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Ngumbau N, Unger JA, Wandika B, Atieno C, Beima-Sofie K, Dettinger J, Nzove E, Harrington EK, Karume AK, Osborn L, Sharma M, Richardson BA, Seth A, Udren J, Zanial N, Kinuthia J, Drake AL. Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial. PLoS One 2024; 19:e0300642. [PMID: 38557692 PMCID: PMC10984530 DOI: 10.1371/journal.pone.0300642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes. METHODS AND DESIGN We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy. DISCUSSION The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care.
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Affiliation(s)
- Nancy Ngumbau
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A. Unger
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Brenda Wandika
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Celestine Atieno
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Emmaculate Nzove
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Elizabeth K. Harrington
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Agnes K. Karume
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Lusi Osborn
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Barbra A. Richardson
- Departments of Biostatistics, Global Health, University of Washington, Seattle, Washington, United States of America
| | - Aparna Seth
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jenna Udren
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Noor Zanial
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Guo Y, Du Y, Liu J, Bai J, Gao J, Wu L, Yang Y, Wang W, Chen J, Xu Z, Yan J, Lu N, Li C, Chongsuvivatwong V. Effects of HIV-related worries on fertility motivation moderated by living children among couples living with HIV: A dyadic analysis. Front Psychol 2022; 13:1000100. [PMID: 36438391 PMCID: PMC9685432 DOI: 10.3389/fpsyg.2022.1000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/28/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION HIV-related worries are a major barrier to achieving fertility goals for couples living with HIV (CLWH). We examined the moderating role of living children in the association between HIV-related worries and fertility motivation in CLWH including happiness, well-being, identity, and continuity. METHODS The data of 322 reproductive-aged CLWH were collected for this cross-sectional study from a referral antiretroviral therapy clinic in Kunming, China between October and December 2020. Intra- and interpersonal mechanisms of association between HIV-related worries and fertility motivation moderated by the number of living children in husband-wife dyads were analyzed by the actor-partner interdependence moderation model. RESULTS The high-level HIV-related worries of the wives and husbands were associated with the spouses' fertility motivation. Having at least one child helped to ameliorate the negative association between one's own HIV-related worries and fertility motivation. However, there was no evidence of such moderation in the spouse. CONCLUSION Whether the CLWH has at least one living child should be taken into account in counseling. Childless families should be counseled on HIV-related worries as those worries have a greater negative effect on fertility motivation than couples who have a child.
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Affiliation(s)
- Yingwu Guo
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Yingrong Du
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jun Liu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jingsong Bai
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jianpeng Gao
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Lei Wu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Yongrui Yang
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Weibo Wang
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Jie Chen
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Zhaoyuan Xu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Junfang Yan
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Nihong Lu
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Chongxi Li
- Department of Infectious Diseases, Third People’s Hospital of Kunming City, Kunming, China
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
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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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Naicker N, Yende-Zuma N, Kharsany ABM, Shozi H, Nkosi D, Naidoo A, Garrett N, Abdool Karim SS. Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa. BMC Pregnancy Childbirth 2022; 22:596. [PMID: 35883114 PMCID: PMC9317085 DOI: 10.1186/s12884-022-04829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. METHODS We evaluated pregnancies among women ≥ 18 years between 2004 and 2019 in the CAPRISA 002 study. We analysed pregnancy rates following HIV acquisition, CD4 counts and HIV viral load dynamics and pregnancy outcomes. We used linear regression to assess if the mean CD4 and log10 viral load close to delivery increases or decreases linearly across three different timepoints. RESULTS In total 245 women enrolled into the HIV negative study phase, 225 into the HIV infection phase and 232 in the antiretroviral therapy (ART) phase. Median follow-up time was 2.0 years [Interquartile Range (IQR) 0.8-2.0] during the HIV negative phase, 2.6 years; (IQR) 1.2-4.8] during HIV infection and 3.7 years (IQR 1.8-5.0) on ART, with maximum follow-up time of 2, 10 and 6 years respectively. Overall, 169 pregnancies occurred in 140 women, of which 16 pregnancies were observed during acute or early HIV infection [Incidence Rate (IR) 8.0 per 100 women-years; 95% confidence interval (CI): 4.6-12.9], 48 during established infection [IR 9.3; (CI 6.8-12.3)] and 68 on ART [IR 8.9; (CI: 7.0 - 11.4)]. Birth outcomes from 155/169 (91.7%) pregnancies were 118 (76.1%) full term live births, 17 (10.9%) premature live births, 9 (5.8%) therapeutic/elective miscarriages, 8 (5.1%) spontaneous miscarriages and 3 (1.9%) spontaneous foetal deaths or stillbirths. Six mother-to-child transmission events occurred, with four documented prior to 2008. Over time, mean CD4 count in pregnant women increased from 395 cells/µL (2004-2009) to 543 cells/µL (2010-2014) and to 696 cells/µL (2015-2019), p < 0.001. Conversely, the viral load declined from 4.2 log10 copies/ml to 2.5 log10 copies/ml and to 1.2 log10 copies/ml (p < 0.001) for the corresponding periods. CONCLUSIONS Pregnancy rates following HIV acquisition were high, emphasising a need for timeous ART provision and contraception counselling in women recently diagnosed with HIV. CD4 count and HIV viral load trajectories reflect improvements in treatment guidance for pregnant women over time.
