Positions

Overview

  • 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.
  • Selected Publications

    Academic Article

    Year Title Altmetric
    2019 A scoping review of interventions to address intimate partner violence in sub-Saharan African healthcareGlobal Public Health.  14:1335-1346. 2019
    2019 High Incidence of Intended Partner Pregnancy Among Men Living With HIV in Rural Uganda: Implications for Safer Conception ServicesJournal of Acquired Immune Deficiency Syndromes.  81:497-507. 2019
    2019 Protocol for a longitudinal study to evaluate the use of tenofovir-based PrEP for safer conception and pregnancy among women in South Africa.BMJ Open.  9:e027227. 2019
    2019 Safer conception care to eliminate transmission of HIVLancet HIV.  6:e413-e414. 2019
    2019 Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan AfricaAIDS and Behavior.  23:1656-1667. 2019
    2019 Factors Associated with Pregnancy Intentions Amongst Postpartum Women Living with HIV in Rural Southwestern UgandaAIDS and Behavior.  23:1552-1560. 2019
    2019 Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trialPLoS Medicine.  16:e1002832. 2019
    2019 ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South AfricaJournal of the International AIDS Society.  22. 2019
    2019 Sexual Relationship Power and Periconception HIV-Risk Behavior Among HIV-Infected Men in Serodifferent RelationshipsAIDS and Behavior2019
    2018 Contraceptive use following unintended pregnancy among Ugandan women living with HIVPLoS ONE.  13. 2018
    2018 HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of RiskArchives of Sexual Behavior.  47:1969-1982. 2018
    2018 Prevalence and correlates of physical and sexual intimate partner violence among women living with HIV in UgandaPLoS ONE.  13. 2018
    2018 Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIVAIDS and Behavior.  22:1713-1724. 2018
    2018 Developing a Safer Conception Intervention for Men Living with HIV in South AfricaAIDS and Behavior.  22:1725-1735. 2018
    2018 Healthcare providers’ understanding of HIV serodiscordance in South Africa and Uganda: implications for HIV prevention in sub-Saharan AfricaAfrican Journal of AIDS Research.  17:137-144. 2018
    2018 "i beg you...breastfeed the baby, things changed": Infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmissionBMC Public Health.  18. 2018
    2017 Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception carePLoS ONE.  12. 2017
    2017 Program Implementation of Option B+ at a President's Emergency Plan for AIDS Relief-Supported HIV Clinic Improves Clinical Indicators but Not Retention in Care in Mbarara, UgandaAIDS patient care.  31:335-341. 2017
    2017 Understanding coping strategies during pregnancy and the postpartum period: A qualitative study of women living with HIV in rural UgandaBMC Pregnancy and Childbirth.  17. 2017
    2017 Psychosocial challenges facing women living with HIV during the perinatal period in rural UgandaPLoS ONE.  12. 2017
    2017 Supporting HIV prevention and reproductive goals in an HIV-endemic setting: Taking safer conception services from policy to practice in South AfricaJournal of the International AIDS Society.  20:36-42. 2017
    2017 HIV-affected couples and individuals who desire children should be offered options for safer conceptionJournal of the International AIDS Society.  20. 2017
    2017 Magnetic resonance elastography shear wave velocity correlates with liver fibrosis and hepatic venous pressure gradient in adults with advanced liver diseaseBioMed Research International.  2017. 2017
    2017 The Role of Relationship Dynamics and Gender Inequalities As Barriers to HIV-Serostatus Disclosure: Qualitative Study among Women and Men Living with HIV in Durban, South Africa.Frontiers in Public Health.  5:188. 2017
    2016 Simtuzumab treatment of advanced liver fibrosis in HIV and HCV-infected adults: results of a 6-month open-label safety trialLiver International.  36:1783-1792. 2016
    2016 Promises and pitfalls of data sharing in qualitative researchSocial Science and Medicine.  169:191-198. 2016
    2016 The Association Between Post-traumatic Stress Disorder and Markers of Inflammation and Immune Activation in HIV-Infected Individuals With Controlled ViremiaPsychosomatics.  57:423-430. 2016
    2016 PrEP as Peri-conception HIV Prevention for Women and MenCurrent HIV/AIDS Reports.  13:131-139. 2016
    2016 "i always worry about what might happen ahead": Implementing safer conception services in the current environment of reproductive counseling for HIV-affected men and women in UgandaBioMed Research International.  2016. 2016
    2016 HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periodsJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology.  71:399-406. 2016
    2015 Periconception HIV Risk Behavior Among Men and Women Reporting HIV-Serodiscordant Partners in KwaZulu-Natal, South AfricaAIDS and Behavior.  19:2291-2303. 2015
