Table 2.

Key themes related to safer conception strategy topics of interest (n= 41 studies)

	Patients	Providers
Topic 1—availability of SCS	Unaware about availability of safer conception services [20, 31, 33, 36, 39, 55], Integration of services for sexual and reproductive health to increase SCS availability and uptake [43, 45], Few discussed fertility goals with providers. Discussions around pregnancy focused on maternal and child health and not on sexual HIV transmission. Few received safer conception counselling [30, 39, 41, 46].	Providers training and self-efficacy increases SCS availability [35] and providers desired additional training on SCS [22, 45, 50], Lack of provider training and guidelines in safer conception strategies and preconception counselling for PLHIV [51] and health workforce shortages that limit the quality of counselling, poor linkages to HIV care, and lack of integration of HIV and reproductive health services [24, 45, 48–51], Tailored guidelines and training are required for providers to implement SCS [42, 51, 55], Providers were concerned about future children’s health [47, 53].
Topic 2—feasibility or acceptability of SCS delivery	Acceptability impacted by knowledge on SCS services [20, 27, 28, 33, 34, 36, 55], Difficulty with disclosure of HIV status [54, 61, 64], Serodiscordant clients fear negative reaction from providers [27, 41,46,51], Fears about mother to child transmission [63], Male partners generally uninvolved in safer conception conversations [27, 39, 61], but men desired knowledge about SCS [41, 43], Power imbalances within couples [27, 31, 39, 59], Different preferences for certain SCSs depending on if the female or male partner was HIV-infected (e.g. ART preferred when male was positive, self-insemination when female was positive) [12, 19, 63], Mixed attitudes by community regarding SCS for serodiscordant couples; [57] Stigma from the community is a barrier to discussion of having children and SCS uptake among HIV affected couples [22, 54], Women, men, and couples expressed willingness to access safer conception intervention and desire counseling [11, 12, 15, 19, 21, 22, 28, 30, 31, 40, 41, 50, 55, 58–60], Assisted reproduction strategies generated negative reactions from couples. Education and explanation of these services may improve uptake [57].	Providers face challenges when discussing SCS with couples due to confidentiality issues and one partner being more involved than the other [61] and acceptability of SCS may be higher if women know their partner’s serostatus [43, 64] Health care providers indifferent or opposed to PLWH having children [22, 39, 47, 51–53], Providers do not recommend child-bearing for PLWH or serodiscordant couples due to secondary transmission concerns [22, 51, 53], Providers self-efficacy and communication with patients assists feasibility and acceptability [35], Providers uncomfortable discussing sex and SCS limiting SCS discussion [20, 50], Provider education about SCS was needed and feasible [24, 45, 52, 54], Effective sperm washing technologies are available and effective at preventing male to female HIV transmission [37].
Topic 3—education and promotion of SCS	Clients’ fear of judgment is a barrier to SCS counseling and education [41, 51, 54]/ Individuals may not be aware of their partner’s HIV status which is a barrier to reaching discordant couples with counseling messages on SCS [43, 61, 64] Education and promotion awareness has impact on SCS uptake and acceptance [25, 33, 36, 40, 55, 59, 60].	Providers rarely initiated discussion of fertility intentions and reproductive goals with clients during visits [24, 41 42, 46, 50, 58, 61], When assessed, usually only the woman’s reproductive goals were discussed not the man’s or couples [42, 61], Sharing success stories of safer conception is effective at increasing SCS uptake and acceptance [22, 57], Provider’s confidence to provide counseling and education increased by promotion [35], Providers lack understanding of SCS [47, 48, 50, 52, 53].