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Sharkey T, Parker R, Wall KM, Malama K, Pappas-DeLuca K, Tichacek A, Peeling R, Kilembe W, Inambao M, Allen S. Use of "Strengthening Our Vows" Video Intervention to Encourage Negotiated Explicit Sexual Agreements in Zambian Heterosexual HIV Seroconcordant-Negative Couples. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2649-2667. [PMID: 37024634 PMCID: PMC10524092 DOI: 10.1007/s10508-023-02590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 02/09/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Negotiating sexual agreements in combination with couples' voluntary HIV counseling and testing (CVCT) may help further reduce HIV transmission in Zambian concordant HIV-negative couples (CNC). Though CVCT has been shown to reduce HIV transmission in CNC by 47%, approximately half of residual infections occur in this group. We developed a "Strengthening Our Vows" video session to foster communication and negotiation of explicit sexual agreements to reduce concurrent sexual exposures and prevent HIV transmission to the spouse due to unprotected, extramarital sex. CNC were recruited through CVCT services at five clinics in Lusaka and Ndola in 2016. Enrolled CNC attending the facilitated group video sessions were encouraged to discuss sexual agreements at home and return 1-2 weeks later for follow-up assessment. One-fourth of the 580 CNC returning reported a history of extramarital partners and/or a sexually transmitted infection (STI) prior to enrollment. More than 95% reported a friendly, supportive 15-60 min negotiation culminating in an agreement to remain monogamous or disclose sexual contacts and use condoms together until a repeat HIV test 30 days after an outside sexual exposure. Two-thirds of participants identified at least one threat to adherence of their agreements including alcohol use, financial pressures, travel, discord in the home, and post-partum or menstrual abstinence. CNC negotiated explicit sexual agreements to avoid exposure to HIV through concurrent partnerships and protect the spouse in the event of an outside sexual contact. Open communication was a consistent theme to facilitate mutual protective efforts. Long-term follow-up of HIV/STI incidence is ongoing to assess the impact of these agreements.Trial registration This sub-study is part of a trial retrospectively registered on ClinicalTrials.gov (Identifier: NCT02744586) on April 20, 2016.
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Affiliation(s)
- Tyronza Sharkey
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA.
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rachel Parker
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Kristin M Wall
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Kalonde Malama
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Katina Pappas-DeLuca
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Amanda Tichacek
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Rosanna Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - William Kilembe
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Mubiana Inambao
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Susan Allen
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
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Wesevich A, Hosseinipour MC, Golin CE, McGrath N, Tsidya M, Chimndozi L, Bhushan N, Hoffman I, Miller WC, Rosenberg NE. Female adherence self-efficacy before and after couple HIV testing and counseling within Malawi's Option B+ program. AIDS Care 2019; 32:170-174. [PMID: 31238717 DOI: 10.1080/09540121.2019.1634789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adherence self-efficacy, belief in one's ability to adhere to daily medication, is strongly associated with antiretroviral therapy (ART) adherence and preventing mother-to-child HIV transmission. Couple-based interventions could enhance self-efficacy and adherence. We assessed the relationship between couple HIV testing and counseling (cHTC) and adherence self-efficacy using a 100-point culturally-adapted adherence self-efficacy scale (ASES). Secondarily, we explored the relationship between ASES and ART adherence. Ninety HIV-positive pregnant women at an antenatal clinic in Lilongwe, Malawi were enrolled in an observational cohort study. They were assessed with ASES immediately before and one month after receiving cHTC. Median ASES scores were 100 (IQR 95, 100) before and 100 (IQR 99, 100) after cHTC; there was a significant median difference (p = 0.02) for participants before and after cHTC. This change in ASES scores was associated with the odds of self-reported ART adherence in the full population (OR 1.1, p = 0.01), and there was a trend in the same direction for participants with imperfect baseline ASES scores (OR 1.1, p = 0.2). In our population, adherence self-efficacy and ART adherence were both quite high, and those who had room to improve in self-efficacy may have benefited from cHTC, which in turn could impact ART adherence and ultimately mother-to-child transmission.