    2015 “If I don’t use a condom … I would be stressed in my heart that I’ve done something wrong”: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South AfricaAIDS and Behavior.  19:1666-1675. 2015
    2015 The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural UgandaContraception.  92:152-159. 2015
    2015 Pioglitazone for Hepatic Steatosis in HIV/Hepatitis C Virus CoinfectionAIDS Research and Human Retroviruses.  31:961-966. 2015
    2015 Safer conception strategies for HIV-serodiscordant couples: How safe is safe enough?Journal of Infectious Diseases.  212:1525-1528. 2015
    2014 Depression during pregnancy and the postpartum among HIV-infected women on antiretroviral therapy in UgandaJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology.  67:S179-S187. 2014
    2014 Lost opportunities to reduce periconception HIV transmission: Safer conception counseling by South African providers addresses perinatal but not sexual HIV transmissionJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology.  67:S210-S217. 2014
    2014 High medication adherence during periconception periods among HIV-1-uninfected women participating in a clinical trial of antiretroviral pre-exposure prophylaxisJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology.  67:91-97. 2014
    2014 South Africans with recent pregnancy rarely know partner's HIV serostatus: Implications for serodiscordant couples interventionsBMC Public Health.  14. 2014
    2014 Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in UgandaAIDS Research and Treatment.  2014. 2014
    2014 Inkwari: An Emerging High-Risk Place Potentiating HIV Spread Among Young Adults in a Hyper-Endemic South African SettingArchives of Sexual Behavior.  44:307-315. 2014
    2014 Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: A randomized clinical trialJournal of the American Medical Association.  312:362-371. 2014
    2014 Whoonga: Potential recreational use of HIV antiretroviral medication in South AfricaAIDS and Behavior.  18:511-518. 2014
    2013 Reliability and validity of instruments for assessing perinatal depression in African settings: Systematic review and meta-analysisPLoS ONE.  8. 2013
    2013 HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periodsAIDS.  27. 2013
    2013 Correction: Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda (PLoS ONE)PLoS ONE.  8. 2013
    2013 Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, UgandaPLoS ONE.  8. 2013
    2013 Women with Pregnancies Had Lower Adherence to 1% Tenofovir Vaginal Gel as HIV Preexposure Prophylaxis in CAPRISA 004, a Phase IIB Randomized-Controlled TrialPLoS ONE.  8. 2013
    2013 Dissemination of Research Findings to Research Participants Living with HIV in Rural Uganda: Challenges and RewardsPLoS Medicine.  10. 2013
    2013 Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban, South AfricaAIDS and Behavior.  17:461-470. 2013
    2013 Erratum: Antiretrovirals and safer conception for HIV-serodiscordant couples (Current Opinion in HIV and AIDS (2012) 7 (569-578)Current Opinion in HIV and AIDS.  8:86. 2013
    2012 A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couplesReproductive Health Matters.  20:50-60. 2012
    2012 Antiretrovirals and safer conception for HIV-serodiscordant couplesCurrent Opinion in HIV and AIDS.  7:569-578. 2012
    2012 Contraceptive use and associated factors among women enrolling into HIV care in southwestern UgandaInfectious Diseases in Obstetrics & Gynecology.  2012. 2012
    2012 Reproductive counseling by clinic healthcare workers in Durban, South Africa: Perspectives from HIV-infected men and women reporting serodiscordant partnersInfectious Diseases in Obstetrics & Gynecology.  2012. 2012
    2011 Birth weight for gestational age norms for a large cohort of infants born to HIV-negative women in Botswana compared with norms for U.S.-born black infantsBMC Pediatrics.  11. 2011
    2011 A risk-factor guided approach to reducing lactic acidosis and hyperlactatemia in patients on antiretroviral therapyPLoS ONE.  6. 2011
    2010 Periconception pre-exposure prophylaxis to prevent HIV transmission: Benefits, risks, and challenges to implementationAIDS.  24:1975-1982. 2010
    2010 Outcomes after virologic failure of first-line ART in South AfricaAIDS.  24:1007-1012. 2010
    2009 Strategies for harm reduction among HIV-affected couples who want to conceiveAIDS and Behavior.  13. 2009
    2006 Naïve T-cell dynamics in human immunodeficiency virus type 1 infection: Effects of highly active antiretroviral therapy provide insights into the mechanisms of naïve T-cell depletionJournal of Virology.  80:2665-2674. 2006
    2004 BAY 50-4798, a novel, high-affinity receptor-specific recombinant interleukin-2 analog, induces dose-dependent increases in CD25 expression and proliferation among unstimulated, human peripheral blood mononuclear cells in vitroClinical Immunology.  113:248-255. 2004

    Education And Training

  • Master of Public Health in Health Professions and Related Clinical Sciences, Harvard University 2011
  • Doctor of Medicine, Miami University 2004
  • Full Name

  • Lynn Matthews