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Affiliation(s)
- Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- School of Laboratory Medicine and Medical Science, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Duduzile Nkosi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Anushka Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, NY 10032, USA
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Akoth C, Oguta JO, Kyololo OM, Nyamu M, Ndirangu MN, Gatimu SM. Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study. Front Glob Womens Health 2022; 2:669760. [PMID: 34977861 PMCID: PMC8716368 DOI: 10.3389/fgwh.2021.669760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya. Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions. Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend. Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.
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Affiliation(s)
- Catherine Akoth
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - James Odhiambo Oguta
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.,Health Section, UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Martin Nyamu
- Institute of Tropical and Infectious Diseases, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Samwel Maina Gatimu
- School of Economics, University of Nairobi, Nairobi, Kenya.,Diabetic Foot Foundation of Kenya, Nairobi, Kenya
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Chace Dwyer S, Jain A, Liambila W, Warren CE. The role of unintended pregnancy in internalized stigma among women living with HIV in Kenya. BMC WOMENS HEALTH 2021; 21:106. [PMID: 33731107 PMCID: PMC7968281 DOI: 10.1186/s12905-021-01224-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV. METHODS Baseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored. RESULTS About 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2-2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents' characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3-2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination. CONCLUSIONS Results suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.
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Affiliation(s)
- Sara Chace Dwyer
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA.
| | - Aparna Jain
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA
| | | | - Charlotte E Warren
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA
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Adeagbo MJ, Naidoo K. Exploring narratives and advocating support and peer mentorship to improve HIV-positive adolescent mothers' lives in South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:231-241. [PMID: 33119456 DOI: 10.2989/16085906.2020.1808486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Research on adolescent sexuality, health and parenting has gained much attention in recent years. This growing body of research, however, has arguably limited qualitative outputs on HIV-positive adolescent mothers' sexual and reproductive health choices, needs, and rights in South Africa that could lead to informed policymaking. Through in-depth interviews conducted with a select group of ten HIV-positive adolescents and three key informants, the article explores the sexual, motherhood, risk discourses and reproductive health issues and rights of HIV-positive adolescent mothers as they come to terms with choices they have made and the challenges ahead. The findings highlight the dominant narratives on what are deemed to be the forces that shape these adolescent mothers' new social realities. With existing policies in place for adolescents, it is argued that a "one-size-fits-all" policy approach does not work, especially for HIV-positive adolescent mothers. Drawing on this identified gap and the tensions between individual needs, and the public welfare provision, the article highlights the need for tailored policy that will accommodate and promote the overall well-being of HIV-positive adolescent mothers and their children.
