Unmet patient needs and information gaps in fertility counseling for persons living with HIV/AIDS: Evidence from Ghana

Persons living with HIV/AIDS face significant unmet reproductive health needs despite antiretroviral therapy availability that enables safer conception. Understanding patient experiences and perspectives regarding fertility counseling within HIV care settings is essential for developing comprehensive, patient-centered reproductive health services. This study explored patient experiences and perceived needs regarding fertility counseling among PLWHA attending St. Michael's Hospital ART clinic in Ghana, examining the content and quality of reproductive health information provision during routine HIV care. A qualitative phenomenological study following COREQ guidelines was conducted with 12 PLWHA aged 25-45 years receiving ART services between August and October 2024. In-depth semi-structured interviews explored participants' experiences with fertility counseling, information received about reproductive options, and perceived gaps in healthcare provider counseling. Thematic analysis employed NVivo software with systematic coding procedures and investigator triangulation to ensure rigor. Ethical approval was obtained from Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication and Ethics (CHRPE/AP/569/24), and all participants provided written informed consent. Three major themes emerged from participant experiences. Most participants (n = 11, 91.7%, 95% CI: 73.0-98.8%) reported receiving minimal provider-initiated discussions about safer conception methods and appropriate pregnancy timing. Ten participants (83.3%, 95% CI: 62.2-94.5%) described insufficient counseling regarding contraceptive-ART integration, including drug interactions, dual protection methods, and contraceptive options compatible with ART regimens. All participants (n = 12, 100%, 95% CI: 83.9-100%) lacked awareness of assisted reproductive technologies and safer conception services that could facilitate childbearing while minimizing transmission risks. Patterns were consistent across participants regardless of relationship status. This study reveals substantial patient-perceived gaps in fertility counseling for PLWHA at this district-level facility in Ghana. Comprehensive, proactive reproductive health counseling integrated into routine HIV care, addressing both horizontal transmission prevention and maternal-child health outcomes, may benefit PLWHA reproductive decision-making. Standardized provider training programs and development of contextualized counseling protocols warrant further investigation to address information gaps and support informed reproductive autonomy among PLWHA in similar settings.