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Lungu EA, Chewe M. Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of vertical transmission of HIV. BMC Public Health 2024; 24:1004. [PMID: 38605313 PMCID: PMC11008021 DOI: 10.1186/s12889-024-18127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/16/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Prevention of vertical (mother to child) transmission of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress over the past decade in Zambia, the country is yet to reach global and national target for elimination of vertical transmission of HIV. Avoidance of unintended pregnancy among women living with HIV is one of the cost-effective interventions in a comprehensive approach to prevent vertical transmission of HIV. Therefore, this study aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia. METHODS The study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 27,153 women aged 15-49 years over the three survey periods among whom 4,113 had an HIV positive result following a rigorous HIV testing algorithm of the demographic and health surveys, and these constituted our sample size of women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among women living with HIV. RESULTS Over the three survey points, unmet need for family planning among women living with HIV has largely remained unchanged from 20.8% in 2007 to 20.5% in 2013/14 and 21.1% in 2018 DHS. Residence, age of women, household wealth, woman's parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia. CONCLUSION Preventing HIV infection in a child preserves life, contributes to improving quality of life from its early stages and averts lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of interventions to prevent vertical transmission of HIV including shaping programming regarding preventing unintended pregnancies among women living with HIV. Among other aspects, policy and practice need to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV.
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Affiliation(s)
- Edgar Arnold Lungu
- Health and HIV Section, UNICEF Zambia, PO Box 33610, Alick Nkhata Rd, Long Acres, Lusaka, Zambia.
| | - Mwimba Chewe
- Department of Public Health, University of Zambia, PO Box: 50110, Burma Road, Lusaka, Zambia
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Amsalu M, worku K, Ayalew M, Alamneh AA. Contraceptive use and associated factors among women of reproductive age on antiretroviral therapy in Awabel Woreda health centers, Northwest Ethiopia. SAGE Open Med 2023; 11:20503121231190275. [PMID: 38020801 PMCID: PMC10640806 DOI: 10.1177/20503121231190275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The family planning options for reproductive-age women who are in antiretroviral therapy should consider different types of contraceptive methods including condom use. There is a high unmet need and unplanned pregnancies in Ethiopia among HIV-positive women. Attention was not given towards contraceptive use for HIV women in Ethiopia including the study area. The study aimed to assess contraceptive use and associated factors among women of reproductive age (15-49 years) on Antiretroviral therapy in Awabel Woreda, Northwest Ethiopia. Methods A facility-based cross-sectional study was conducted among 572 women of reproductive age who were receiving HIV care and treatment. Data were collected using interviewer-administered questionnaire, entered by Epidata3.1 and exported to IBM SPSS for statistics version 20 for analysis.Multivariable logistic regression was used to identify factors associated with contraceptive use and the presence of significant association was declared at p-value <0.05 and 95% confidence level. Result A total of 526 out of 572 women have responded, with a response rate of 91.9%. Two-thirds (66.5% (95% CI: 63.5, 69.5)) of the study participants were using contraceptive methods at the time of the survey. Women living in areas (Adjusted Odds Ratio = 1.95; 95% CI: 1.16, 3.72), and those who disclosed their HIV status to their partner (Adjusted Odds Ratio = 2.61; 95% CI: 1.37, 4.95) were more likely to use contraceptives. While Women (Adjusted Odds Ratio = 0.41; 95% CI: 0.24, 0.69) and their partners (Adjusted Odds Ratio = 0.57; 95% CI: 0.34, 0.97) who had desire to have a child were less likely to use contraceptives. Conclusions The prevalence of contraceptive use among reproductive-age women who were on antiretroviral therapy (ART) was lower than a systematic review done in Ethiopia and higher than the national target. Intervention targeting on implementation of contraceptive methods, and counseling about contraceptives to address their question of fertility desire and knowledge were recommended.
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Affiliation(s)
- Menichil Amsalu
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kalkidan worku
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mulugeta Ayalew
- Federal Police Hospital Department of Disease Prevention, Addis Ababa, Ethiopia
| | - Alehegn Aderaw Alamneh
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Wariyo A, Oljira L, Golicha W, Dirirsa G. Effect of predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar Towns, Eastern Ethiopia: a retrospective cohort study. BMC Womens Health 2022; 22:548. [PMID: 36572915 PMCID: PMC9793559 DOI: 10.1186/s12905-022-02135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. OBJECTIVE To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. METHODS Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan-Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. RESULTS The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. CONCLUSION The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes.
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Affiliation(s)
- Abdi Wariyo
- grid.449426.90000 0004 1783 7069School of Public Health, College of Health and Medical Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Lemessa Oljira
- grid.192267.90000 0001 0108 7468School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Wako Golicha
- grid.472427.00000 0004 4901 9087School of Public Health, Bule Hora University, Bule Hora, Ethiopia
| | - Gebisa Dirirsa
- grid.192267.90000 0001 0108 7468Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Nakalema S, Chappell CA, Pham M, Byakika-Kibwika P, Kaboggoza J, Walimbwa SI, Musaazi J, Nakijoba R, Mbabazi L, Kyohairwe I, Nassiwa S, Jeppson J, Winchester L, Siccardi M, Fletcher CV, Scarsi KK, Lamorde M. Pharmacokinetics of levonorgestrel and etonogestrel contraceptive implants over 48 weeks with rilpivirine- or darunavir-based antiretroviral therapy. J Antimicrob Chemother 2022; 77:3144-3152. [PMID: 36059130 DOI: 10.1093/jac/dkac296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pharmacokinetic data are lacking for progestin-releasing subdermal contraceptive implants when used with either rilpivirine- or darunavir/ritonavir-based ART. OBJECTIVES To characterize the pharmacokinetics of etonogestrel or levonorgestrel implants when administered with these ART regimens over 48 weeks. PATIENTS AND METHODS Two separate, parallel, three-group, non-randomized, pharmacokinetic studies evaluated either etonogestrel or levonorgestrel in women receiving rilpivirine- or darunavir-based ART compared with women without HIV (control group). Participants on ART were switched to rilpivirine-based ART with a run-in period of 6 weeks or darunavir-based ART with a run-in of 2 weeks prior to implant insertion. Plasma was collected on Day 0, and 1, 4, 12, 24, 36 and 48 weeks post-insertion. Plasma progestin concentrations were compared between ART and control groups by geometric mean ratio (GMR) and 90% CI. RESULTS At the primary endpoint of Week 24, progestin concentrations were similar between the rilpivirine and control groups [etonogestrel: 1.18 (0.99-1.37); levonorgestrel: 1.16 (0.97-1.33)]. At Week 24, progestin exposure was higher in the darunavir groups compared with the control group [etonogestrel: 2.56 (1.69-3.28); levonorgestrel: 1.89 (1.38-2.29)]. Results remained consistent through to Week 48. No differences in etonogestrel-related adverse events were observed, but both ART groups experienced more menstrual abnormalities versus the control group with levonorgestrel. CONCLUSIONS Etonogestrel and levonorgestrel concentrations were not altered by rilpivirine-based ART. Although progestin concentrations were higher in the ART groups containing ritonavir-boosted darunavir, no implant-related serious adverse events were observed. Both progestin-releasing implants are an appropriate contraceptive option with either rilpivirine- or darunavir/ritonavir-based ART.
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Affiliation(s)
- Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Julian Kaboggoza
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ritah Nakijoba
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Leah Mbabazi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Sylvia Nassiwa
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Jeffrey Jeppson
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lee Winchester
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marco Siccardi
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Kimberly K Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Omona K, Muhanuzi G. Factors influencing utilization of modern family planning services by persons living with Human Immunodeficiency Virus at Luwero Hospital, Uganda. Afr Health Sci 2022; 22:463-476. [PMID: 36910352 PMCID: PMC9993286 DOI: 10.4314/ahs.v22i3.50] [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: 11/16/2022] Open
Abstract
Introduction The use of modern family planning methods is key for achieving the prevention of unintended pregnancies among women living with HIV, in the prevention of Mother-to-child transmission (PMTCT) package. The purpose of this study was to examine the factors influencing the utilization of modern family planning services by persons living with HIV at Luwero Hospital, Uganda. Methods The study was conducted among 210 persons living with HIV attending the ART clinic and was based on cross-sectional descriptive and analytical design. Sampling was by simple random techniques. Data was collected using researcher-administered questionnaires. Results The uptake of Modern FP services is low (36.7%) among persons living with HIV. It was attributed to client-related factors such as being married [AOR: 2.2, 95% CI [1.123-4.140], p = 0.038]) and other factors. These are; religious views discouraging use of modern FP (p= 0.034), negative side effects (AOR: 1.8, 95% CI [0.043-1.968], p = 0.044) and services being unfriendly for persons living with HIV (p=0.000]). Conclusions Despite the presence of modern family planning services, uptake among persons living with HIV is low. Poor utilization is a recipe for unintended pregnancy and thus jeopardizes efforts in the elimination of mother-to-child transmission of HIV.
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Affiliation(s)
- Kizito Omona
- Lecturer, Uganda Martyrs University, Faculty of Health Sciences, Kampala, Uganda
| | - Geoffrey Muhanuzi
- MPH Specialist, Kampala University, Department of Public Health, Kampala, Uganda
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Ayenew A. Women living with HIV and dual contraceptive use in Ethiopia: systematic review and meta-analysis. Contracept Reprod Med 2022; 7:11. [PMID: 35778746 PMCID: PMC9250199 DOI: 10.1186/s40834-022-00179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Despite different preventive strategies that have been implemented in the country, the prevalence of HIV/AIDS is still significantly increasing in Ethiopia. The concurrence of HIV and unintended pregnancy makes the use of dual contraception a back bone for the simultaneous protection against HIV, and unintended pregnancy. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of dual contraceptive use among women living with HIV in Ethiopia. Method We used databases; (PubMed, Google Scholar, EMBASE, Cochrane Library, African Online Journals, and Hinary), other gray and online repository accessed studies were searched using different search engines. For critical appraisal of studies Newcastle-Ottawa Quality Assessment Scale (NOS) was used. The analysis was done using STATA 11 software. The Cochran Q test and I2 test statistics were used to assess the heterogeneity. To detect publication bias funnel plot and Egger’s test were used. The pooled prevalence of dual contraception use and the odds ratio (OR) with a 95% confidence interval was presented by using forest plots. Result Eleven studies were included in this review, with a total of 4083 women living with HIV in Ethiopia. The pooled prevalence of dual contraception use in Ethiopia was 34.08% (95%CI: 20.77–47.38). Having open partner discussion (OR = 3.96, 95%CI:2.3,6.8), provision of post test counseling (AOR = 4.38, 95%CI:2.93,6.54), disclosed HIV status to sexual partners (OR = 5.9, 95%CI:4.19,8.33), partner involvement in post-test counseling (OR = 3.52, 95%CI:2.37,5.23), and being on highly active antiretroviral therapy (HAART) (OR = 2.9, 95%CI:1.56,5.46) were the determinant factors of dual contraceptive use in Ethiopia. Conclusion The overall prevalence of dual contraceptive use among women living with HIV in Ethiopia was low. Having open partner discussion, provision of post-test counseling, disclosed HIV status to sexual partner, partner involvement in post-test counseling, and currently on highly active antiretroviral therapy (HAART) were the associated factors of dual contraceptive use. Therefore, efforts should be made to provide post-test counseling, and initiate partner involvement in post-test counseling. Moreover, promoting open partner discussion, counseling to disclose HIV status to their sexual partner and to start HAART will be helpful in enhancing the use of dual contraceptive method use.
