1
|
Nguyen LT, Minh Giang L, Nguyen DB, Nguyen TT, Lin C. Unraveling reproductive and maternal health challenges of women living with HIV/AIDS in Vietnam: a qualitative study. Reprod Health 2024; 21:34. [PMID: 38468301 DOI: 10.1186/s12978-024-01768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA's maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA's family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically. METHODS Between December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti. RESULTS Qualitative analyses of participant quotes revealed how limited information on one's health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences. CONCLUSIONS Overall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.
Collapse
Affiliation(s)
- Lynn T Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, 855 Tiverton Dr, Los Angeles, CA, USA
| | - Le Minh Giang
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Diep B Nguyen
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Trang T Nguyen
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Chunqing Lin
- David Geffen School of Medicine, University of California, Los Angeles, 855 Tiverton Dr, Los Angeles, CA, USA.
- , 760 Westwood Plaza, 17-369E, Los Angeles, CA, 90024, USA.
| |
Collapse
|
2
|
Duc NHC, Nakamura K, Kizuki M, Seino K, Rahman M. Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam. J Rural Med 2015; 10:65-78. [PMID: 26705431 PMCID: PMC4689735 DOI: 10.2185/jrm.2902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/25/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. METHODS Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. RESULTS Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. CONCLUSIONS More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.
Collapse
Affiliation(s)
- Nguyen Huu Chau Duc
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
- Department of Pediatrics, Hue University of Medicine and
Pharmacy, Vietnam
| | - Keiko Nakamura
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Masashi Kizuki
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Kaoruko Seino
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Mosiur Rahman
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| |
Collapse
|
3
|
Conseil A, Mounier-Jack S, Rudge JW, Coker R. Assessing the effects of HIV/AIDS and TB disease control programmes on health systems in low- and middle-income countries of Southeast Asia: a semi-systematic review of the literature. Public Health 2013; 127:1063-73. [PMID: 24275033 DOI: 10.1016/j.puhe.2013.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 09/23/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically review the literature on if and how HIV/AIDS and TB programmes have impacted on general healthcare systems in Association of Southeast Asian Nations (ASEAN) countries. METHODS Medline, Embase, Global Health and CINHAL were searched for English language literature published between 1st January 2003 and 31st March 2011. Papers included had to focus on: HIV and/or TB control programmes; the low- and-middle-income ASEAN countries; and factors related to any health systems functions. The effects were examined along six system functions: Stewardship and Governance; Financing; Planning; Service Delivery; Monitoring and Evaluation; and Demand Generation. A comprehensive thematic analytical tool aligned with the above six health systems functions was developed to support data extraction and analysis. FINDINGS 88 papers met the inclusion criteria. Most programme effects highlighted were related with health service delivery. The other five health system functions were seldom scrutinized, and each covered by less than a quarter of papers. Overall 69% of effects highlighted were positive effects whereas 31% were negative. CONCLUSION There was a paucity of robust evidence. Effects on health systems were rarely a focus of research protocols but more often a minor component in the Results/Discussion sections. Particular attention should be paid by Global Health Initiatives to the negative effects that emerged from this study, such as the development of parallel systems, specific incentives not available to the general health systems, and lack of integration of services with private healthcare providers.
Collapse
Affiliation(s)
- A Conseil
- Department of Global Health Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | | | | | | |
Collapse
|
4
|
Tudor Car L, Brusamento S, Elmoniry H, van Velthoven MHMMT, Pape UJ, Welch V, Tugwell P, Majeed A, Rudan I, Car J, Atun R. The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review. PLoS One 2013; 8:e56550. [PMID: 23483887 PMCID: PMC3590218 DOI: 10.1371/journal.pone.0056550] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.