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Affiliation(s)
| | - Kammila Naidoo
- Sociology Department, University of Johannesburg, South Africa
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Magadi MA. HIV and Unintended Fertility in Sub-Saharan Africa: Multilevel Predictors of Mistimed and Unwanted Fertility Among HIV-Positive Women. POPULATION RESEARCH AND POLICY REVIEW 2020. [DOI: 10.1007/s11113-020-09620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Determinants of Fertility Desire among Women Living with HIV in the Childbearing Age Attending Antiretroviral Therapy Clinic at Jimma University Medical Center, Southwest Ethiopia: A Facility-Based Case-Control Study. Int J Reprod Med 2020; 2020:6504567. [PMID: 32851055 PMCID: PMC7441441 DOI: 10.1155/2020/6504567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background High fertility and aspiration to have more children are a normal phenomenon in many developing countries including Ethiopia. The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Despite the growing number of women living with HIV/AIDS, the issues of fertility and childbearing intention have not been widely studied in Ethiopia. Objective To identify determinants of fertility desire among women living with HIV in the childbearing age attending antiretroviral therapy clinic at Jimma University Medical Center, Southwest Ethiopia. Methods A facility-based case-control study was conducted in March 2019. Cases were women living with HIV who had fertility desire, and controls were those who had not. Data was collected using a face-to-face interview using a pretested questionnaire. The data was entered into EpiData 3.1 and exported to SPSS Version 24 for analysis. Bivariate and multivariable logistic regression analyses were used to identify candidate and independent determinants of fertility desire, respectively. Independent determinants associated with fertility desire were assessed using AORs with their corresponding 95% CIs at P value < 0.05 cutoff point. Results. Three hundred forty-four (115 cases and 229 controls) were included into the study with a 100% response rate. Age categories 15-24 (AOR: 4.1; 95% CI: 2.0, 8.4) and 25-34 (AOR: 2.3; 95% CI: 1.3, 4.2) years, not using family planning (AOR: 2.3; 95% CI: 1.4, 4.0), and having a sexual partner (AOR: 1.9; 95% CI: 1.1, 3.2) were independent predictors of fertility desire. Conclusions Age of women, family planning, and sexual partner were found to be the independent predictors of fertility desire among women living with HIV/AIDS. Policymakers and health care providers who are working on an ART clinic should try to consider the effects of these factors for women living with HIV while developing HIV/AIDS interventions and discussing on sexual and reproductive health issues with their clients, respectively.
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"They haven't asked me. I haven't told them either": fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia. Reprod Health 2020; 17:124. [PMID: 32807202 PMCID: PMC7433147 DOI: 10.1186/s12978-020-00971-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite the importance of women living with HIV (WLHIV) engaging in fertility plan discussions with their healthcare providers (HCPs), little research exists. This study explored perceptions surrounding fertility plan discussions between WLHIV and their HCPs in western Ethiopia, from the perspectives of both women and providers. Methods Thirty-one interviews (27 with WLHIV and 4 with HCPs) were conducted at four healthcare facilities in western Ethiopia in 2018. Data were transcribed verbatim and translated into English. Codes and themes were identified using inductive thematic analysis. Results There was a discordance between HCPs and WLHIV’s perception regarding the delivery of fertility plan discussions. Only nine of the 27 WLHIV reported they had discussed their personal fertility plans with their HCPs. When discussions did occur, safer conception and contraceptive use were the primary focus. Referrals to mother support groups, adherence counsellors as well as family planning clinics (where they can access reproductive counselling) facilitated fertility discussions. However, lack of initiating discussions by either HCPs or women, high client load and insufficient staffing, and a poor referral system were barriers to discussing fertility plans. Where discussions did occur, barriers to good quality interactions were: (a) lack of recognizing women’s fertility needs; (b) a lack of time and being overworked; (c) mismatched fertility desire among couples; (d) non-disclosure of HIV-positive status to a partner; (e) poor partner involvement; (f) fear of repercussions of disclosing fertility desires to a HCP; and (g) HCPs fear of seroconversion. Conclusions Our findings highlight the need for policies and guidelines to support fertility plan discussions. Training of HCPs, provision of non-judgmental and client-centered fertility counselling, improving integration of services along with increased human resources are crucial to counselling provision. Enhancing partner involvement, and supporting and training mother support groups and adherence counsellors in providing fertility plan discussions are crucial to improving safer conception and effective contraceptive use, which helps in having healthy babies and reducing HIV transmission.
