{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:56:49Z","timestamp":1792501009808,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,7]],"date-time":"2019-04-07T00:00:00Z","timestamp":1554595200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R21TW009908"],"award-info":[{"award-number":["R21TW009908"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["F31MH113420"],"award-info":[{"award-number":["F31MH113420"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R00HD076679"],"award-info":[{"award-number":["R00HD076679"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,4]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>Safer conception strategies minimize HIV<\/jats:styled-content> risk during condomless sex to become pregnant. Gaps remain in understanding the acceptability, feasibility and choices HIV<\/jats:styled-content>\u2010serodiscordant couples make when multiple safer conception options are available.<\/jats:p><\/jats:sec>Methods<\/jats:title>We conducted a pilot study of a comprehensive safer conception package for HIV<\/jats:styled-content>\u2010serodiscordant couples with immediate fertility desires in Kenya from March 2016 to April 2018. The intervention package included antiretroviral therapy (ART<\/jats:styled-content>) for HIV<\/jats:styled-content>\u2010positive partners, oral pre\u2010exposure prophylaxis (PrEP<\/jats:styled-content>) for HIV<\/jats:styled-content>\u2010negative partners, daily fertility and sexual behaviour tracking via short message service (SMS<\/jats:styled-content>) surveys, counselling on self\u2010insemination, and referrals for voluntary medical male circumcision and fertility care. Couples attended monthly visits until pregnancy with HIV<\/jats:styled-content> testing for negative partners at each visit. We estimated the number of expected HIV<\/jats:styled-content> seroconversions using a counterfactual cohort simulated from gender\u2010matched couples in the placebo arm of a previous PrEP<\/jats:styled-content> clinical trial. We used bootstrap methods to compare expected and observed seroconversions.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 74 enrolled couples, 54% were HIV<\/jats:styled-content>\u2010negative female\/HIV<\/jats:styled-content>\u2010positive male couples. The 6 and 12\u2010month cumulative pregnancy rates were 45.3% and 61.9% respectively. In the month preceding pregnancy, 80.9% of HIV<\/jats:styled-content>\u2010positive partners were virally suppressed, 81.4% of HIV<\/jats:styled-content>\u2010negative partners were highly adherent to PrEP<\/jats:styled-content>, and SMS<\/jats:styled-content> surveys indicated potential timing of condomless sex to peak fertility (median of sex acts\u00a0=\u00a010, interquartile range (IQR<\/jats:styled-content>) 7 to 12; median condomless sex acts\u00a0=\u00a03.5, IQR<\/jats:styled-content> 1 to 7). Most (95.7%) pregnancies were protected by \u22652 strategies: 57.4% were protected by high PrEP<\/jats:styled-content> and ART<\/jats:styled-content> adherence, male circumcision with or without timed condomless sex; 10 (21.3%) were protected by viral suppression in the HIV<\/jats:styled-content>\u2010positive partner and male circumcision with or without timed condomless sex; 8 (17.0%) were protected by high PrEP<\/jats:styled-content> adherence and male circumcision with or without timed condomless sex. We observed 0 HIV<\/jats:styled-content> seroconversions (95% CI<\/jats:styled-content> 0.0 to 6.0 per 100 person years), indicating a 100% reduction in HIV<\/jats:styled-content> risk (p<\/jats:italic>\u00a0=\u00a00.04).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The use of multiple safer conception strategies, primarily PrEP<\/jats:styled-content>, ART<\/jats:styled-content>, male circumcision and\/or tracking fertility, was acceptable and feasible for African HIV<\/jats:styled-content>\u2010serodiscordant couples and significantly reduced HIV<\/jats:styled-content> transmission risk. It is important to increase the availability of and counselling about safer conception services in regions with HIV<\/jats:styled-content> epidemics involving heterosexual transmission and high fertility.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25261","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T06:26:33Z","timestamp":1554704793000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Implementation of a comprehensive safer conception intervention for HIV\u2010serodiscordant couples in Kenya: uptake, use and effectiveness"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6039-0352","authenticated-orcid":false,"given":"Renee","family":"Heffron","sequence":"first","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Epidemiology University of Washington Seattle WA 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