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Affiliation(s)
- Austin Wesevich
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Mina C Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Carol E Golin
- Departments of Medicine and of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nuala McGrath
- Departments of Primary Care and Population Sciences and of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Mercy Tsidya
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Limbikani Chimndozi
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Nivedita Bhushan
- University of North Carolina Project, Lilongwe, Malawi.,Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Irving Hoffman
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - William C Miller
- Division of Epidemiology, The Ohio State University, Columbus, USA
| | - Nora E Rosenberg
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Amuquandoh A, Escamilla V, Mofolo I, Rosenberg NE. Exploring the spatial relationship between primary road distance to antenatal clinics and HIV prevalence in pregnant females of Lilongwe, Malawi. Int J STD AIDS 2019; 30:639-646. [PMID: 30890119 DOI: 10.1177/0956462419830232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While urbanization in a sub-Saharan African (SSA) context can lead to greater independence in women, various sociological, biological, and geographical factors in urban areas may keep women at a higher risk for HIV than men. Access to major roads during Malawi's transition into rapid urbanization may leave women disproportionately vulnerable to HIV infection. It is not well established whether women who report to health clinics closer to major roads have higher or lower levels of HIV. In this study we explored the spatial heterogeneity of HIV prevalence among pregnant females in Lilongwe District, Malawi. Using Geographic Information Systems, we visually represented patterns of HIV prevalence in relation to primary roads. HIV prevalence data for 2015 were obtained from 44 antenatal clinics (ANC) in Lilongwe District. ANC prevalence data were aggregated to the administrative area and mapped. Euclidean distance between clinics and two primary roads that run through Lilongwe District were measured. A correlation was run to assess the relationship between area-level ANC HIV prevalence and clinic distance to the nearest primary road. ANC HIV prevalence ranged from 0% to 10.3%. Clinic to major road distance ranged from 0.1 to 35 km. Correlation results ( r= -0.622, p = 0.002) revealed a significant negative relationship between clinic distance to primary road and HIV prevalence, indicating that the farther the clinics stood from primary roads, the lower the reported antenatal HIV prevalence. Overall, the clinic catchments through which the major roads run reported higher ANC HIV prevalence. Antenatal HIV prevalence decreases as ANC distance from primary roads increases in Lilongwe, Malawi. As urbanization continues to grow in this region, road distance may serve as a good indicator of HIV burden and help to guide targeted prevention and treatment efforts.
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Affiliation(s)
- Amy Amuquandoh
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi.,2 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Veronica Escamilla
- 3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Innocent Mofolo
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi
| | - Nora E Rosenberg
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi.,4 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bhushan NL, Golin CE, McGrath N, Maman S, Tsidya M, Chimndozi L, Wesevich A, Hoffman IF, Hosseinipour MC, Miller WC, Rosenberg NE. The impact of HIV couple testing and counseling on social support among pregnant women and their partners in Lilongwe, Malawi: an observational study. AIDS Care 2019; 31:199-206. [PMID: 30182730 PMCID: PMC6322660 DOI: 10.1080/09540121.2018.1510102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Couples HIV testing and counseling (couple counseling) promotes safer sexual behaviors, increases communication between couples, and decreases HIV transmission. However, the impact of couple counseling on social support, critical for persons living with HIV, has not been examined. Ninety couples with a recently tested HIV-positive pregnant woman (female-positive couples) and 47 couples with a recently tested HIV-negative pregnant woman (female-negative couples) were enrolled in an observational study at an antenatal clinic in Malawi. Each couple member was assessed immediately before and one month after couple counseling for partner, family, and peer social support using the Multidimensional Scale of Perceived Social Support. Before couple counseling, social support was lower among women than men in both female-positive couples (β = -10.00, p < .01) and female-negative couples (β = -8.43, p < .01). After couple counseling, social support increased for women in female-positive couples (β = 4.01, p < .01) and female-negative couples (β = 4.69, p < .01) but not for men in either type of couple. Couple counseling could be an effective strategy to increase social support for women, including those with recent HIV diagnoses.
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Affiliation(s)
- Nivedita L Bhushan
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Carol E Golin
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Nuala McGrath
- d Faculty of Medicine and Faculty of Social, Human, and Mathematical Sciences , University of Southampton , Southampton , UK
| | - Suzanne Maman
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mercy Tsidya
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Limbikani Chimndozi
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Austin Wesevich
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Irving F Hoffman
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mina C Hosseinipour
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - William C Miller
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- e Division of Epidemiology , The Ohio State University , Columbus , OH , USA
| | - Nora E Rosenberg
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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