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Tusubira AK, Kibira SPS, Makumbi FE. Modern contraceptive use among postpartum women living with HIV attending mother baby care points in Kabarole District, Uganda. BMC WOMENS HEALTH 2020; 20:78. [PMID: 32321480 PMCID: PMC7178756 DOI: 10.1186/s12905-020-00944-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preventing unintended pregnancies among women living with HIV is important for improving maternal and child health outcomes. Despite multiple contacts between postpartum women and healthcare providers at health facilities, modern contraceptive use during postpartum period remains low even among women with intentions to limit or delay childbearing. We estimated postpartum modern contraceptive use, unmet need and factors associated with modern contraceptive use among HIV positive women attending mother-baby HIV care points. METHODS We conducted a cross-sectional study, between April and May 2016, among HIV positive women attending postpartum care at six health facilities in Kabarole district, Uganda. Health facilities were stratified by level prior to selecting participants using systematic sampling. We administered structured questionnaires to women who had delivered within the last two to 18 months. Women who reported current use of a modern method were categorized as modern contraceptive users. Women not using but wanted to stop childbearing or space childbirth by at least 2 years were considered to have unmet need for modern contraception. We estimated a modified Poisson regression model to examine variations in the use of modern methods by various characteristics of participants. RESULTS We interviewed 369 women. Forty percent of them were using a modern method, with injectables being the most widely used. A third (33%) of the women had unmet need for modern methods, with unmet need for spacing (24%) being higher than for limiting births (9%). Modern contraceptive use was significantly higher among women who had delivered seven or more months earlier (Adj.PR = 2.02; CI: 1.49, 2.74); women who were counseled on family planning during antenatal care (Adj.PR = 1.53; CI: 1.07, 2.18); those who obtained methods through the care points (Adj.PR =2.27; CI: 1.32, 3.90); and those who jointly made decisions regarding childbearing with their partners (Adj.PR = 1.49; CI: 1.02, 2.17). CONCLUSION Use of modern contraceptives was low while unmet need was high among postpartum women living with HIV. The findings suggest that there are gaps which indicate the need to strengthen contraceptive service delivery at these care-points. Providing family planning counseling early would improve uptake of contraception upon resumption of menses and sexual activity.
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Affiliation(s)
- Andrew K Tusubira
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P. O Box 7072, Kampala, Uganda.
| | - Simon Peter Sebina Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Centre for International Health, Department of Global Public Health and Primary care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia. Am J Obstet Gynecol 2020; 222:S917.e1-S917.e15. [PMID: 31953114 DOI: 10.1016/j.ajog.2019.12.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/05/2019] [Accepted: 12/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Integrating family planning interventions with HIV studies in developing countries has been shown to prevent mother-to-child HIV transmission and simultaneously reduce HIV and unintended pregnancy in high-risk populations. As part of a prospective cohort study on HIV incidence and risk factors in Zambian women having unprotected sex, we also offered family planning counseling and immediate access to long-acting reversible contraceptives. Although long-acting reversible contraceptives are the most effective form of contraception, many Zambian women are limited to oral or injectable methods because of a lack of knowledge or method availability. This project offers to single mothers who are enrolled in a cohort study information about and access to long-acting reversible contraceptives at enrollment and at each follow-up visit. OBJECTIVE This study evaluates how fertility intentions affect long-acting reversible contraceptive use in HIV-negative single mothers in Zambia. Our primary outcome was long-acting reversible contraceptive use throughout the study participation. We also estimated rates of long-acting reversible contraceptive uptake and discontinuation. We specifically studied single mothers because they are at high risk for unintended pregnancy, which can have significant negative ramifications on their financial, social, and psychologic circumstances. STUDY DESIGN From 2012-2017, Zambia Emory HIV Research Project recruited 521 HIV-negative single mothers ages 18-45 years from government clinics in Lusaka and Ndola, Zambia's 2 largest cities. Participants were followed every 3 months for up to 5 years. At each visit, we discussed fertility goals and contraceptive options and offered a long-acting reversible method to any woman who was not pregnant or who already was using a long-acting reversible or permanent contraceptive method. Data were collected on demographic factors, sexual behavior, and reproductive history. Multivariable logistic regression was used to model baseline fertility intentions with long-acting reversible contraceptive use. RESULTS We enrolled 518 women; 57 women did not return for any follow-up visits. There was a significant increase in long-acting reversible contraceptive use during the study. At baseline, 93 of 518 women (18%) were using a long-acting reversible method, and 151 of 461 women (33%) used a long-acting reversible method at the end of follow-up period (P<.0001). Four women chose an intrauterine device, and 91 women chose an implant for their first uptake event. After we adjusted the data for other confounders, we found that women in Ndola who did not desire any more children were more likely to use a long-acting reversible contraceptive (adjusted prevalence ratio, 2.02; 95% confidence interval, 1.88-3.42). During follow up, 37 of 183 long-acting reversible contraceptive users (20%) discontinued their method; women who desired future children at baseline were more likely to discontinue earlier (P=.016). CONCLUSION This study demonstrates that integrated family planning services can increase long-acting reversible contraceptive use successfully among Zambian single mothers, who are a vulnerable population that disproportionately is affected by unintended pregnancy. A steady increase in use over time confirms the importance of repeated messaging about these unfamiliar methods. Thus, it is imperative that family planning interventions target single mothers in developing countries to promote effective contraceptive use.