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Affiliation(s)
- Asteray Ayenew
- Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Jahagirdar D, Walters M, Vongpradith A, Dai X, Novotney A, Kyu HH, Wang H. Incidence of HIV in Sub-Saharan Africa, 2000-2015: The Interplay Between Social Determinants and Behavioral Risk Factors. AIDS Behav 2021; 25:145-154. [PMID: 34089423 PMCID: PMC8541936 DOI: 10.1007/s10461-021-03279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
HIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.
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Affiliation(s)
| | | | | | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Amanda Novotney
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Sherwood J, Lankiewicz E, Roose-Snyder B, Cooper B, Jones A, Honermann B. The role of contraception in preventing HIV-positive births: global estimates and projections. BMC Public Health 2021; 21:536. [PMID: 33740919 PMCID: PMC7977320 DOI: 10.1186/s12889-021-10570-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/07/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Meeting the contraceptive needs of women living with HIV (WLHIV) has primary health benefits for women, in addition to being a key element to prevent mother-to-child HIV transmission. This analysis will estimate the current number of infant HIV infections prevented by contraception in the era of increased HIV treatment coverage and; 2) model the additional HIV benefits of preventing unintended births to WLHIV. METHODS Secondary data analysis was conducted using publicly available data from the United Nations Programme on HIV/AIDS (UNAIDS) and Population Division, Demographic Health Surveys, and peer-review literature. National data from 70 countries, that had a UNAIDS estimate for the number of WLHIV nationally, were combined into country-level models. Models estimated the current number of infant HIV infections averted by contraception annually and potentially averted if unintended births to WLHIV were prevented. Estimates take into account pregnancy and live birth rates, contraceptive coverage, contraceptive method mix and failure rates, and HIV treatment coverage during pregnancy to prevent mother to child transmission. RESULTS Contraception use among WLHIV prevents an estimated 43,559 new infant HIV infections annually across 70 countries. Countries with the largest number of infant infections averted by contraception included South Africa (9441), Nigeria (4195), Kenya (3508), Zimbabwe (2586), and India (2145). Preventing unintended births to WLHIV could avert an additional 43,768 new infant infections per year, with the greatest potential gains to be made in South Africa (12,036), Nigeria (2770), Uganda (2552), and the Democratic Republic of the Congo (2324). CONCLUSIONS Contraception continues to play an integral role in global HIV prevention efforts in the era of increasing HIV treatment coverage, especially in sub-Saharan Africa. Broad contraceptive availability, increased contraceptive voluntarism and method mix are key components to preventing unintended births and ending new infant HIV infections worldwide.
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Affiliation(s)
- Jennifer Sherwood
- Public Policy Office, amfAR, Foundation for AIDS Research, 1100 Vermont Avenue NW, Suite 600, District of Columbia, Washington, DC, 20005, USA.
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elise Lankiewicz
- Public Policy Office, amfAR, Foundation for AIDS Research, 1100 Vermont Avenue NW, Suite 600, District of Columbia, Washington, DC, 20005, USA
| | | | - Bergen Cooper
- Center for Health and Gender Equity (CHANGE), Washington DC, USA
| | - Austin Jones
- Public Policy Office, amfAR, Foundation for AIDS Research, 1100 Vermont Avenue NW, Suite 600, District of Columbia, Washington, DC, 20005, USA
| | - Brian Honermann
- Public Policy Office, amfAR, Foundation for AIDS Research, 1100 Vermont Avenue NW, Suite 600, District of Columbia, Washington, DC, 20005, USA
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Amare G, Cherie N, Mekonen AM. Dual Contraceptive Use and Associated Factors Among Reproductive Age Group on Antiretroviral Therapy in Borena District, Northeast Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2021; 13:107-114. [PMID: 33531844 PMCID: PMC7847380 DOI: 10.2147/hiv.s289045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Dual contraceptive method use is defined as the use of any modern contraceptive method with a condom for the reduction of mother-to-child transmission of HIV and sexually transmitted infections between sexual partners. The goal of this study was to assess the proportion and factors associated with dual contraceptive use among reproductive age women on antiretroviral therapy in Borena district, Northeast Ethiopia. Objective To assess the proportion of dual contraceptive use and associated factors among the reproductive age women on antiretroviral therapy in Borena district, Northeast Ethiopia. Methods An institutional-based cross-sectional study was conducted among HIV positive reproductive age group women on antiretroviral therapy in Borena district from February 1 to March 1, 2020. A systematic random sampling technique was used to include 417 study participants. A structured interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was used to identify the factors associated with dual contraceptive use. Odds ratio with 95% confidence interval (CI) and P-value were calculated to assess the strength of association. Results The results showed that 19.4% of the HIV positive reproductive age group on antiretroviral therapy were using dual contraceptive method. Urban area (AOR=3.66, 95% CI=1.66-8.09), educated to secondary education and above (AOR=3.54, 95% CI=1.29-9.76), those who have no desire to have a child (AOR=4.41, 95% CI=2.66-7.59), those with partners whose HIV status was negative (AOR=4.96, 95% CI=2.66-12.02) and those with partners whose HIV status was positive (AOR=2.45, 95% CI=1.25-4.81) were more likely to use the dual contraception method. Conclusion This study showed that the proportion of dual contraceptive use was found to be low in accordance with the WHO recommendation. Therefore increased awareness on the advantages of dual contraception and knowing partner's HIV status is important.
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Affiliation(s)
- Gashaw Amare
- Department of Reproductive Health and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Niguss Cherie
- Department of Reproductive Health and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Asnakew Molla Mekonen
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
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Rucinski KB, Powers KA, Pettifor AE, Black V, Pence BW, Chi BH, Rees H, Schwartz SR. Trajectories of fertility intentions among women living with HIV in South Africa. AIDS Care 2021; 33:180-186. [PMID: 32008361 PMCID: PMC7395884 DOI: 10.1080/09540121.2020.1719969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Abstract
Fertility intentions are thought to be dynamic among women of reproductive age, yet few studies have assessed fertility intentions over time among women with HIV. We examine temporal patterns of fertility intentions in women with HIV to assess the extent to which fertility intentions - and the corresponding need for safer conception and judicious antiretroviral therapy (ART) regimen selection - vary over time. 850 non-pregnant HIV-positive women aged 18-35 on or being initiated onto ART in Johannesburg, South Africa were enrolled into a prospective cohort study (2009-2010). Fertility intentions were assessed at enrollment and at 30-day intervals via an interviewer-administered questionnaire. We used group-based trajectory modelling to identify longitudinal patterns of fertility intentions over 12 months. We identified four patterns of fertility intentions, which we labelled "consistently low" (representing ∼60% of the population), "low and increasing" (∼23%), "high and increasing" (∼12%), and "high and decreasing" (∼5%). Our findings suggest that a single family-planning assessment at one time point is insufficient to fully identify and meet the reproductive needs of women with HIV. As HIV testing and treatment evolve in South Africa, routine screening for fertility intentions can offer important opportunities to optimize HIV treatment, prevention, and maternal and child health.
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Affiliation(s)
- Katherine B Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Kimberly A Powers
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vivian Black
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Kassie MD, Habitu YA, Berassa SH. Unmet need for family planning and associated factors among women living with HIV in Gondar city, Northwest Ethiopia: cross-sectional study. Pan Afr Med J 2021; 38:22. [PMID: 33777290 PMCID: PMC7955604 DOI: 10.11604/pamj.2021.38.22.21431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 12/31/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION all women, including those living with HIV, have the right to choose the timing, spacing, and number of their births and need access to family planning services. This study aimed at assessing the prevalence and factors associated with an unmet need for family planning among women receiving Antiretroviral Therapy (ART) services. METHODS a facility-based cross-sectional study was conducted from March to April 2018 in Gondar city, Ethiopia. A systematic random sampling technique was used to recruit 441 reproductive-age women on ART. The data were collected using a pretested structured questionnaire. The bivariate and backward multivariable logistic regression model was fitted to identify factors associated with the unmet need for family planning. RESULTS the prevalence of the unmet need for family planning among women living with HIV was 24.5%. Increase in women´s age (AOR: 0.90, 95% CI (0.85, 0.95)), having more than three children (AOR: 0.13, 95% CI (0.04, 0.38)), intention to have more children (AOR: 0.09, 95% CI (0.03, 0.23)), not disclosing sero-status to partner (AOR: 0.40, 95% CI (0.20, 0.82)) and having no experience of contraception use (AOR: 0.43, 95% CI (0.21, 0.90)) were protective factors against unmet need for family planning. Rural residence (AOR: 2.17, 95% CI (1.05, 4.46)) was associated with increased odds of unmet need for family planning. CONCLUSION one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.
