scale-up; however, low uptake of PrEP and MMC among HIV-negative men needs improvement. Targeted community-based efforts to reach men unlinked to safer conception services are needed, alongside streamlined approaches for service scale-up within existing HIV and non-HIV service delivery platforms.
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Sheree R
authors.initials: SR
authors.lastname: Schwartz
authors.affiliation: Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
authors.forename: Jean
authors.initials: J
authors.lastname: Bassett
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.|Johns Hopkins School of Medicine, Lusaka, Zambia.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Holmes
authors.affiliation: Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
authors.forename: Nompumelelo
authors.initials: N
authors.lastname: Yende
authors.affiliation: Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Phofa
authors.affiliation: Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.|Right to Care, Johannesburg, South Africa.
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium.
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D021841:Safe Sex; D012747:Sexual Partners; D013019:South Africa
keywords: HIV prevention; implementation; pre-exposure prophylaxis; safer conception; self-insemination; serodiscordance; sub-Saharan Africa; timed condomless sex