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Pfitzer A, Wille J, Wambua J, Stender SC, Strachan M, Ayuyo CM, Muhavi TFK, Wabwile V, Mehta SD, Sasser E. Contraceptive implant failures among women using antiretroviral therapy in western Kenya: a retrospective cohort study. Gates Open Res 2020; 3:1482. [PMID: 32051928 PMCID: PMC6996231 DOI: 10.12688/gatesopenres.12975.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background: Women living with HIV have the right to choose whether, when and how many children to have. Access to antiretroviral therapy (ART) and contraceptives, including implants, continues to increase in Kenya. Studies have reported drug-drug interactions leading to contraceptive failures among implant users on ART. This retrospective record review aimed to determine unintentional pregnancy rates among women 15-49 years of age, living with HIV and concurrently using implants and ART in western Kenya between 2011 and 2015. Methods: We reviewed charts of women with more than three months of concurrent implant and ART use. Implant failure was defined as implant removal due to pregnancy or birth after implant placement, but prior to scheduled removal date. The incidence of contraceptive failure was calculated by woman-years at risk, assuming a constant rate. Results: Data from 1,152 charts were abstracted, resulting in 1,190 implant and ART combinations. We identified 115 pregnancies, yielding a pregnancy incidence rate of 6.32 (5.27–7.59), with 9.26 among ETG and 4.74 among LNG implant users, respectively. Pregnancy incidence rates did not differ between EFV- and NVP-based regimens (IRR=1.00, CI: 0.71-1.43). No pregnancies were recorded among women on PI-based regimens, whereas pregnancy rates for efavirenz and nevirapine-containing regimens were similar, at 6.41 (4.70–8.73) and 6.44 (5.13–8.07), respectively. Pregnancy rates also differed significantly by implant type, with LNG implant users half as likely to experience pregnancy as ETG implant users (0.51, CI: 0.33-0.79, p>0.01). Conclusions: Our findings highlight the implications of drug-drug interaction on women’s choices for contraception.