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Affiliation(s)
| | - Yohannes Ayanaw Habitu
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simegnew Handebo Berassa
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bishop IJ, Gertz AM, Simon B, Tawe L, Lechiile K, Liu S, Teodoro N, Mussa A, Avalos A, Malima S, Maotwe T, Mokganya L, Westhoff CL, Morroni C. Etonogestrel concentrations among contraceptive implant users in Botswana using and not using dolutegravir-based antiretroviral therapy. Contraception 2020; 102:174-179. [DOI: 10.1016/j.contraception.2020.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
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13
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Mukamuyango J, Ingabire R, Parker R, Nyombayire J, Abaasa A, Asiki G, Easter SR, Wall KM, Nyirazinyoye L, Tichacek A, Kaslow N, Price MA, Allen S, Karita E. Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda. Reprod Health 2020; 17:126. [PMID: 32807177 PMCID: PMC7433361 DOI: 10.1186/s12978-020-00981-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-to-child transmission (PMTCT). METHODS In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. RESULTS Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at enrollment, prior discussion of LARC by the couple, and women not having concerns about negative side effects of implant were associated with LARC uptake. CONCLUSIONS Fertility goal-based LARC recommendations combined with couples' HIV counselling and testing resulted in a high uptake of LARC methods, even among discordant couples using condoms for HIV prevention, in Catholic clinics, and in rural populations. This model successfully integrates prevention of HIV and unplanned pregnancy.
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Affiliation(s)
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Andrew Abaasa
- London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sarah Rae Easter
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Nadine Kaslow
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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Krishna GR, Haddad LB. Interactions between Hormonal Contraception and Anti-Retroviral Therapy: An Updated Review. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020; 9:98-104. [PMID: 33552676 DOI: 10.1007/s13669-020-00289-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review Hormonal contraception provides women living with HIV the ability to control their fertility and avoid pregnancy-related morbidity. Due to shared metabolic pathways, there has been concern over drug-drug interactions between hormonal contraception and anti-retroviral therapy, which may affect the drugs' safety and efficacy. This article aims to provide an updated review of the most recent data around hormonal contraceptives and anti-retroviral therapy. Recent findings Prior data have suggested possible pharmacologic interactions between certain hormonal contraceptives and anti-retroviral therapy. The most significant interactions implicated include those between progestin-based contraceptive implants and efavirenz as well as between combined hormonal contraceptives and protease inhibitors. Most past studies, however, feature small sample sizes with few clinical outcomes reported. Summary Recent data since 2017 have largely affirmed prior studies on this topic, showing possible pharmacokinetic relationships between certain contraceptives and anti-retrovirals. Notably, while the effectiveness of progestin-based contraceptives, specifically the implant, appears reduced with efavirenz use, the overall effectiveness may remain higher than most other contraceptive methods. Larger studies are needed to provide further guidance before contraceptive-prescribing recommendations can be changed.
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Affiliation(s)
- Gopika R Krishna
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Lisa B Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, USA
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15
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Chappell CA, Achilles SL. Drug interactions: not just for orally administered drugs. Lancet HIV 2020; 6:e563-e564. [PMID: 31498104 DOI: 10.1016/s2352-3018(19)30185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Catherine A Chappell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Sharon L Achilles
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA.
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Nabirye J, Matovu JKB, Bwanika JB, Makumbi F, Wanyenze RK. Missed opportunities for family planning counselling among HIV-positive women receiving HIV Care in Uganda. BMC WOMENS HEALTH 2020; 20:91. [PMID: 32370797 PMCID: PMC7201557 DOI: 10.1186/s12905-020-00942-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/12/2020] [Indexed: 11/23/2022]
Abstract
Introduction HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between receipt of FP counselling and current use of modern contraception to inform programming. Methods Data were drawn from a quantitative national cross-sectional survey of 5198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counselling was defined as provision of FP information (i.e. available FP methods and choices) to an HIV-positive woman by a health provider during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counselling were done on 2760 HIV-positive women aged 15–49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counselling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1. Results Overall, 2104 (76.2%) HIV-positive women reported that they received FP counselling at any of the three critical time-points. Of the 24% (n = 656) who did not, 37.9% missed FP counselling at ANC; 41% missed FP counselling during delivery; while 54% missed FP counselling at the post-natal care visit. HIV-positive women who received any FP counselling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33). Conclusion Nearly one-quarter of HIV-positive women did not receive any form of FP counselling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counselling into HIV care at all critical time-points.
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Affiliation(s)
- Juliet Nabirye
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Joseph K B Matovu
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. .,Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - John Baptist Bwanika
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
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Abay F, Yeshita HY, Mekonnen FA, Sisay M. Dual contraception method utilization and associated factors among sexually active women on antiretroviral therapy in Gondar City, northwest, Ethiopia: a cross sectional study. BMC Womens Health 2020; 20:26. [PMID: 32050961 PMCID: PMC7017555 DOI: 10.1186/s12905-020-0890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother to child transmission is responsible for 90% of child infection with human immune deficiency virus (HIV). Dual contraceptive use is one of the best actions to prevent mother's human immune deficiency virus transmission to her child and partner. This study aimed at assessing the prevalence and factors associated with dual contraceptive use among sexually active women on antiretroviral therapy in Gondar City, northwest, Ethiopia. METHODS An institution based cross sectional study was conducted in Gondar City public health facilities from December 1 to 31, 2018. Systematic random sampling technique was utilized to include 563 study participants. Data were collected by interview using a structured questionnaire. Descriptive analysis was made to compute mean, median and proportion. Finally, multivariable logistic regression model was fitted to identify the factors associated with dual contraceptive method utilization. Analysis was performed by using Statistical Package for Social Sciences (SPSS) software version 20. RESULTS The overall prevalence of dual contraceptive method utilization among sexually active women on antiretroviral therapy was 28.8% (95% CI: 24.9, 32.7). Women aged 35-49 years (Adjusted odds ratio (AOR): 6.99; 95% CI: 3.11, 15.71)), who lived in urban areas (AOR: 4.81; 95% CI: 2.04, 11.31), attended secondary and above education (AOR: 4.43; 95% CI: 1.92, 10.22), and disclosed HIV status to sexual partners (AOR: 9.84; 95% CI: 3.48, 27.81) were more likely to use dual contraceptive method. CONCLUSION In this study, the proportion of women who utilized dual contraceptive method was low. Age, place of residence, educational status and disclosure of HIV status were factors associated with dual contraceptive use. Therefore, providing education about the advantages of disclosing HIV status to sexual partners and strengthening of counseling about the advantages of dual contraceptive use will be helpful in enhancing the use of dual contraceptive method among sexually active women on antiretroviral therapy.
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Affiliation(s)
- Fewuze Abay
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hedija Yenus Yeshita
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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18
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Kebede YB, Geremew TT, Mehretie Y, Abejie AN, Bewket L, Dellie E. Associated factors of modern contraceptive use among women infected with human immunodeficiency virus in Enemay District, Northwest Ethiopia: a facility-based cross-sectional study. BMC Public Health 2019; 19:1584. [PMID: 31779605 PMCID: PMC6883555 DOI: 10.1186/s12889-019-7675-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background The prevention of unplanned pregnancy among women infected with human immunodeficiency virus (HIV) is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Of the prevention strategies, deployment of modern contraceptives is principal one. However, there were limited facts on utilization of modern contraceptives and associated factors among HIV infected women, in particular of resource-limited settings in Ethiopia. Hence, we aimed to quantify the proportion of modern contraceptive utilization and the possible related factors among women infected HIV. Methods A facility-based cross-sectional study was conducted on randomly selected 632 women infected with HIV from 05 February to 25 March 2018. Data on their treatment, socio-economic, and demographic background were collected through a structured interviewer administered questionnaire. Binary logistic regression model was fitted to identify the associated factors of modern contraceptive use among women infected with HIV. Result We found 61.4% (95% CI, 57.6–65.2) were using modern contraceptives. Greater than four family size (AOR:2.17; 95%CI: 1.31–3.59), family planning counseling service (AOR: 2.37; 95% CI: 1.44–3.91), discussing contraceptive issues with sexual partner (AOR: 1.76; 95% CI: 1.12–2.77), history of giving birth (s) (AOR:2.21; 95%CI:1.20–4.05) and World Health Organization (WHO) clinical stage III or IV (AOR: 3.59; 95%CI: 1.37, 9.44) were positively associated with modern contraceptives use, whereas, older age (AOR: 0.45; 95% CI: 0.24–0.81) and being widowed (AOR: 0.34; 95% CI: 0.14–0.83), abridged the chances of modern contraceptives use. Conclusion The prevalence of modern contraceptive use among women infected with HIV is low. Higher family size, counseling on contraceptives, discussing contraceptives issues with partner, history of giving births and WHO clinical stage III/IV were positively related with contraceptives use, whereas, older age and being widowed abridged the chances of contraceptives use among HIV infected women. Therefore, our findings support calls for the district health office and the antiretroviral treatment clinics of the resource-limited settings to work more on family planning counseling services and promoting more dialogues with sexual partners on modern contraceptives use.
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Affiliation(s)
- Yibeltal Bimrew Kebede
- Dejen Primary Hospital, East Gojjam Zone Health Department, Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia.
| | - Tesfahun Taddege Geremew
- Department of Reproductive Health and Population Studies, School of Public health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP), Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Yohannes Mehretie
- Department of Reproductive Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Negesse Abejie
- Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.,Center of Excellence for Human Nutrition, School of Human Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Liknaw Bewket
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chinaeke EE, Fan-Osuala C, Bathnna M, Ozigbu CE, Olakunde B, Ramadhani HO, Ezeanolue EE, Sam-Agudu NA. Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study. Reprod Health 2019; 16:2. [PMID: 30621714 PMCID: PMC6323844 DOI: 10.1186/s12978-018-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background Nigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria. Methods In this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use. Results Out of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates. Conclusions Family planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates. Clinical trials registration Clinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.
