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Open Access 01-12-2021 | Fertility | Research

Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya

Authors: Yasaman Zia, Jennifer Velloza, Lynda Oluoch, Richard Momanyi, Sarah Mbugua, John Njoroge, Stephen Gakuo, Edwin Mugo, Nicholas Thuo, Catherine Kiptinness, Njambi Njuguna, Kenneth Ngure, Nelly R. Mugo, Renee Heffron

Published in: Reproductive Health | Issue 1/2021

Abstract

Background

For couples affected by HIV, and serodifferent couples in particular, pregnancy desire is often juxtaposed against the risk of HIV transmission between the couple and the potential neonate leading to thinking about measures to minimize risk of HIV transmission. We assess the use of fertility awareness methods [FAM] and evaluate the drivers of alignment between indicators of fertility and sexual behavior among HIV-serodifferent couples desiring pregnancy.

Methods

HIV-serodifferent couples from Thika, Kenya were enrolled into an open-label pilot evaluation of safer conception strategies. Women responded to daily 7-item short message service [SMS] surveys on FAM and sexual activity. Menstrual cycles were categorized as having condomless sex aligned, not aligned, or partially aligned to the predicted peak fertility. We used binomial logit models with generalized estimating equations to assess alignment between condomless sex during peak fertility days and FAM results. We used Cox proportional hazards to compare pregnancy incidence among months with sex and peak fertility aligned and mis-aligned.

Results

A total of 6929 SMS surveys across 252 menstrual cycles of 65 women were included. Reporting “sticky” cervical mucus (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [95% CI]: 1.30, 3.90) and positive ovulation prediction kit [OPK] result (aOR: 2.07, 95% CI: 1.11, 3.86) were associated with increased likelihood of alignment of condomless sex during peak fertility. Pregnancy incidence was statistically similar among periods with sex aligned and not aligned with peak fertility.

Conclusions

Among women engaged in a comprehensive safer conception program, a moderate percentage of women aligned condomless sex and predicted peak fertility days at least once. While FAM, particularly cervical mucus and OPK, are an inexpensive option for couples to consider using as a component of their safer conception strategies, antiretroviral-based strategies remain important to minimize risk.

Liao C, Wahab M, Anderson J, Coleman JS. Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive. J Int AIDS Soc. 2015;18:19447. https://doi.org/10.7448/IAS.18.1.19447.CrossRefPubMedPubMedCentral

Family planning/contraception methods. World Health Organization; 2020.

Grimes DA, Gallo MF, Grigorieva V, Nanda K, Schulz KF. Fertility awareness-based methods for contraception: systematic review of randomized controlled trials. Contraception. 2005;72:85–90. https://doi.org/10.1016/j.contraception.2005.03.010.CrossRefPubMed

Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of fertility awareness-based methods for pregnancy prevention: a systematic review. Obstet Gynecol. 2018;132:591–604. https://doi.org/10.1097/AOG.0000000000002784.CrossRefPubMed

Finocchario-Kessler S, Wanyenze R, Mindry D, Beyeza-Kashesya J, Goggin K, Nabiryo C, et al. “I May Not Say We Really Have a Method, It Is Gambling Work”: knowledge and acceptability of safer conception methods among providers and HIV clients in Uganda. Health Care Women Int. 2014;35:896–917. https://doi.org/10.1080/07399332.2014.924520.CrossRefPubMedPubMedCentral

Velloza J, Ngure K, Kiptinness C, Quame-Amaglo J, Thuo N, Dew K, et al. A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study. MHealth. 2019;5:4. https://doi.org/10.21037/mhealth.2019.01.04.CrossRefPubMedPubMedCentral

Diamond-Smith N, Onyango GO, Wawire S, Ayodo G. Knowledge of menstruation and fertility among adults in rural Western Kenya: gaps and opportunities for support. PLoS ONE. 2020;15:e0229871. https://doi.org/10.1371/journal.pone.0229871.CrossRefPubMedPubMedCentral

Hancuch K, Baeten J, Ngure K, Celum C, Mugo N, Tindimwebwa E, et al. Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences. AIDS Care. 2018;30:973–81. https://doi.org/10.1080/09540121.2018.1437251.CrossRefPubMedPubMedCentral

Joseph Davey D, West S, Umutoni V, Taleghani S, Klausner H, Farley E, et al. A systematic review of the current status of safer conception strategies for HIV affected heterosexual couples in Sub-Saharan Africa. AIDS Behav. 2018;22:2916–46. https://doi.org/10.1007/s10461-018-2170-x.CrossRefPubMed

10.

Zafer M, Horvath H, Mmeje O, van der Poel S, Semprini AE, Rutherford G, et al. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil Steril. 2016;105(645–655):e2. https://doi.org/10.1016/j.fertnstert.2015.11.028.CrossRef

11.

Ngure K, Kimemia G, Dew K, Njuguna N, Mugo N, Celum C, et al. Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples. J Int AIDS Soc. 2017. https://doi.org/10.7448/IAS.20.2.21309.CrossRefPubMedPubMedCentral

12.