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Affiliation(s)
- Anne Pfitzer
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW Suite 300, Washington, DC, 20036, USA
| | - Jacqueline Wille
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW Suite 300, Washington, DC, 20036, USA
| | | | | | - Molly Strachan
- Maternal and Child Survival Program/Jhpiego, 1776 Massachusetts Ave, NW Suite 300, Washington, DC, 20036, USA
| | | | | | | | - Supriya D Mehta
- School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, IL, 60612, USA
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Yator O, Mathai M, Albert T, Kumar M. Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi. Front Psychiatry 2020; 11:532557. [PMID: 33716799 PMCID: PMC7947326 DOI: 10.3389/fpsyt.2020.532557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/21/2020] [Indexed: 12/04/2022] Open
Abstract
Background: We look at how various HIV-related stigma subtypes, especially internalizing types, interact with postpartum depression (PPD) among women living with HIV. Additionally, we identify key psychosocial risk factors that influence stigma and PPD among women attending Prevention of Mother-to-Child Transmission (PMTCT) clinics. Methods: In this cross-sectional design, 123 women living with HIV were recruited. Participants ages between 18 and 50, who were at least 8 weeks postpartum seeking PMTCT services at Kenyatta National Hospital (KNH), between June and September 2014 participated in the study. HIV/AIDS Stigma Instrument-PLWHA (HASI-P) was used to assesses stigma and Postpartum depression was assessed by Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV-related stigma Scale. Post survey a few in-depth-interviews were conducted to explore individuals' stigma and depression experiences. Results: The mean age was 31.2 years (SD = 5.2). Fifty-nine (48%) women screened positive for significant depressive symptoms. Post-partum depression was a significant predictor of internalized stigma, enacted, and total stigma (P < 0.05). Older age was associated with less internalized stigma. Living with a partner was associated with more internalized stigma. Having an income above 100 USD per month was protective against stigma. Having good family social support was protective against internalized stigma. A higher educational level was protective against enacted stigma. Being treated for STIs was a risk factor for both enacted and overall stigma. Conclusions: HIV-related stigma needs to be addressed through integrated mental health care programs in PMTCT. Postpartum depression requires comprehensive management to improve short- and long-term outcomes of women living with HIV.
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Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Pfitzer A, Wille J, Wambua J, Stender SC, Strachan M, Ayuyo CM, Muhavi TFK, Wabwile V, Mehta SD, Sasser E. Contraceptive implant failures among women using antiretroviral therapy in western Kenya: a retrospective cohort study. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.12975.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Women living with HIV have the right to choose whether, when and how many children to have. Access to antiretroviral therapy (ART) and contraceptives, including implants, continues to increase due to a multitude of efforts. In Kenya, 4.8% of adults are living with HIV, and in 2017, 54% were receiving an efavirenz-based ART regimen. Meanwhile, 16.1% of all Kenyan married (and 10.4% of unmarried) women used implants. Studies have reported drug interactions leading to contraceptive failures among implant users on ART. This retrospective record review aimed to determine unintentional pregnancy rates among women 15-49 years of age, living with HIV and concurrently using implants and ART in western Kenya between 2011 and 2015. Methods: We reviewed charts of women with more than three months of concurrent implant and ART use. Implant failure was defined as implant removal due to pregnancy or birth after implant placement, but prior to scheduled removal date. The incidence of unintended pregnancy was calculated by woman-years at risk, assuming a constant rate. Results: Data from 1,152 charts were abstracted, resulting in 1,190 implant and ART combinations. We identified 115 pregnancies, yielding a pregnancy incidence rate of 6.32 (5.27–7.59), with 9.26 among ETG and 4.74 among LNG implant users, respectively. No pregnancies were recorded among women on non-NNRTI-based regimens, whereas pregnancy rates for efavirenz and nevirapine-containing regimens were similar, at 6.41 (4.70–8.73) and 6.44 (5.13–8.07), respectively. Conclusions: Our findings highlight the implications of drug interaction on women’s choices for contraception.