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Affiliation(s)
- Eric E Chinaeke
- Department of Clinical Pharmacy and Outcome Sciences, University of South Carolina College of Pharmacy, Columbia, USA
| | - Chinenye Fan-Osuala
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Miriam Bathnna
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Chamberline E Ozigbu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Babayemi Olakunde
- School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.,National Agency for the Control of AIDS, Abuja, Nigeria
| | - Habib O Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Echezona E Ezeanolue
- Healthy Sunrise Foundation, Las Vegas, USA.,Department of Paediatrics and Child Health, University of Nigeria, Enugu, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria. .,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
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Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa. PLoS One 2018; 13:e0209114. [PMID: 30571702 PMCID: PMC6301780 DOI: 10.1371/journal.pone.0209114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Fertility intentions and contraceptive use are often not assessed in the context of clinical HIV care, representing a possible programming gap if women's family planning needs change over time. We aimed to identify longitudinal patterns of unmet need for contraception over a 12-month period among women living with HIV taking antiretroviral therapy (ART). STUDY DESIGN 850 non-pregnant, HIV-positive women aged 18-35 on or initiating ART in Johannesburg, South Africa, were enrolled into a prospective cohort study in 2009-2010. Fertility intentions and contraceptive use were assessed during routine HIV care visits via an interviewer-administered questionnaire, and women were referred for on-site contraceptive counseling. We used group-based trajectory modeling to identify patterns of unmet need for contraception over 12 months, first in the entire population and then in a subset of recent ART initiators. RESULTS In the full population we identified four patterns of unmet need for contraception over one year. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9% a consistently low probability, 16.7% a decreasing probability, and 10.4% an increasing probability over time. Contraceptive method discontinuation and rapidly changing fertility intentions were the primary drivers of changing (increasing or decreasing) unmet need over follow-up. Results were similar in recent ART initiators. CONCLUSIONS Half of women were estimated to have a high probability of unmet need that persisted over time, and more than a quarter were estimated to experience patterns of changing unmet need over 12 months. Family planning needs should be assessed more regularly in HIV-positive women to prevent unintended pregnancies and support safer conception among women trying to conceive.
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Nance N, Ralph L, Padian N, Cowan F, Buzdugan R, Mushavi A, Mahomva A, McCoy SI. Unintended pregnancy and subsequent postpartum long-acting reversible contraceptive use in Zimbabwe. BMC WOMENS HEALTH 2018; 18:193. [PMID: 30477497 PMCID: PMC6258256 DOI: 10.1186/s12905-018-0668-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The postpartum period is an opportune time for contraception adoption, as women have extended interaction with the reproductive healthcare system and therefore more opportunity to learn about and adopt contraceptive methods. This may be especially true for women who experience unintended pregnancy, a key target population for contraceptive programs and programs to eliminate mother-to-child HIV transmission. Among women in Zimbabwe surveyed in 2014, we examined the relationship between pregnancy intention associated with a woman's most recent pregnancy, and her subsequent postpartum contraceptive use. METHODS In our analysis we utilized a dataset from a random selection of catchment areas in Zimbabwe to examine the association between pregnancy intention of most recent pregnancy and subsequent postpartum contraceptive use using multinomial logistic regression models. We also explored whether this association differed by women's HIV status. Finally, we examined the association between pregnancy intention and changes in contraception from the pre- to postpartum periods. RESULTS Findings suggest that women who reported that their pregnancy was unintended adopted less modern (all non-traditional) contraceptive methods overall, but adopted long-acting reversible contraception (LARC) more frequently than women reporting an intended pregnancy (OR 1.41; CI 1.18, 1.68). Among HIV-positive women, this relationship was particularly strong (OR 3.12; CI 1.96, 4.97). However, when examining changes in contraceptive use from the pre-pregnancy to the postpartum period, women who had an unintended pregnancy had lower odds of changing to a more effective method postpartum overall (OR 0.71; CI 0.64, 0.79). CONCLUSIONS We did not find evidence of higher modern method adoption in the postpartum period among women with an unintended pregnancy. However, women who were already on a method in the pre-pregnancy period were catalyzed to move to more effective methods (such as LARC) postpartum. This study provides evidence of low modern (non-traditional) method adoption in general in the postpartum period among a vulnerable sub-population in Zimbabwe (women who experience unintended pregnancy). Simultaneously, however, it shows a relatively greater portion specifically of LARC use among women with an unintended pregnancy. Further research is needed to more closely examine the motivations behind these contraceptive decisions in order to better inform distribution and counseling programs.
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Affiliation(s)
- Nerissa Nance
- University of California, Berkeley School of Public Health, Berkeley, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, USA
| | - Nancy Padian
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Frances Cowan
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK.,Centre for Sexual Health and HIV AIDS Research Zimbabwe (CeSHHAR), Harare, Zimbabwe
| | - Raluca Buzdugan
- University of California, Berkeley School of Public Health, Berkeley, USA
| | | | - Agnes Mahomva
- Elizabeth Glazier Pediatric AIDS Foundation, Washington, D.C., USA
| | - Sandra I McCoy
- University of California, Berkeley School of Public Health, Berkeley, USA
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Yaya I, Patassi AA, Landoh DE, Bignandi EM, Kolani K, Namoro ADD, Patchali PM, Djalogue L, Ekouevi DK, Saka B. Modern contraceptive use among HIV-infected women attending HIV care centres in Togo: a cross-sectional study. BMJ Open 2018; 8:e019006. [PMID: 29691241 PMCID: PMC5922471 DOI: 10.1136/bmjopen-2017-019006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Contraceptive use among HIV-infected women in Togo is poorly documented. We aim at assessing the prevalence of modern contraceptive use and associated factors among HIV-infected women in Togo. DESIGN Cross-sectional study. SETTING The study was conducted in five HIV care centres in the Centrale and Kara regions in Togo. PARTICIPANTS We included 461 HIV-positive women aged between 15 and 49 years and who were sexually active. MAIN OUTCOME MEASURE The outcome variable was HIV-infected women who were using modern contraceptive methods. RESULTS A total of 461 HIV-infected women were interviewed, with an average age of 34.3 (±7.1). Among them, 332 (73.1%) women reported using contraceptive methods, mostly condom alone (74.7%) or in combination with hormonal contraceptive (16.9%). In multivariate analysis, education level (primary: adjusted OR (aOR)=1.99, 95% CI (1.05 to 3.76); secondary level and higher: aOR=3.95, 95% CI (2.03 to 7.67)), WHO clinical stage (stage II: aOR=0.7, 95% CI (0.37 to 1.33)), follow-up in private care facilities (aOR=2.54, 95% CI (1.22 to 5.29)) and having a child (aOR=2.51, 95% CI (1.41 to 4.5)) were associated with higher contraceptive use, while marital status (living in union: aOR=0.45, 95% CI (0.28 to 0.74)) and WHO stages III and IV (aOR=0.47, 95% CI (0.24 to 0.94)) were associated with lower contraceptive use. CONCLUSION About three-quarters of sexually active HIV-infected women in Togo were using contraceptive methods, and private health facilities favoured this contraceptive use. It is important to strengthen the implementation of interventions to increase the incentives for HIV-infected women to use contraception in Togo.
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Affiliation(s)
- Issifou Yaya
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | | | | | | | | | | | - Didier Koumavi Ekouevi
- Département de Sante Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
| | - Bayaki Saka
- Service de dermatologie, CHU Sylvanus Olympio, Lomé, Togo
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Iyun V, Brittain K, Phillips TK, le Roux S, McIntyre JA, Zerbe A, Petro G, Abrams EJ, Myer L. Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study. BMJ Open 2018; 8:e019979. [PMID: 29615449 PMCID: PMC5892733 DOI: 10.1136/bmjopen-2017-019979] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission. There are few data investigating how HIV status and use of antiretroviral therapy (ART) may influence pregnancy planning in high HIV burden settings. Our objective was to examine the prevalence and determinants of unplanned pregnancy among HIV-positive and HIV-negative women in Cape Town, South Africa. DESIGN Cross-sectional analysis. SETTINGS Single primary-level antenatal care clinic in Cape Town, South Africa. PARTICIPANTS HIV-positive and HIV-negative pregnant women, booking for antenatal care from March 2013 to August 2015, were included. MAIN OUTCOME MEASURES Unplanned pregnancy was measured at the first antenatal care visit using the London Measure of Unplanned Pregnancy (LMUP). Analyses examined LMUP scores across four groups of participants defined by their HIV status, awareness of their HIV status prior to the current pregnancy and/or whether they were using antiretroviral therapy (ART) prior to the current pregnancy. RESULTS Among 2105 pregnant women (1512 HIV positive; 593 HIV negative), median age was 28 years, 43% were married/cohabiting and 20% were nulliparous. Levels of unplanned pregnancy were significantly higher in HIV-positive versus HIV-negative women (50% vs 33%, p<0.001); and highest in women who were known HIV positive but not on ART (53%). After adjusting for age, parity and marital status, unplanned pregnancy was most common among women newly diagnosed and women who were known HIV positive but not on ART (compared with HIV-negative women, adjusted OR (aOR): 1.43; 95% CI 1.05 to 1.94 and aOR: 1.57; 95% CI 1.13 to 2.15, respectively). Increased parity and younger age (<24 years) were also associated with unplanned pregnancy (aOR: 1.42; 95% CI 1.25 to 1.60 and aOR: 1.83; 95% CI 1.23 to 2.74, respectively). CONCLUSIONS We observed high levels of unplanned pregnancy among HIV-positive women, particularly among those not on ART, suggesting ongoing missed opportunities for improved family planning and counselling services for HIV-positive women.
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Affiliation(s)
- Victoria Iyun
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Stanzi le Roux
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Anova Health Institute, Johannesburg, South Africa
| | - Allison Zerbe
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Greg Petro
- Department of Obstetrics and Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York City, New York, USA
- College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Bintabara D, Nakamura K, Seino K. Determinants of facility readiness for integration of family planning with HIV testing and counseling services: evidence from the Tanzania service provision assessment survey, 2014-2015. BMC Health Serv Res 2017; 17:844. [PMID: 29273033 PMCID: PMC5741912 DOI: 10.1186/s12913-017-2809-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania. METHODS Data from the 2014-2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed. RESULTS A total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9-5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1-3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4-5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3-5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2-35.6]. CONCLUSION The proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.
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Affiliation(s)
- Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Public Health, College of Health Sciences, The University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Efavirenz decreases etonogestrel exposure: a pharmacokinetic evaluation of implantable contraception with antiretroviral therapy. AIDS 2017; 31:1965-1972. [PMID: 28692531 DOI: 10.1097/qad.0000000000001591] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The primary objective of this study was to characterize the pharmacokinetics of etonogestrel (ENG) released from a contraceptive implant in Ugandan women living with HIV who were receiving efavirenz (EFV) or nevirapine (NVP)-based antiretroviral therapy (ART), compared with ART-naive women over 24 weeks. DESIGN Nonrandomized, parallel-group study with three arms: ART-naive, NVP, or EFV-based ART (N = 20/group). METHODS Sparse pharmacokinetic sampling of ENG, NVP, or EFV were performed at screening, entry, and then 1, 4, 12, and 24-week postimplant insertion. The primary endpoint was ENG concentrations at week 24, compared between the ART-naive group and each ART group, using geometric mean ratio (GMR) with 90% confidence intervals. RESULTS Sixty participants competed the 24-week study and data from 58 participants are included; one participant each was excluded from the NVP group and EFV group because of a sample processing error and ART nonadherence, respectively. At week 24, geometric mean ENG was 362, 341, and 66 pg/ml in the ART-naive, NVP, and EFV groups, respectively [GMR: NVP : ART-naive 0.94 (0.90-1.01); EFV : ART-naive 0.18 (0.17-0.20)]. NVP and EFV concentrations were lower at week 24 compared to preimplant [NVP: geometric mean 5.7 versus 6.8 mg/l, respectively, GMR 0.84 (0.83-0.85); EFV: geometric mean 3.6 versus 4.9 mg/l, respectively, GMR 0.73 (0.69-0.80)]. CONCLUSION After 24 weeks of combined use, ENG exposure was 82% lower in women using EFV-based ART compared with ART-naive women. In contrast, NVP did not significantly impact ENG exposure. These results raise concerns about reduced effectiveness of implantable contraception for women taking EFV-based ART.
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Mudiope P, Musingye E, Makumbi CO, Bagenda D, Homsy J, Nakitende M, Mubiru M, Mosha LB, Kagawa M, Namukwaya Z, Fowler MG. Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as "family planning champions" increases referrals and uptake of family planning among HIV-infected mothers. BMC Health Serv Res 2017; 17:444. [PMID: 28655314 PMCID: PMC5488413 DOI: 10.1186/s12913-017-2386-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/13/2017] [Indexed: 05/29/2023] Open
Abstract
Background In 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic. Methods The Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification and referral of HIV Positive mothers in need of FP services; and accompanied referred mothers to FP clinics. We compiled and compared the average proportions of mothers in need that were referred and took up FP in the pre-intervention (3 months), intervention (6 months), and post-intervention(3 months) periods using interrupted time series with segmented regression models with an autoregressive term of one. Results Overall, during the intervention, the proportion of referred mothers in need of FP increased by 30.4 percentage points (P < 0.001), from 52.7 to 83.2 percentage points. FP uptake among mothers in need increased by over 31 percentage points (P < 0.001) from 47.2 to 78.5 percentage points during the intervention. There was a positive non-significant change in the weekly trend of referral β3 = 2.9 percentage points (P = 0.077) and uptake β3 = 1.9 percentage points (P = 0.176) during the intervention as compared to the pre-intervention but this was reversed during the post intervention. Over 57% (2494) mothers took up Depo-Provera injectable-FP method during the study. Conclusions To support overstrained health care work force in post-natal clinics, peers in trained effective family planning can be a valuable addition to clinic staff in limited-resource settings. The study provides additional evidence on the utilization of peer mothers in HIV care, improves health services uptake including family planning which is a common practice in many donor supported programs. It also provides evidence that may be used to advocate for policy revisions in low-income countries to include peers as support staff especially in busy clinic settings with poor services uptake. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2386-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Mudiope
- Directorate of Clinical Services - Elizabeth Glazer Pediatric Foundation, RHITES SW Project, Plot 7 Galt Road, Boma Mbarara, P.O.Box 881, Mbarara, Uganda.
| | - Ezra Musingye
- Makerere University Walter Reed Project, Plot 42, Nakasero Road, Kampala, Uganda
| | - Carolyne Onyango Makumbi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Danstan Bagenda
- College of Public Health, University of Nebraska Medical Center, Omaha, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Jaco Homsy
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Mai Nakitende
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Mike Mubiru
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Linda Barlow Mosha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Mike Kagawa
- Department of Obstetrics and gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Zikulah Namukwaya
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, P.O. BOX 23491, Kampala, Uganda
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University, 600 North Wolfe St., Carnegie, Baltimore, MD, 443, USA
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Incidence and Predictors of Pregnancy among Women on ART in Debre Markos Referral Hospital, Northwest Ethiopia: A Five-Year Retrospective Cohort Study. AIDS Res Treat 2017; 2017:3261205. [PMID: 28656105 PMCID: PMC5474550 DOI: 10.1155/2017/3261205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/03/2017] [Accepted: 05/10/2017] [Indexed: 11/17/2022] Open
Abstract
Globally, death of women due to HIV/AIDS related causes during pregnancy or within 42 days after pregnancy was estimated to be 37,000. In Ethiopia, 42,900 pregnant women living with HIV gave birth in the year 2011. This study was aimed to assess incidence and predictors of pregnancy among women on ART in Debre Markos Referral Hospital, Northwest Ethiopia. A retrospective cohort study was conducted using data recorded from September 2011 to August 2015. Data was extracted from February to March, 2016, from 1,239 records and analyzed using SPSS version 16. A Kaplan-Meier survival analysis was used to estimate the probabilities of being pregnant. The Cox proportional hazards model was done and results were expressed using hazard ratios with 95% CI. A total of 1,239 women on ART were included in the study. The incidence of pregnancy was 49.2 per 1,000 person-years. Living in rural, being married, being widowed, being unemployed, and having <2 children at enrollment were found to be positively associated with being pregnant. The incidence of pregnancy among women on ART was found to be considerable. Provision of family planning and other reproductive health interventions have to be coupled with the ART service to address the problem.
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28
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Crankshaw TL, Smit JA, Beksinska ME. Placing contraception at the centre of the HIV prevention agenda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:157-62. [PMID: 27399045 DOI: 10.2989/16085906.2016.1204330] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past decade, the global response to the HIV epidemic has been unprecedented, and enormous progress has been made. Significant investment in the roll out of antiretroviral treatment (ART) and efforts to increase treatment coverage have greatly reduced the number of AIDS-related deaths worldwide. There are a growing number of promising innovations to expand the HIV prevention mix. However, the reach of these interventions is still very limited in adolescent girls and young women (15-24 years) and the full realisation of the intervention mandates has not yet been achieved. The HIV prevention field has been criticised for the tendency to adopt a narrow focus. The Fast-Track Strategy offers a unique opportunity for the HIV prevention field to broaden its gaze and to begin to identify synergies (and efficiencies) with prevention approaches from other global development priorities, namely sexual and reproductive health and rights (SRHR). This paper applies a SRHR lens to HIV prevention by highlighting the critical relationship between unintended pregnancy and HIV, and seeks to expand on earlier debates that prevention of HIV and prevention of unintended pregnancy are inextricably linked, complementary activities with interrelated and common goals. We call for the prioritisation of prevention of unintended pregnancy amongst two overlapping population groups - girls and young women (15-24 years old) and women living with HIV - as a key tactic to accomplish the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track Strategy and as a way to fully realise existing HIV prevention efforts. We discuss the intersecting pathways between HIV prevention and unintended pregnancy prevention and build a case for contraception to be placed at the centre of the HIV prevention agenda.
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Affiliation(s)
- Tamaryn L Crankshaw
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Jennifer A Smit
- b MatCH Research (Maternal, Adolescent, & Child Health Research) Unit, Department of Obstetrics and Gynaecology , Faculty of Health Sciences , University of the Witwatersrand , South Africa
| | - Mags E Beksinska
- b MatCH Research (Maternal, Adolescent, & Child Health Research) Unit, Department of Obstetrics and Gynaecology , Faculty of Health Sciences , University of the Witwatersrand , South Africa
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29
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Scarsi KK, Darin KM, Chappell CA, Nitz SM, Lamorde M. Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV. Drug Saf 2016; 39:1053-1072. [PMID: 27562873 PMCID: PMC5048570 DOI: 10.1007/s40264-016-0452-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Family planning options, including hormonal contraceptives, are essential for improving reproductive health among the more than 17 million women living with HIV worldwide. For these women, prevention of unintended pregnancy decreases maternal and child mortality, as well as reduces the risk of perinatal HIV transmission. Similarly, treatment of HIV with antiretroviral therapy (ART) is essential for reducing morbidity and mortality among HIV-positive individuals, as well as preventing HIV transmission between sexual partners or from mother to child. Importantly, despite the benefits of hormonal contraceptives, barriers to effective family planning methods exist for HIV-positive women. Specifically, drug-drug interactions can occur between some antiretroviral medications and some hormonal contraceptives, which may influence both contraceptive efficacy and tolerability. In addition, safety concerns have been raised about the impact of hormonal contraceptives on HIV disease progression, tolerability, and the risk of female-to-male HIV transmission. This review article summarizes the potential for drug-drug interactions, tolerability, and contraceptive effectiveness when hormonal contraceptives are combined with ART. In addition, the evidence surrounding the influence of hormonal contraceptives on HIV transmission and HIV disease progression in women living with HIV are summarized.
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Affiliation(s)
- Kimberly K Scarsi
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA.
| | - Kristin M Darin
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephanie M Nitz
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Antelman G, Medley A, Mbatia R, Pals S, Arthur G, Haberlen S, Ackers M, Elul B, Parent J, Rwebembera A, Wanjiku L, Muraguri N, Gweshe J, Mudhune S, Bachanas P. Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania. ACTA ACUST UNITED AC 2016; 41:e1. [PMID: 25512359 DOI: 10.1136/jfprhc-2013-100784] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.
