Status of family planning integration to HIV care in Amhara regional state, Ethiopia

Sociobehavioral Risk Factors and Clinical Implications of Late Presentation Among People Living with HIV in the Brazilian Amazon Region

This study aimed to analyze the prevalence, sociobehavioral factors and clinical-laboratory consequences of late presentation among people living with HIV (PLHIV) in the Brazilian Amazon region. In total, 402 HIV + individuals treated at reference units in Belém city (Pará, Brazil) between 2018 and 2019 were evaluated. Late presentation was defined as a first-collection LTCD4+ count below 350 cells/µL. Sociodemographic, behavioral and clinical data were obtained from questionnaires or medical records. Th1, Th2 and Th17 cytokine profiles were evaluated by flow cytometry. Longitudinal data on viral load, T lymphocytes, and antiretroviral therapy administration were obtained from control and logistic databases. Approximately 52.73% of the participants were late presenters and sought medical care 7-12 + months after their primary HIV diagnosis. Sociobehavioral factors associated with late presentation included illicit drug use for more than 5 years, polyamory, no alcohol consumption, homosexuality, and sexual inactiveness after HIV diagnosis. Clinically, late presentation was associated with coinfection rate; polysymptomatology; high IFN-ɣ, IL-6 and IL-10 levels; nonresponse to antiretroviral therapy; and virological failure- and tuberculosis coinfection-motivated changes to therapy. In summary, the prevalence of late presentation in Pará in the Brazilian Amazon region is high. Delays in seeking specialized care after a primary HIV diagnosis cause medium/long-term changes in the life expectancy and health of PLHIV.

Magnitude and associated factors of unmet need for family planning among reproductive-aged women in Ethiopia: An umbrella review

INTRODUCTION

The World Health Organization defines women with an unmet need for family planning as individuals who are fecund, sexually active, and wanting to either to limit childbirth or postpone their next birth but are not utilizing any form of contraception. Previous meta-analyses and systematic reviews have focused on this topic, but no comprehensive summary of the evidence was available. Therefore, the aim of this study was to provide a summary of the findings on the unmet need for family planning among reproductive-aged women in Ethiopia.

METHOD

A search was conducted in PubMed, Google Scholar, CINAHL, Scopus, Cochrane Library, and RESEARCH 4 LIFE including Hinari, to identify relevant systematic reviews and meta-analyses of studies on the prevalence and determinants of the unmet need for family planning in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews tool, and the estimates were pooled using a random-effects meta-analysis model.

RESULTS

The umbrella review included five studies with a total of 56,169 reproductive-aged women. The pooled prevalence of unmet need for family planning was found to be 27.44% (95% CI: 22.32-32.55), with the heterogeneity index (I square = 99.45%, P = 0.000). Failure to discuss with her partner about family planning methods (OR: 2.90, 95% CI: 1.81, 4.00), being illiterate (OR: 2.17, 95% CI: 1.42, 2.92), age at first marriage (OR: 1.37, 95% CI: 1.30, 1.44), and educational status of woman's partner (OR: 2.61, 95% CI: 0.83, 4.40) were the factors significantly and positively associated with unmet needs for family planning.

CONCLUSION

The study concludes that the unmet need for family planning in Ethiopia is a significant issue that can be addressed through increasing the educational levels of women and their partners, promoting open discussions about family planning, and preventing early marriages. Collaboration between families, school administrators, and healthcare providers is essential to mitigating this problem.

Family planning integration in Ethiopia's primary health care system: a qualitative study on opportunities, challenges and best practices

BACKGROUND

Family planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration.

METHODS

A qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report.

RESULTS

Family planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers' capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness.

CONCLUSIONS

Integration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.

Contraceptive use and associated factors among women of reproductive age on antiretroviral therapy in Awabel Woreda health centers, Northwest Ethiopia

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.

Integration of family planning into HIV services: a systematic review

BACKGROUND

The unmet need for safe and effective contraception still remains high. In 2017, about 25% of women of childbearing age who wanted to avoid pregnancy in the developing world were not using a modern contraceptive method. The biggest proportion (21%) of these women live in Sub-Saharan Africa. Little attention has been paid to the health systems factors impacting the integration of family planning into HIV services. This systematic review intends to document health systems factors constraining or facilitating the integration of family planning into HIV services.

METHODS

A search of electronic databases such as PubMed and Google Scholar was conducted using keywords. We considered peer-reviewed articles which were published in English between 1st January 2010 and 31st December 2020. The peer-reviewed articles which were considered focussed on identifying barriers and facilitators at the levels of the health system which influence the success or failure of integrated family planning and HIV programs, availability of integrated family planning services in HIV care, the evidence on the feasibility, effectiveness and cost-effectiveness of integrating family planning and HIV services and investigating the outcomes of programs aimed at strengthening family planning integration in HIV counselling, testing and care. Twenty-seven articles that identify factors affecting integration of family planning into HIV services met the inclusion criteria and were thematically analysed.

RESULTS

Health systems factors constraining integration of family planning and HIV services were human resource turnover and shortages, lack of policy guidance on integrated care, poor oversight, unclear service delivery guidelines, inadequate infrastructure and insufficient monitoring systems. Facilitators to the successful integration of family planning into HIV services were identified as training in family planning for service providers, the creation of a supportive policy environment to accommodate service integration, supportive supervision and a positive attitude by service providers towards service integration.

CONCLUSION

Increase in the health workforce to support integrated service delivery, skills enhancement for service providers and improvement in family planning commodity stock levels play a key role in facilitating the integration of family planning into HIV services.

Unmet need for family planning among reproductive-age women living with HIV in Ethiopia: A systematic review and meta-analysis

Background

Closing the gap of unmet for family planning is crucial to eliminate new pediatric HIV infections likewise to improve maternal and child health among reproductive-age women living with HIV. However, studies conducted on unmet need for family planning among reproductive-age women living with HIV showed inconsistent and non-conclusive findings on the magnitude of the problem. Moreover, there was no meta-analysis conducted in this area. So this systematic review and meta-analysis were conducted to estimate the pooled prevalence unmet need for family planning among reproductive-age women living with HIV in Ethiopia.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review both published and unpublished studies in Ethiopia. All studies in PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health databases were searched. Meta-analysis was performed using STATA 14 software. The heterogeneity and publication bias were assessed using the I² statistics and Egger regression asymmetry test, respectively. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI).

Results

This review included 7 studies, and 3333 study participants. The pooled prevalence of unmet need for family planning among reproductive-age women living with HIV in Ethiopia was 25.13% (95%CI: 19.97, 30.29). The pooled prevalence of unmet need for spacing and limiting was 13.91% (95%CI: 10.11, 17.72) and 9.11% (95%CI: 6.43, 11.78), respectively.

Conclusions

One-fourths of reproductive-age women living with HIV had an unmet need for family planning. A variety of programmatic investments are needed to achieve more meaningful progress toward the reduction of unmet need for family planning among reproductive-age women living with HIV.

The Level of Unmet Need for Family Planning and Its Predictors among HIV-Positive Women in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Studies indicated that the need for family planning appears to be greater for human immuno-deficiency virus- (HIV-) positive women than the general population to reduce the risk of pediatrics HIV infection and related consequences of unintended pregnancy. We aimed to assess the level of unmet need for family planning and its predictors among HIV-positive women in Ethiopia.

METHODS

Online databases such as PubMed, SCOPUS, EMBASE, HINARI, Google Scholar, and digital libraries of universities were used to search for studies to be included in this systematic review and meta-analysis. Quality assessment of included studies was conducted using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data were extracted using the format prepared on Excel workbook and analyzed by the Stata 11 software. Cochran (Q test) and I 2 test statistics were used to assess the heterogeneity of studies. Similarly, the funnel plot and Egger's regression asymmetry test were used to assess publication bias.

RESULT

This systematic review and meta-analysis was conducted using nine primary studies with a total of 6,154 participants. The pooled prevalence of unmet need for family planning among HIV-positive women was found to be 25.72% (95% CI: 21.63%, 29.81%). Participants age 15-24 years ((OR = 3.12; 95% CI: 1.59, 6.11) I 2 = 27.5%; p = 0.252), being illiterate ((OR = 2.69; 95% CI: 1.69, 4.26) I 2 = 0.0%; p = 0.899), failure to discuss FP with partner ((OR = 3.38; 95% CI: 2.20, 5.18) I 2 = 0.0%; p = 0.861), and no access to family planning information ((OR = 4.70; 95% CI: 2.83, 7.81) I 2 = 0.0%; p = 0.993) were found to be a significant predictors of unmet need for family planning among HIV-positive women.

CONCLUSION

The level of unmet need for family planning among HIV-positive women was found to be high in Ethiopia. Being young age, illiteracy, failed to discuss family planning issues with a partner, and no access to family planning information were found to be the significant predictors of unmet need for family planning among HIV-positive women in Ethiopia. Improving information access and encouraging partners' involvement in family planning counseling and services could reduce the level of unmet need for family planning.

Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis

BACKGROUND

Preventing unintended pregnancies among HIV positive women has a vital role to prevent mother to child transmission. Besides, increasing access to contraceptives has a number of economical importance and reducing the costs for mitigating the unintended pregnancy consequences. Therefore, this study is aimed at assessing the contraceptive use and method of preference among HIV positive women in Ethiopia.

METHODS

A systematic review and meta-analysis reporting guideline was applied. Articles searched from the Scopus, Pubmed/MEDLINE, EMBASE, AJOL, Hinari, and Google scholar were included in this review. The Stata 11 software was used to compute the analysis. Heterogeneity of the studies was detected using the Cochran Q test and I 2 test statistics. Egger's test was used to check the evidence of publication bias within the studies. Subgroup analysis and sensitivity analysis was computed with the evidence of heterogeneity.

RESULTS

Ten thousand one hundred twenty one (10121) women living with HIV/AIDS were recruited in this study. The national estimated prevalence of contraceptive use among HIV positive women in Ethiopia was 57.78% (95% CI: 48.53-67.03). Injectables and male condom were the most preferred contraceptives accounted for 36.00% (95% CI: 6.64-45.35) and 32.74% (95% CI: 21.08-44.40), respectively. Discussion with husband/partner (AOR: 4.70, 95% CI: 2.18-10.12), disclosure of HIV status to spouse/partner (AOR: 2.18, 95% CI: 1.55-3.06), ever counseled for modern contraceptives (AOR: 2.79, 95% CI: 2.01-3.88), attending secondary and above education (AOR: 3.12, 95% CI: 2.15-4.51), and having more than one live child (AOR: 2.61, 95% CI: 1.86-3.66) were increasing the likelihood of contraceptive use whereas not currently married women (AOR: 0.23, 95% CI: 0.16-0.34) was decreases the odds of contraceptive use.

CONCLUSION

In Ethiopia, more than half of the women living with HIV/AIDS were using contraceptives. Discussion with husband/partner, disclosure of HIV status to spouse/partner, ever counseled for modern contraceptives, attending secondary and above education, and having more than one live child were increasing the uptake of contraceptives among HIV positive women. Partner discussion, having adequate information towards contraceptive use, and having desired number of child could increase the utilization; as a result, obstetric complication with HIV positive women due to unintended pregnancy is significantly decreasing.