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Narasimhan M, Yeh PT, Haberlen S, Warren CE, Kennedy CE. Integration of HIV testing services into family planning services: a systematic review. Reprod Health 2019; 16:61. [PMID: 31138307 PMCID: PMC6538541 DOI: 10.1186/s12978-019-0714-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. METHODS We conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017. RESULTS Of 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes. CONCLUSIONS Global progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Consistent condom use among highly effective contraceptive users in an HIV-endemic area in rural Kenya. PLoS One 2019; 14:e0216208. [PMID: 31059524 PMCID: PMC6502455 DOI: 10.1371/journal.pone.0216208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Women of reproductive age are at the highest risk of both HIV infection and unintended pregnancy in sub-Saharan Africa. Highly effective contraceptives (HECs) such as hormonal injectable and implants are widely used in this region. HECs are effective for preventing pregnancies. However, unlike condoms, HECs offer no protection against HIV. Dual-method use, or the use of condoms with HECs, is an ideal option to reduce HIV risk but is infrequently practiced. Rather, women tend not to use condoms when they use HECs and increase their HIV risk from their sexual partners. However, it remains unknown whether HIV status affects such tendency. Given the increasing popularity of HECs in sub-Saharan Africa, this study examined the association between the use of HECs and condom use among HIV-positive and negative women. Methods A cross-sectional study was conducted among 833 sexually active women aged 18–49 years, recruited from six clinics in Siaya county, Kenya. From March to May 2017, female research assistants interviewed the women using a structured questionnaire. Multiple logistic regression analysis was conducted to examine the association between HEC use and consistent condom use in the past 90 days, adjusting for potential confounders. It was also examined with regular partners (husbands or live-in partners) and non-regular partners, separately. In addition, a sub-sample analysis of HIV-negative or unknown women was conducted. Results In total, 735 women were available for the analysis. Among the women, 231 (31.4%) were HIV-positive. HIV-positive women were more likely to use HECs than HIV-negative or status unknown women (70.1% vs. 61.7%, p = 0.027). HEC use was significantly associated with decreased condom use with a regular partner (adjusted odds ratio (AOR) = 0.25; 95% CI 0.15–0.43, p<0.001) and a non-regular partner (AOR = 0.25; 95% CI 0.11–0.58, p = 0.001). However, compared with HIV-negative or status unknown women, HIV-positive women were more likely to use HECs and condoms consistently with a regular partner (AOR = 6.54, 95% CI 2.15–20.00, p = 0.001). Other factors significantly associated with consistent condom use included partner’s positive attitude toward contraception, partner’s HIV-positive status, high HIV risk perception, and desire for children in the future. Conclusion Dual-method use was limited among HIV-negative women and women who had HIV-negative partners due to inconsistent condom use. The use of HECs was significantly associated with decreased condom use, regardless of partner type and their HIV status. Due to this inverse association, HIV-negative women may increase their HIV risk from their sexual partners. Therefore, interventions should be strengthened to reduce their dual risks of HIV infection and unintended pregnancy by promoting dual-method use. Family planning services should strengthen counseling on the possible risk of HIV infection from their sexual partners and target not only women but also their partners, who may play a key role in condom use.
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Wittlin BB, Carvalho AW, Lima GP, Andersson R, Johansson S, Machado ES, P. Da Costa T, Hofer CB. Unintended Repeat Pregnancies Among HIV Positive Women in Rio De Janeiro, Brazil. Open AIDS J 2018. [DOI: 10.2174/1874613601812010174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
High rates of unintended pregnancies among HIV positive women have been reported by several studies. Among repeated pregnancies, these rates may be higher. Our aim was to describe the unintended pregnancy rate in repeat gestations of the same group of HIV-positive women.
Methodology:
From a prospective cohort of HIV-infected pregnant women followed-up from 1995 to 2013 in an Antenatal Clinic (ANC) in Rio de Janeiro, we selected women who had at least two consecutive pregnancies. Patient data were prospectively obtained from standardized questionnaires. The main dependent variable was if the pregnancy was intended or unintended. Some of the other variables were: age, the interval between pregnancies, household income, CD4 cells count at admission in the ANC and at delivery, viral load<1000 copies/ml at admission and close to delivery, and attempts to illegal abortion.
Results:
From a total of 287 women included, the number of unintended pregnancies increased from 138 (63.6%) at first pregnancy to 198 (81.8%) at second pregnancy (p < 0.01). At first pregnancy, we observed 8 women who had made an attempt to illegal abortion (7 with an unintended pregnancy and 1 with a wanted pregnancy, p = 0.06), while at second pregnancy, 34 of them had made an attempt (33 with unintended pregnancy and 1 with a wanted pregnancy, p < 0.01). Regarding viral load suppression close to delivery, there was no statistic difference between first and second pregnancies (72,7% vs. 70,5%, p = 0.36) as well as between intended and unintended pregnancies (in first pregnancy: 80% vs. 86%, p = 0.4; in second pregnancy: 72% vs. 83%, p = 0,1).
Conclusion:
High rates of unintended pregnancies and illegal abortion attempts, along with their increase from one pregnancy to the subsequent, reinforce the need for continuous family planning practices in HIV-infected patients. The majority of the women were able to reach undetectable viral load at the end of the pregnancy, including those with unintended pregnancies.