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Affiliation(s)
- Gretchen Antelman
- Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amy Medley
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Redempta Mbatia
- Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania
| | - Sherri Pals
- Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gilly Arthur
- Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Sabina Haberlen
- Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Marta Ackers
- HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Batya Elul
- Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julie Parent
- Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia
| | - Anath Rwebembera
- Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | - Lucy Wanjiku
- Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Justice Gweshe
- Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia
| | - Sandra Mudhune
- Senior M&E Officer, Research and Evaluation, The International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pamela Bachanas
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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31
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Worke MD, Bezabih LM, Woldetasdik MA. Utilization of contraception among sexually active HIV positive women attending art clinic in University of Gondar Hospital: a hospital based cross-sectional study. BMC Womens Health 2016; 16:67. [PMID: 27769220 PMCID: PMC5073466 DOI: 10.1186/s12905-016-0348-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Contraception helps to prevent unplanned pregnancies among human immune virus positive women. The contraceptive utilization status and associated factors were not well addressed in the study area. Therefore, this study aimed to assess utilization of contraceptives and associated factors among human immune virus positive reproductive age group women appearing at anti-retroviral therapy clinic at the University of Gondar Hospital, North West Ethiopia. METHOD An institution based cross-sectional study was conducted among 397 systematically selected HIV positive reproductive age women who visited ART unit of the University of Gondar teaching referral hospital from January 8-20, 2014. The data were collected using pre tested and structured questionnaires through face-to-face interviews. The data were entered into Epi-Info version 3.5, and cleaned and analyzed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95 % confidence interval and P-value of 0.05. RESULTS The study revealed that the overall utilization of any type of contraception was 50 %. Of them, 4.1 % got contraception from anti-retroviral therapy unit. Fear of side effects was the most common (42 %) reason for not using contraception. Women who attended secondary education, married and who had 4-6 children were more likely to use contraception than their counterparts were; (AOR: 5.63; 95 % CI: 1.74-18.21), (AOR: 8.07; 95 % CI: 3.10-20.99) and (AOR: 3.61; 95 % CI: 1.16-11.26) respectively. However, Women between 35-49 years, had no intention to have another child and discordant couples were 83 %, 76 % and 65 % less likely to use contraception respectively than their counterparts. CONCLUSIONS The results of this study revealed that the utilization of contraception was low. Women between 35-49 years, those who had no intention to have another child and whose partner was HIV sero-negative and fear of side effect of the contraception played an important role for not using contraception. Therefore, there is a need to give attention about integration of family planning service with HIV care and support service.
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Affiliation(s)
- Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lealem Meseret Bezabih
- Department of Gynecology and Obstetrics, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulat Adefris Woldetasdik
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women. J Acquir Immune Defic Syndr 2016; 71:345-52. [PMID: 26379070 PMCID: PMC4752415 DOI: 10.1097/qai.0000000000000848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression. Methods: From 1994 to 2012, HIV discordant couples recruited at couples' voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly. Multivariate survival analyses explored associations between time-varying contraception, pregnancy, and breastfeeding and 2 outcomes among HIV-positive women: (1) time to death and (2) time to antiretroviral treatment (ART) initiation. Results: Among 1656 female seropositive, male seronegative couples followed for 3359 person-years (PY), 224 women died [6.7/100 PY; 95% confidence interval (CI): 5.8 to 7.6]. After 2003, 290 women initiated ART (14.5/100 PY; 95% CI: 12.9 to 16.2). In a multivariate model of time to death, hormonal implant [adjusted hazard ratio (aHR) = 0.30; 95% CI: 0.10 to 0.98] and injectable (aHR = 0.59; 95% CI: 0.36 to 0.97) were significantly protective relative to nonhormonal method use, whereas oral contraceptive pill (OCP) use was not (aHR = 1.08; 95% CI: 0.74 to 1.57) controlling for baseline HIV disease stage, time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In a multivariate model of time-to-ART initiation, implant was significantly protective (aHR = 0.54; 95% CI: 0.31 to 0.95), whereas OCP (aHR = 0.70; 95% CI: 0.44 to 1.10) and injectable (aHR = 0.85; 95% CI: 0.55 to 1.32) were not relative to nonhormonal method use controlling for variables above, woman's age, and literacy. Pregnancy was not significantly associated with death (aHR = 1.07; 95% CI: 0.68 to 1.66) or ART initiation (aHR = 1.24; 95% CI: 0.83 to 1.86), whereas breastfeeding was protective for death (aHR = 0.34; 95% CI: 0.19 to 0.62) and ART initiation (aHR = 0.49; 95% CI: 0.29 to 0.85). Conclusions: Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with death or ART initiation, whereas breastfeeding was protective for both. Findings from this 18-year cohort study suggest that (1) HIV-positive women desiring pregnancy can be counseled to do so and breastfeed and (2) all effective contraceptive methods, including injectables and implants, should be promoted to prevent unintended pregnancy.
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Abeje G, Motbaynor A. Demand for family planning among HIV positive women on ART: the case of South Gondar and North Wollo Zones Amhara region. BMC Res Notes 2016; 9:43. [PMID: 26809646 PMCID: PMC4727345 DOI: 10.1186/s13104-016-1850-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 01/11/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although family planning for human immune deficiency virus positive women has numerous advantages, evidences in different parts of the world showed the existence of persistent unmet need. There were few studies done in Ethiopia on level of unmet need for family planning among women in reproductive age on antiretroviral therapy (ART). This study was therefore done to determine the level of demand and unmet need for family planning among women on ART in South Gondar and North Wollo Zones, Amhara region. METHODS Institution based cross-sectional study design was used. Data was collected from June 15 to 25, 2013 in South Gondar and North Wollo Zones. Study participants were recruited from six health centers and two hospitals. The study participants were proportionally allocated to the health institutions. Multistage sampling technique was used to recruit study participants. Trained nurses interviewed the respondents using pretested structured Amharic questionnaire. Data was entered, cleaned and analyzed using Statistical Package for Social Science version 16. Ratios and proportions were computed to determine demand and unmet need for family planning. RESULTS A total of 530 women in reproductive age on ART were interviewed in this study. Two hundred ninety-three women were married. Fourteen (2.6%) women were pregnant at the time of interview. Five of these pregnancies were not planned. In this study, 242 (45.7%) women reported that they were using contraceptives. Most women (74.4%) were using injectable (depo). Among those who were not using contraceptives, 84 (29.2%) reported that they will use in the future. Fifty-two (61.9%) of them said that they will use injectables (depo). In this study, the total demand for family planning among women on ART was 86.7%. From this, 62.1% and 24.6% was met and unmet need respectively. CONCLUSIONS This study revealed that the level of demand and met need for modern contraceptives among reproductive age women on antiretroviral therapy in South Gondar and North Wollo Zones was higher than that of sexually active married women in Ethiopia. But the level of unmet need is still similar with that of sexually active married women in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | - Achenef Motbaynor
- College of Health Sciences, Madawalabu University, Bale Goba, Ethiopia.
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Scarsi KK, Darin KM, Nakalema S, Back DJ, Byakika-Kibwika P, Else LJ, Dilly Penchala S, Buzibye A, Cohn SE, Merry C, Lamorde M. Unintended Pregnancies Observed With Combined Use of the Levonorgestrel Contraceptive Implant and Efavirenz-based Antiretroviral Therapy: A Three-Arm Pharmacokinetic Evaluation Over 48 Weeks. Clin Infect Dis 2015; 62:675-682. [PMID: 26646680 PMCID: PMC4772838 DOI: 10.1093/cid/civ1001] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Levonorgestrel subdermal implants are preferred contraceptives with an expected failure rate of <1% over 5 years. We assessed the effect of efavirenz- or nevirapine-based antiretroviral therapy (ART) coadministration on levonorgestrel pharmacokinetics. METHODS This nonrandomized, parallel group, pharmacokinetic evaluation was conducted in three groups of human immunodeficiency virus-infected Ugandan women: ART-naive (n = 17), efavirenz-based ART (n = 20), and nevirapine-based ART (n = 20). Levonorgestrel implants were inserted at baseline in all women. Blood was collected at 1, 4, 12, 24, 36, and 48 weeks. The primary endpoint was week 24 levonorgestrel concentrations, compared between the ART-naive group and each ART group by geometric mean ratio (GMR) with 90% confidence interval (CI). Secondary endpoints included week 48 levonorgestrel concentrations and unintended pregnancies. RESULTS Week 24 geometric mean levonorgestrel concentrations were 528, 280, and 710 pg/mL in the ART-naive, efavirenz, and nevirapine groups, respectively (efavirenz: ART-naive GMR, 0.53; 90% CI, .50, .55 and nevirapine: ART-naive GMR, 1.35; 90% CI, 1.29, 1.43). Week 48 levonorgestrel concentrations were 580, 247, and 664 pg/mL in the ART-naive, efavirenz, and nevirapine groups, respectively (efavirenz: ART-naive GMR, 0.43; 90% CI, .42, .44 and nevirapine: ART-naive GMR, 1.14; 90% CI, 1.14, 1.16). Three pregnancies (3/20, 15%) occurred in the efavirenz group between weeks 36 and 48. No pregnancies occurred in the ART-naive or nevirapine groups. CONCLUSIONS Within 1 year of combined use, levonorgestrel exposure was markedly reduced in participants who received efavirenz-based ART, accompanied by contraceptive failures. In contrast, nevirapine-based ART did not adversely affect levonorgestrel exposure or efficacy. CLINICAL TRIALS REGISTRATION NCT01789879.
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Affiliation(s)
- Kimberly K Scarsi
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha
| | - Kristin M Darin
- Center for Global Health.,Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - David J Back
- Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Pauline Byakika-Kibwika
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Laura J Else
- Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Sujan Dilly Penchala
- Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Allan Buzibye
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan E Cohn
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Concepta Merry
- Center for Global Health.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medicine, Trinity College Dublin, Ireland
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study. J Acquir Immune Defic Syndr 2015; 69:377-84. [PMID: 25835605 DOI: 10.1097/qai.0000000000000612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess fertility desires by availability and use of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai, Uganda. DESIGN Retrospective analyses of longitudinal data from the Rakai Community Cohort Study. METHODS Study participants were retrospectively identified and categorized by HIV status. Availability of ART/PMTCT services in Rakai was defined in three periods: (1) pre-ART/PMTCT (<2005), (2) ART/PMTCT rollout (2005-2006), and (3) universal ART/PMTCT (>2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by χ. "Modified" Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (CIs) of desire for another child among previously and currently pregnant women; PRRs were adjusted for demographic and behavioral factors. RESULTS A total of 4227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout [adjusted (adj.) PRR: 1.08, 95% CI: 1.04 to 1.13] and the universal availability periods (adj. PRR: 1.11, 95% CI: 1.08 to 1.14) compared with pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and nonusers in cross-sectional analysis (adj. PRR: 0.84, 95% CI: 0.62 to 1.14) and 1 year after ART/PMTCT use (adj. PRR: 1.27, 95% CI: 0.83 to 1.94). CONCLUSIONS Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women.
