SAFER: Safer conception strategies to prevent HIV transmission among HIV sero-different couples desiring pregnancy

Safer conception strategies are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods, or method acceptability. We piloted a comprehensive safer conception program for HIV-sero-different couples planning pregnancy in Zimbabwe, measuring feasibility, method uptake, acceptability, pregnancy, and HIV transmission. Couples in this prospective study were given a choice of one or more safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum.  At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks.