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Assessing the unmet health needs of informal settlements

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There are a growing number of HIV-infected women and men in South Africa who desire children. Having unprotected sex in order to conceive puts couples where one person is HIV positive and one person negative (HIV-discordant) or where both are HIV-positive (HIV positive concordant) at risk for transmission and may result in conception during times of high viremia, particularly when those infected are not yet receiving ART or not yet eligible for ART. While programs for the Prevention-of-Mother-to-Child (PMTCT) programs are accessible to women after they become pregnant, services which assist in the planning of safer families in the context of HIV-infection are not yet available.

Research (eg. HPTN 052 study) has demonstrated that ART initiation at CD4 count <550 reduces HIV transmission between HIV-discordant couples by 96%. WHWC is starting a “Safer Conception Clinic” where implementation research will be carried out to assess how a change in policy relates to a gradual increase in treatment access, ahead of “Test and Treat” strategies.

Services will pilot the SAAFER approach:
- Screen current health status and reproductive history of couple, including HIV status, ART history and current regimen, most recent CD4 cell count and viral loads of both partners. Assess current STI symptoms, STI history, and female menstrual cycle.
- Advocate for partner testing if status is unknown or confirmed negative >3 months ago.
- Assess and address readiness for conception: HAART initiation if CD4 <550 in discordant couples, proper regimen assignment for HIV-infected women on HAART, viral load monitoring, treatment of STI symptoms, and emphasizing the need for perfect adherence.
- Family planning provision until couple is ready to conceive.
- Educate couple in methods for safer conception using low-cost technologies (e.g. self-insemination, unprotected sex only during ovulation, etc.).
- Review patient pregnancy status, STI symptoms, transmission risks and sub-fertility.

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