Stanford JB, Willis SK, Hatch EE, Rothman KJ, Wise LA. Fecundability in relation to use of fertility awareness indicators in a North American preconception cohort study. Fertil Steril. 2019;112:892–9. https://doi.org/10.1016/j.fertnstert.2019.06.036.CrossRefPubMed

13.

Mu Q, Fehring RJ. Efficacy of achieving pregnancy with fertility-focused intercourse: MCN. Am J Matern/Child Nurs. 2014;39:35–40. https://doi.org/10.1097/NMC.0b013e3182a76b88.CrossRef

14.

Piot P, Bartos M, Larson H, Zewdie D, Mane P. Coming to terms with complexity: a call to action for HIV prevention. Lancet. 2008;372:845–59. https://doi.org/10.1016/S0140-6736(08)60888-0.CrossRefPubMed

15.

Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet. 2008;371:2183–91. https://doi.org/10.1016/S0140-6736(08)60953-8.CrossRefPubMed

16.

Heffron R, Ngure K, Velloza J, Kiptinness C, Quame-Amalgo J, Oluch L, et al. Implementation of a comprehensive safer conception intervention for HIV-serodiscordant couples in Kenya: uptake, use and effectiveness. J Intern AIDS Soc. 2019;22:e25261. https://doi.org/10.1002/jia2.25261.CrossRef

17.

Bull JR, Rowland SP, Scherwitzl EB, Scherwitzl R, Danielsson KG, Harper J. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. Digit Med. 2019;2:83. https://doi.org/10.1038/s41746-019-0152-7.CrossRef

18.

Shilaih M, Goodale BM, Falco L, Kübler F, De Clerck V, Leeners B. Modern fertility awareness methods: wrist wearables capture the changes in temperature associated with the menstrual cycle. Biosci Rep. 2018;38:9. https://doi.org/10.1042/BSR20171279.CrossRef

19.

Barron ML, Fehring RJ. Basal body temperature: is it useful for couples seeking pregnancy? Am J Matern Child Nurs. 2005;30:290–6.CrossRef

20.

Iliyasu Z, Galadanci HS, Oladimeji AI, Babashani M, Gajida AU, Aliyu MH. Predictors of safer conception practices among HIV-infected women in Northern Nigeria. Int J Health Policy Manag. 2019;8:480–7. https://doi.org/10.15171/ijhpm.2019.27.CrossRefPubMedPubMedCentral

21.

Wagner GJ, Linnemayr S, Goggin K, Mindry D, Beyeza-Kashesya J, Finocchario-Kessler S, et al. Prevalence and correlates of use of safer conception methods in a prospective Cohort of Ugandan HIV-affected couples with fertility intentions. AIDS Behav. 2017;21:2479–87. https://doi.org/10.1007/s10461-017-1732-7.CrossRefPubMedPubMedCentral

22.

Matthews LT, Smit JA, Moore L, Milford C, Greener R, Mosery FN, et al. Periconception HIV risk behavior among men and women reporting HIV-serodiscordant partners in KwaZulu-Natal, South Africa. AIDS Behav. 2015;19:2291–303. https://doi.org/10.1007/s10461-015-1050-x.CrossRefPubMedPubMedCentral

23.

Steiner RJ, Black V, Rees H, Schwartz SR. Low receipt and uptake of safer conception messages in routine HIV care: findings from a prospective cohort of women living with HIV in South Africa. J Acquir Immune Defic Syndr. 2016;72:9.CrossRef

24.

Thijssen A, Meier A, Panis K, Ombelet W. ‘Fertility Awareness-Based Methods’ and subfertility: a systematic review. Facts Views Vis Ob/Gyn. 2014;6:113–23.

25.

Ngure K, Thuo N, Velloza J, Mugo NR, Quame-Amaglo J, Kiptinness C, et al. “She takes hers and I take mine”: experiences of HIV serodiscordant couples using Safer Conception Strategies in Thika, Kenya. In: International AIDS society: 10th annual IAS conference on HIV science, Mexico City, Mexico, 2019. Abstract TUPEC485.

26.

Schwartz SR, Bassett J, Mutunga L, Yende N, Mudavanhu M, Phofa R, et al. HIV incidence, pregnancy, and implementation outcomes from the Sakh’umndeni safer conception project in South Africa: a prospective cohort study. Lancet HIV. 2019;6:e438–46. https://doi.org/10.1016/S2352-3018(19)30144-4.CrossRefPubMedPubMedCentral

27.

Saleem HT, Narasimhan M, Denison JA, Kennedy CE. Achieving pregnancy safely for HIV-serodiscordant couples: a social ecological approach. J Int AIDS Soc. 2017. https://doi.org/10.7448/IAS.20.2.21331.CrossRefPubMedPubMedCentral

Title: Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya
Authors: Yasaman Zia
Jennifer Velloza
Lynda Oluoch
Richard Momanyi
Sarah Mbugua
John Njoroge
Stephen Gakuo
Edwin Mugo
Nicholas Thuo
Catherine Kiptinness
Njambi Njuguna
Kenneth Ngure
Nelly R. Mugo
Renee Heffron
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Fertility
Human Immunodeficiency Virus
Published in: Reproductive Health / Issue 1/2021
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/s12978-021-01128-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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