Dr. Matthews joined the Division of Infectious Diseases in January 2019. She studies strategies to reduce HIV transmission among HIV-affected men and women who want to have children (“safer conception”). At least 50% of people living with HIV choose to have children and ~40% of persons living with HIV in sub-Saharan Africa have an uninfected partner. HIV-transmission in the context of condomless sex to allow for pregnancy contributes to a large proportion of infections among men, women and, therefore, children. Advances in HIV prevention including ART-mediated viral suppression for partners living with HIV, PrEP for HIV-exposed partners, STI treatment, condomless sex timed to peak fertility, and manual insemination can support men and women to safely meet reproductive goals.
Her research is based in South Africa and Uganda. She has published over 35 manuscripts on this topic and built a research platform and collaborations that position her to design and test safer conception interventions. Her current program has three major components.
1. Assessing Demand for and Nature of Existing Safer Conception Services
• Dr. Matthews identified periconception risk-reduction for HIV-affected couples as important while working in Rwanda (2006) and South Africa (2008 – as a Schwartz Global Health Fellow).
• She published a harm-reduction approach on minimizing periconception HIV transmission while respecting couples’ reproductive choices. This publication (>150 citations) helped shift the “safer conception” focus from assisted reproductive technologies to less resource-intense strategies, highlighting the potential for safer conception programming to reduce HIV incidence globally.
• Subsequent research with persons living with HIV, their partners, & providers showed that:
- People living with HIV prioritize conception over HIV-transmission and are eager for safer conception advice.
- Men make most conception decisions.
- Healthcare providers lack safer conception knowledge and remain uncomfortable supporting persons living with HIV to have children.
2. Testing Safer Conception Interventions
• Pre-exposure prophylaxis (PrEP) can reduce HIV transmission risk by 90%.
• Dr. Matthews is the Principal Investigator of an R01-funded project seeking to evaluate use of PrEP by 350 women in South Africa who want to have a child in the next year and believe they will be exposed to HIV. To date about 70% of women choose to use PrEP8148 and over half are able to adhere to at doses sufficient to protect them from HIV acquisition. Dr. Matthews is also evaluating this strategy with a Doris Duke Charitable Foundation Clinician Scientist Development Award in Uganda, where uptake and adherence are even higher.
• These studies will inform how to support women seeking pregnancy to access an important HIV prevention strategy.
3. Engaging Men
• Men are interested in having HIV-uninfected children, control many decisions around sex and reproduction, and pursue condomless sex to meet reproductive goals.
• Dr. Matthews worked with collaborators to design a “healthy baby” intervention (R34-funded) to promote uptake of and adherence to ART with infected men who want to have a child with a stable, uninfected partner. Eighty percent of men in the South African program initiated ART and 100% of those have suppressed HIV-RNA, effectively eliminating the risk of HIV transmission to their partners and children.
• Dr. Matthews and collaborators began a safer conception clinical program in Uganda in January 2016 (pilot funding) which has enrolled nearly 300 couples and leverages the motivations of men to have healthy children to engage them in HIV care and treatment thus reducing transmission to partners and children. Her team will evaluate engagement and retention in care for male participants to test the effectiveness of this strategy. These pilot data inform an R01 proposal to evaluate the effect of safer conception care on linkage to care, retention in care, VL suppression among men in our clinic compared to another local clinic. The clinical program is funded through Grand Challenges Canada and her collaborative team is currently seeking funding to scale the program.