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Kimani J, Warren C, Abuya T, Mutemwa R, Mayhew S, Askew I. Family planning use and fertility desires among women living with HIV in Kenya. BMC Public Health 2015; 15:909. [PMID: 26381120 PMCID: PMC4574729 DOI: 10.1186/s12889-015-2218-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/03/2015] [Indexed: 11/12/2022] Open
Abstract
Background Enabling women living with HIV to effectively plan whether and when to become pregnant is an essential right; effective prevention of unintended pregnancies is also critical to reduce maternal morbidity and mortality as well as vertical transmission of HIV. The objective of this study is to examine the use of family planning (FP) services by HIV-positive and HIV-negative women in Kenya and their ability to achieve their fertility desires. Methods Data are derived from a random sample of women seeking family planning services in public health facilities in Kenya who had declared their HIV status (1887 at baseline and 1224 at endline) and who participated in a longitudinal study (the INTEGRA Initiative) that measured the benefits/costs of integrating HIV and sexual/reproductive health services in public health facilities. The dependent variables were FP use in the last 12 months and fertility desires (whether a woman wants more children or not). The key independent variable was HIV status (positive and negative). Descriptive statistics and multivariate logistic regression analysis were used to describe the women’s characteristics and to examine the relationship between FP use, fertility desires and HIV status. Results At baseline, 13 % of the women sampled were HIV-positive. A slightly higher proportion of HIV-positive women were significantly associated with the use of FP in the last 12 months and dual use of FP compared to HIV-negative women. Regardless of HIV status, short-acting contraceptives were the most commonly used FP methods. A higher proportion of HIV-positive women were more likely to be associated with unintended (both mistimed and unwanted) pregnancies and a desire not to have more children. After adjusting for confounding factors, the multivariate results showed that HIV-positive women were significantly more likely to be associated with dual use of FP (OR = 3.2; p < 0.05). Type of health facility, marital status and household wealth status were factors associated with FP use. Factors associated with fertility desires were age, education level and household wealth status. Conclusions The findings highlight important gaps related to utilization of FP among WLHIV. Despite having a greater likelihood of reported use of FP, HIV-positive women were more likely to have had an unintended pregnancy compared to HIV-negative women. This calls for need to strengthen family planning services for WLHIV to ensure they have better access to a wide range of FP methods. There is need to encourage the use of long-acting reversible contraceptive (LARC) to reduce the risk of unintended pregnancy and prevention of vertical transmission of HIV. However, such policies should be based on respect for women’s right to informed reproductive choice in the context of HIV/AIDS. Trial registration NCT01694862
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Affiliation(s)
- James Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Charlotte Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Timothy Abuya
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Richard Mutemwa
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | | | - Susannah Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Ian Askew
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
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Yigzaw M, Zakus D, Tadesse Y, Desalegn M, Fantahun M. Paving the way for universal family planning coverage in Ethiopia: an analysis of wealth related inequality. Int J Equity Health 2015; 14:77. [PMID: 26369946 PMCID: PMC4568578 DOI: 10.1186/s12939-015-0214-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family planning plays a significant role in reducing maternal and child mortality and ultimately in achieving national and international development goals. It also has an important role in reducing new pediatric HIV infections by preventing unwanted pregnancies among HIV positive women. Investing in family planning is one of the smart investments for development as population dynamics have a fundamental influence on the pillars of sustainable development, including that of a sustainable environment. OBJECTIVE To identify and quantify wealth related differences in family planning use between poor and rich Ethiopian women based on the Demographic and Health Survey asset based wealth quintiles. METHODS The proportion of women who used contraceptives during implementation of the 2011 and 2005 Ethiopia Demographic and Health Surveys was calculated across wealth quintiles. Data were stratified for place of residence to analyze and determine inequalities in family planning use separately for rural and urban women. Socioeconomic inequalities according to wealth were measured using the slope index of inequality and the relative index of inequality. RESULT The absolute difference of contraceptive prevalence between poorest and richest women was over 25.3 percentage points (95% CI = 18.9-31.7) in 2011. Contraceptive use was more than twice (RII: 2.6, 95% CI = 2.0 - 3.3) as prevalent among the richest compared with the poorest. CONCLUSION Despite efforts to provide contraceptives for free at all public health facilities, wealth based inequalities still prevail in Ethiopia. People at lower socioeconomic strata should be empowered more to avoid the root causes of inequality and to achieve national Health Sector Development Program Goals.
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Affiliation(s)
- Muluneh Yigzaw
- Ethiopian Public Health Associetion, Addis Ababa, Ethiopia.
| | - David Zakus
- Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, Canada.
| | | | | | - Mesganaw Fantahun
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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Abbawa F, Awoke W, Alemu Y. Fertility desire and associated factors among clients on highly active antiretroviral treatment at finoteselam hospital Northwest Ethiopia: a cross sectional study. Reprod Health 2015; 12:69. [PMID: 26260021 PMCID: PMC4531807 DOI: 10.1186/s12978-015-0063-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/06/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The accessibility of antiretroviral treatment changed the lives of persons living with HIV from hopelessness to hopefulness. Thus, many of them decided to have children. In Ethiopia, where there is high prevalence of HIV, level of fertility desire among persons living with HIV could have significant part in safe motherhood and child health. The aim of this study was to assess the level of fertility desire and identify factors associated with it among clients on highly active antiretroviral treatment at Finoteselam Hospital, Northwest Ethiopia. METHODS A cross-sectional study design supplemented by in-depth interview was conducted on 422 clients on Highly Active Antiretroviral Treatment from July 1 to August 12, 2013. Structured questionnaire was used to collect the data. Data were entered in to EPi Info version 3.5.1 and exported to SPSS software version 16 for further analysis. Descriptive and summary statistics were computed. Proportions were calculated to estimate fertility desire level. Binary logistic regression model was fitted to identify factors associated with fertility desire. RESULTS A total of 422 clients were included in the study of which 217 (51.4%) were males. The median age was 33 (IQR = 12) years. A total of 141(33.4%) of clients had desire for having children. Male clients desire children than their female counterparts [AOR = 3.19, 95 % CI: (1.56, 6.51)]. Clients who had no child had more desire for having children than those who had three or more children [AOR = 6.78, 95 % CI: (2.38, 19.27)] and those who had ≤2 years duration on ART had more desire than those with >2 years duration on ART [AOR = 3.64, 95 % CI: (1.74, 7.64)]. Clients who had discussion with ART service provider about sexuality, Fertility desire and family planning had more child desire [AOR = 3.12, 95 % CI: (1.54, 6.32)]. CONCLUSIONS One third of clients have desire to have a child/children in the future. Male clients and clients who have less than or equal to 2 years ART follow up, with no child and having discussion with ART service provider were associated with increased fertility desire. Guidelines formulated and counseling protocols developed shall consider this desire to achieve their reproductive goals in the healthiest and safest possible manner.
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Affiliation(s)
| | - Worku Awoke
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, BahirDar University, BahirDar, Ethiopia.
| | - Yayehirad Alemu
- Department of Public Health, College of Health Science, Mizan-Tepi University, MizanTeferi, Ethiopia.
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Church K, Wringe A, Lewin S, Ploubidis GB, Fakudze P, Mayhew SH. Exploring the Feasibility of Service Integration in a Low-Income Setting: A Mixed Methods Investigation into Different Models of Reproductive Health and HIV Care in Swaziland. PLoS One 2015; 10:e0126144. [PMID: 25978632 PMCID: PMC4433110 DOI: 10.1371/journal.pone.0126144] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/30/2015] [Indexed: 11/23/2022] Open
Abstract
Integrating reproductive health (RH) with HIV care is a policy priority in high HIV prevalence settings, despite doubts surrounding its feasibility and varying evidence of effects on health outcomes. The process and outcomes of integrated RH-HIV care were investigated in Swaziland, through a comparative case study of four service models, ranging from fully integrated to fully stand-alone HIV services, selected purposively within one town. A client exit survey (n=602) measured integrated care received and unmet family planning (FP) needs. Descriptive statistics were used to assess the degree of integration per clinic and client demand for services. Logistic regression modelling was used to test the hypothesis that clients at more integrated sites had lower unmet FP needs than clients in a stand-alone site. Qualitative methods included in-depth interviews with clients and providers to explore contextual factors influencing the feasibility of integrated RH-HIV care delivery; data were analysed thematically, combining deductive and inductive approaches. Results demonstrated that clinic models were not as integrated in practice as had been claimed. Fragmentation of HIV care was common. Services accessed per provider were no higher at the more integrated clinics compared to stand-alone models (p>0.05), despite reported demand. While women at more integrated sites received more FP and pregnancy counselling than stand-alone models, they received condoms (a method of choice) less often, and there was no statistical evidence of difference in unmet FP needs by model of care. Multiple contextual factors influenced integration practices, including provider de-skilling within sub-specialist roles; norms of task-oriented routinised HIV care; perceptions of heavy client loads; imbalanced client-provider interactions hindering articulation of RH needs; and provider motivation challenges. Thus, despite institutional support, factors related to the social context of care inhibited provision of fully integrated RH-HIV services in these clinics. Programmes should move beyond simplistic training and equipment provision if integrated care interventions are to be sustained.
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Affiliation(s)
- Kathryn Church
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
| | - George B. Ploubidis
- Centre for Longitudinal Studies, Department of Quantitative Social Science, Institute of Education, University of London, London, United Kingdom
| | | | | | - Susannah H. Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Habte D, Namasasu J. Family planning use among women living with HIV: knowing HIV positive status helps - results from a national survey. Reprod Health 2015; 12:41. [PMID: 25958383 PMCID: PMC4435559 DOI: 10.1186/s12978-015-0035-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/30/2015] [Indexed: 11/16/2022] Open
Abstract
Background Women living with HIV continues to encounter unintended pregnancies with a concomitant risk of mother-to-child transmission of HIV infection. Preventing unintended pregnancy among HIV-infected women is one of the strategies in the prevention of new HIV infections among children. The aim of this analysis was to assess the practice of family planning (FP) among HIV-infected women and the influence of women’s awareness of HIV positive status in the practice of FP. Methods The analysis was made in the Malawi Demographic and Health Survey (DHS) data among 489 non-pregnant, sexually active, fecund women living with HIV. Multiple logistic regression analysis was performed using SPSS software to identify the factors associated with FP use. Adjusted odds ratios (AOR) with 95 % confidence intervals were computed to assess the association of different factors with the practice of family planning. Result Of the 489 confirmed HIV positive women, 184 (37.6 %) reported that they knew that they were HIV positive. The number of women who reported that they were currently using FP method(s) were 251 (51.2 %). The number of women who reported unmet need for FP method(s) were 107 (21.9 %). In the multiple logistic regression analysis, women’s knowledge of HIV positive status [AOR: 2.32(1.54, 3.50)], secondary and above education [AOR: 2.36(1.16, 4.78)], presence of 3–4 alive children [AOR: 2.60(1.08, 6.28)] and more than 4 alive children [AOR: 3.03(1.18, 7.82)] were significantly associated with current use of FP. Conclusion Women’s knowledge of their HIV-positive status was found to be a significant predictor of their FP practice. Health managers and clinicians need to improve HIV counselling and testing coverage among women of child-bearing age and address the FP needs of HIV-infected women.
