HIV and Pregnancy Outcomes from the Sakh’umndeni Safer Conception Clinic

The clinic offered a range of interventions, including antiretroviral therapy (ART) for HIV-positive partners, pre-exposure prophylaxis (PrEP) for HIV-negative partners, timed condomless sex, self-insemination, and male medical circumcision. These strategies aimed to minimize HIV transmission risk to partners and potential children. Between July 2013 and July 2017, 526 individuals (334 women and 192 men) from 334 partnerships participated in the safer conception care program at Witkoppen Clinic. Couples were serodifferent (49%), seroconcordant (44%), or in relationships with one unknown status partner (7%). The median ages of women and men were 34 and 37 years, respectively. At baseline, 64% of HIV-positive women and 45% of HIV-positive men were virally suppressed. The median time-to-first pregnancy was estimated to be 4.0 months, with a range of 1.7 to 7.7 months. Pregnancy incidence was 47.9 per 100 person-years, with a 95% confidence interval of 38.9 to 59.1. HIV-positive women were 52% less likely to conceive than HIV-negative women, with a hazard ratio of 0.48 (95% confidence interval: 0.28, 0.87). The median time-to-pregnancy was 0.8 years for HIV-negative women and 2.1 years for HIV-positive women. Of the 98 pregnancies observed, 66 (67%) resulted in live births, 24 (25%) ended in miscarriage or ectopic pregnancy, 5 (5%) were ongoing, and 3 (3%) were unknown. No horizontal or vertical HIV transmissions were reported. The study highlights the need for approaches to reduce onward transmission risks, particularly among patients trying to conceive on ART, where viral suppression cannot be assumed. Safer conception strategies can help couples successfully conceive an HIV-free child without jeopardizing their partner's health.