Collapse
Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Serena Brusamento
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Hoda Elmoniry
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Michelle H. M. M. T. van Velthoven
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Utz J. Pape
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Vivian Welch
- Centre for Global Health, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Centre for Global Health, University of Ottawa, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom
| | - Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Rifat Atun
- Imperial College Business School, Imperial College London, London, United Kindom
| |
Collapse
|
5
|
Ha TTT, Anh NM, Bao NH, Tuan PL, Caridha R, Gaseitsiwe S, Hien NT, Cam PD, Ehrnst A. HIV-1 mother-to-child transmission, post-test counselling, and antiretroviral prophylaxis in Northern Viet Nam: a prospective observational study. ACTA ACUST UNITED AC 2012; 44:866-73. [PMID: 22803820 DOI: 10.3109/00365548.2012.690160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pregnant women fear being identified as HIV-1-infected and this has hampered prevention programmes and the calculation of transmission rates in Viet Nam. We introduced post-test counselling, antiretroviral prophylaxis, and formula feeding, and determined the vertical transmission rate in parts of Northern Viet Nam. METHODS HIV infection was identified in 234 pregnant women; 182 (77.8%) accepted follow-up of their children. Counselling was given on 3-7 occasions for altogether approximately 6 h on antiretroviral prophylaxis and formula feeding to avoid transmission, and on the importance of surveillance of the child. All children were formula-fed. A polymerase chain reaction (PCR) was used for the diagnosis of HIV-1 in the children. One hundred and thirty-five of the 182 mothers allowed ≥ 3 blood samples to be taken from birth to ≥ 1 y of age, 32/182 provided a birth sample only, and 15/182 provided a sample later only. Nevirapine was given at delivery to 93/135 (69%) women, and to 128/135 (95%) children. Additionally, combination therapy was given to 15/135 (11%) who entered the study before delivery, and azidothymidine to their children for 1 week. RESULTS Nine of 135 (6.7%) children became infected and 2/15 of the others, giving altogether 11/150 infected (7.3%). Intrauterine transmission was identified in 7/167 (4.2%) children by a positive PCR test at birth. PCR was negative at birth but positive at 1 month in 2/135 (1.5%), pointing to delivery-associated transmission. Thus, intrauterine transmission accounted for 78% (7/9). None of the uninfected children died, but 3/11 (p =0.004) of the HIV-1-infected died (in AIDS). CONCLUSION Post-test confidential counselling, formula feeding, and antiretroviral prophylaxis resulted in low rates of delivery-associated and late HIV-1 transmissions.
Collapse
Affiliation(s)
- Tran T T Ha
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Hermanides HS, van Vught LA, Voigt R, Muskiet FD, Durand A, van Osch G, Koolman-Wever S, Gerstenbluth I, Smit C, Duits AJ. Developing quality indicators for the care of HIV-infected pregnant women in the Dutch Caribbean. AIDS Res Ther 2011; 8:32. [PMID: 21939526 PMCID: PMC3186736 DOI: 10.1186/1742-6405-8-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 09/22/2011] [Indexed: 11/10/2022] Open
Abstract
Background Effective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly applied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we developed a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant) women and their newborns. Methods A multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from locally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the feasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential indicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79 newborns of HIV-infected women in Aruba, Curaçao and St Maarten from 2000 to 2010. Results The panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators regarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for Curaçao ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'intrapartum antiretroviral therapy and infant prophylaxis if antepartum antiretroviral therapy was not received', 'scheduled caesarean delivery') and 3 for St Maarten ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'discuss and provide combined antiretroviral therapy to all HIV-infected pregnant women') whilst none for Aruba. Conclusions A systemic evidence-and consensus-based approach was used to develop quality indicators in 3 Dutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability testing even in, at first, comparable settings.
Collapse
|
7
|
Hạnh NTT, Gammeltoft TM, Rasch V. Number and timing of antenatal HIV testing: evidence from a community-based study in Northern Vietnam. BMC Public Health 2011; 11:183. [PMID: 21439043 PMCID: PMC3078880 DOI: 10.1186/1471-2458-11-183] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 03/25/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities. METHODS A cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV testing. RESULTS The prevalence of women who lacked HIV testing among the study group was 10% while more than half of the women tested had had more than two tests during pregnancy. The following factors were associated with the lack of antenatal HIV test: having two children (aOR 2.1, 95% CI 1.3-3.4), living in a remote rural area (aOR 7.8, 95% CI 3.4-17.8), late antenatal care attendance (aOR 3.6, 95% CI 1.3-10.1) and not being informed about PMTCT at their first antenatal care visits (aOR 7.4, 95% CI 2.6-21.1). Among women who had multiple tests, 80% had the second test after 36 weeks of gestation. Women who had first ANC and first HIV testing at health facilities at primary level were more likely to be tested multiple times (OR 2.9 95% CI 1.9-4.3 and OR = 4.7 95% CI 3.5-6.4), respectively. CONCLUSIONS Not having an HIV test during pregnancy was associated with poor socio-economic characteristics among the women and with not receiving information about PMTCT at the first ANC visit. Multiple testing during pregnancy prevailed; the second tests were often provided at a late stage of gestation.
Collapse
Affiliation(s)
- Nguyễn TT Hạnh
- Department of Population, Institute for Preventive Medicine and Public Health, Hanoi Medical University, No.1 Ton That Tung Street, Khuong Thuong, Dong Da, Hanoi, Vietnam
| | - Tine M Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - Vibeke Rasch
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, 5000 Odense C, Denmark
| |
Collapse
|