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Affiliation(s)
- Dereje Habte
- United Nations Development Programme (UNDP)/United Nations Volunteers (UNV), Lilongwe, Malawi.
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Haddad LB, Feldacker C, Jamieson DJ, Tweya H, Cwiak C, Chaweza T, Mlundira L, Chiwoko J, Samala B, Kachale F, Bryant AG, Hosseinipour MC, Stuart GS, Hoffman I, Phiri S. Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi. PLoS One 2015; 10:e0121039. [PMID: 25811849 PMCID: PMC4374940 DOI: 10.1371/journal.pone.0121039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/10/2015] [Indexed: 11/28/2022] Open
Abstract
Background Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic. Methods 200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010. Results Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner’s refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage. Discussion High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.
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Affiliation(s)
- Lisa B. Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
- * E-mail:
| | - Caryl Feldacker
- The Lighthouse Trust, Lilongwe, Malawi
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States of America
| | - Denise J. Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | | | - Carrie Cwiak
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | | | | | | | | | - Fanny Kachale
- Reproductive Health Services, Ministry of Health, Lilongwe, Malawi
| | - Amy G. Bryant
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Gretchen S. Stuart
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Irving Hoffman
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sam Phiri
- The Lighthouse Trust, Lilongwe, Malawi
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Yotebieng M, Norris A, Chalachala JL, Matumona Y, Ramadhani HO, Behets F. Fertility desires, unmet need for family planning, and unwanted pregnancies among HIV-infected women in care in Kinshasa, DR Congo. Pan Afr Med J 2015; 20:235. [PMID: 27386031 PMCID: PMC4919670 DOI: 10.11604/pamj.2015.20.235.5859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/28/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction We assessed the fertility desires, utilization of family planning (FP) methods, and incidence of pregnancies among HIV-infected women receiving care in an HIV clinic with an onsite FP services in Kinshasa, Democratic Republic of Congo. Methods Between November 2011 and May 2012, all HIV-infected women who attended a routine visit at the clinic were interviewed about their fertility desires and utilization of contraceptive methods using a structured questionnaire. Routine follow-up visit data were used to identify pregnancies recorded between the interview and June 2013. Results Overall, of the 699 HIV-infected women interviewed. 249 (35.7%) reported not wanting another child. Of the 499 (72.2%) participants who were sexually active at the time of interview, 177 (35.5%) were using an effective contraceptive method, including 70 (14.0%) women who reported using condoms consistently and 104 (20.8%) who were using injectable contraception. Overall, 88 (17.6%) sexually active participants who did not want another child were not using an effective FP method, and thus are considered to have had unmet need. During the median follow-up time of 22.2 (IQR: 20.2, 23.6) months, among all women interviewed, 96 (14.1%) became newly pregnant [pregnancy rate 9.3 (95%CI: 7.6, 11.4) per 100 women-years] including 21 (8.7%) among women who initially reported not wanting another child [unwanted pregnancy rate 5.8 (95%CI: 3.6, 9.3) per 100 women-years]. Conclusion The persistence of relatively high unmet need among women receiving HIV care in a clinic with onsite FP services suggests the existence of barriers that must be identified and addressed.
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Affiliation(s)
- Marcel Yotebieng
- Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC
| | - Alison Norris
- Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH
| | | | - Yori Matumona
- University of Kinshasa, School of Public Health, Kinshasa, DR Congo
| | - Habib Omari Ramadhani
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC
| | - Frieda Behets
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
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Snow RC, Laski L, Mutumba M. Sexual and reproductive health: progress and outstanding needs. Glob Public Health 2015; 10:149-73. [PMID: 25555027 PMCID: PMC4318113 DOI: 10.1080/17441692.2014.986178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/06/2014] [Indexed: 10/25/2022]
Abstract
We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.
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Affiliation(s)
- Rachel C. Snow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Laura Laski
- Sexual and Reproductive Health Branch, UNFPA, New York, NY, USA
| | - Massy Mutumba
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Harding R, Simms V, Penfold S, Downing J, Namisango E, Powell RA, Mwangi-Powell F, Moreland S, Gikaara N, Atieno M, Higginson IJ. Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study. BMC Infect Dis 2014; 14:613. [PMID: 25403371 PMCID: PMC4240824 DOI: 10.1186/s12879-014-0613-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/04/2014] [Indexed: 11/12/2022] Open
Abstract
Background Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. Methods In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual). Results Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002). Conclusions Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment.
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Speizer IS, Corroon M, Calhoun L, Lance P, Montana L, Nanda P, Guilkey D. Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:410-26. [PMID: 25611476 PMCID: PMC4307858 DOI: 10.9745/ghsp-d-14-00109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Demand generation activities that were significantly associated with increased use of modern contraception in India (Uttar Pradesh), Kenya, Nigeria, and Senegal included: (1) community outreach activities, such as home visits and group discussions about family planning; (2) local radio programs; and (3) branded slogans and print materials circulated widely across the city. Television programming was also significant in India and Nigeria. Exposure to more activities may increase women's likelihood of using contraception. Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all.
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Affiliation(s)
- Ilene S Speizer
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Meghan Corroon
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Lisa Calhoun
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Peter Lance
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Livia Montana
- Harvard University Center for Population and Development Studies, Cambridge, MA, USA
| | - Priya Nanda
- International Center for Research on Women, Asia Regional Office, Delhi, India
| | - David Guilkey
- The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Department of Economics, Chapel Hill, NC, USA
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Marlow HM, Maman S, Moodley D, Curtis S, McNaughton Reyes L. HIV status and postpartum contraceptive use in an antenatal population in Durban, South Africa. Contraception 2014; 91:39-43. [PMID: 25288035 DOI: 10.1016/j.contraception.2014.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/08/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We examined contraceptive use and dual protection in the postpartum period in a Prevention of Mother to Child Transmission population and whether it varied by HIV status. STUDY DESIGN Data are from a prospective study, the South Africa HIV Antenatal Post-test Support Study. Pregnant participants were recruited from a government clinic in an urban township, and the analytic sample was 821. Following enrollment, participants were tested for HIV and administered a questionnaire at baseline and 14 weeks postpartum. We used generalized linear regression models to examine HIV status and use of modern contraceptives at 14 weeks. RESULTS The risk ratio of condom use at 14 weeks postpartum was 1.66 [95% confidence interval (CI): 1.36-2.02] for HIV-positive compared to HIV-negative women. The risk ratio for dual protection (use of a condom and a hormonal method) was 1.96 (95% CI: 1.39-2.79) at 14 weeks for HIV-positive compared to HIV-negative women. CONCLUSIONS HIV positive status may be a motivating factor for women to use condoms and dual protection. In this setting where HIV is highly prevalent, it is ever more important that women control the timing and limiting of births so as to preserve the health of the mother and child. IMPLICATION HIV status may be an important motivating behavioral factor for women to use contraceptives and dual protection in the postpartum period.
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Affiliation(s)
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill
| | - Dhayendre Moodley
- Women's Health and HIV Research Unit, Department of Obstetrics and Gynecology, Nelson R. Mandela School of Medicine, University of KwaZulu Natal
| | - Siân Curtis
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill
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McCoy SI, Buzdugan R, Ralph LJ, Mushavi A, Mahomva A, Hakobyan A, Watadzaushe C, Dirawo J, Cowan FM, Padian NS. Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe. PLoS One 2014; 9:e105320. [PMID: 25144229 PMCID: PMC4140753 DOI: 10.1371/journal.pone.0105320] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. METHODS We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. RESULTS Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. CONCLUSIONS Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.
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Affiliation(s)
- Sandra I. McCoy
- University of California, Berkeley, California, United States of America
- * E-mail:
| | - Raluca Buzdugan
- University of California, Berkeley, California, United States of America
| | - Lauren J. Ralph
- University of California, Berkeley, California, United States of America
| | | | - Agnes Mahomva
- Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe
| | - Anna Hakobyan
- Children’s Investment Fund Foundation, London, United Kingdom
| | | | - Jeffrey Dirawo
- Centre for Sexual Health and HIV Research, Harare, Zimbabwe
| | - Frances M. Cowan
- Centre for Sexual Health and HIV Research, Harare, Zimbabwe
- University College London, London, United Kingdom
| | - Nancy S. Padian
- University of California, Berkeley, California, United States of America
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Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ. Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification. Palliat Med 2014; 28:293-301. [PMID: 23885009 DOI: 10.1177/0269216313498637] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV. AIM To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities. DESIGN Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder. SETTING A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda. RESULTS Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024). CONCLUSION The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.
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Affiliation(s)
- Richard Harding
- 1Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations. J Int AIDS Soc 2014; 17:18822. [PMID: 24572053 PMCID: PMC3936108 DOI: 10.7448/ias.17.1.18822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/17/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION It is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics. METHODS We conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region. RESULTS We identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries. CONCLUSIONS There is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.
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Abstract
PURPOSE OF REVIEW We reviewed recent literature on the role of family planning in eliminating new pediatric HIV infections. RECENT FINDINGS Global commitments to eliminate new pediatric HIV infections recognize that preventing unintended pregnancies among women with HIV is essential to achieving this goal. However, substantial shortcomings exist in translating this policy support into widespread practice. Programs to prevent mother-to-child transmission of HIV continue to be implemented and evaluated as a narrow set of interventions that typically begins in antenatal care, after a woman is already pregnant. In addition, data suggest that women living with HIV experience high rates of unmet need for family planning and unintended pregnancies. Evidence is growing that integrating family planning and HIV services is an effective strategy for increasing access to contraception among women with HIV who do not wish to become pregnant. A number of health system obstacles must be resolved to achieve effective, sustained delivery of integrated services at scale. SUMMARY Prevention of unintended pregnancies among women with HIV must be elevated as a programmatic priority. By strengthening family planning programs for all women, and better integrating family planning and HIV services, progress toward ending new pediatric HIV infections will be accelerated.
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