Implications:
HIV infected patients presenting in antenatal care for sequential unintended pregnancies. Despite the fact that abortion is illegal in this country, a substantial number of women, still attempt it before attending antenatal care. Family planning actions should be performed during the antenatal care.
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Uchendu O, Adeoti H, Adeyera O, Olabumuyi O. After obstetric fistula repair; willingness of women in Northern Nigeria to use family planning. J OBSTET GYNAECOL 2018; 39:313-318. [PMID: 30428739 DOI: 10.1080/01443615.2018.1514591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Utilisation of modern family planning (FP) is important for women with obstetric fistula (OF). Preventing pregnancy ensures a proper healing and the success of fistula repair. In Northern Nigeria, prevalence of OF is high while the prevalence of FP utilisation is low. This study assessed the willingness to use family planning among 420 women receiving care at obstetric fistula centres in three northern Nigerian States using a semi-structured questionnaire. Concerning family planning methods, 56.7% were aware, only three (1.3%) had ever utilised any method and 63.8% were willing to use a family planning method in the near future. Age, type of marriage and the presence of surviving children were the significant predictors of willingness to use family planning among women with fistula. There is a moderate awareness of family planning with very low utilisation rates. However, a high proportion of these women are willing to use FP. Therefore, there is a need for integration of FP services with OF services. Impact statement What is already known on this subject? Obstetric fistula remains a problem of public health significance in developing countries and emphasis is being laid on surgical repair which is successful in 80-95% of cases. What do the results of this study add? The willingness of women with OF to use FP to improve repair success rate and prevent recurrence by delaying pregnancy. What are the implications of these findings for clinical practice and/or further research? It provides a proxy for post-repair practice. It also assesses the integrated fistula repair services which include counselling and providing the use of family planning services.
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Affiliation(s)
- Obioma Uchendu
- a Department of Community Medicine, Faculty of Clinical Sciences , University of Ibadan , Ibadan , Nigeria.,b Department of Community Medicine , University College Hospital , Ibadan , Nigeria
| | - Hadizah Adeoti
- a Department of Community Medicine, Faculty of Clinical Sciences , University of Ibadan , Ibadan , Nigeria
| | - Oluwapelumi Adeyera
- a Department of Community Medicine, Faculty of Clinical Sciences , University of Ibadan , Ibadan , Nigeria
| | - Olayide Olabumuyi
- b Department of Community Medicine , University College Hospital , Ibadan , Nigeria
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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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Peltzer K, Sifunda S, Mandell LN, Rodriguez VJ, Lee TK, Cook R, Weiss SM, Jones DL. Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:9-17. [PMID: 29497335 PMCID: PMC5818871 DOI: 10.2147/hiv.s153212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction This study aimed to assess fertility intentions (planning to have more children in the future) and associated factors among pregnant and postpartum HIV positive women in rural South Africa. Methods In a longitudinal study, as part of a prevention of mother to child transmission (PMTCT) intervention trial, 699 HIV positive prenatal women, were systematically recruited and followed up at 6 months and 12 months postpartum (retention rate = 59.5%). Results At baseline, 32.9% of the women indicated fertility intentions and at 12 months postnatal, 120 (28.0%) reported fertility intentions. In longitudinal analyses, which included time-invariant baseline characteristics predicting fertility intention over time, not having children, having a partner with unknown/HIV-negative status, and having disclosed their HIV status to their partner, were associated with fertility intentions. In a model with time-varying covariates, decreased family planning knowledge, talking to a provider about a future pregnancy, and increased male involvement were associated with fertility intentions. Conclusion Results support ongoing perinatal family planning and PMTCT education.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.,Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Sibusiso Sifunda
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Cook
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Mutemwa R, Mayhew SH, Warren CE, Abuya T, Ndwiga C, Kivunaga J. Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya. Health Policy Plan 2017; 32:iv91-iv101. [PMID: 29194543 PMCID: PMC5886058 DOI: 10.1093/heapol/czx090] [Citation(s) in RCA: 12] [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] [Accepted: 07/03/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility structural and provider factors.
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Affiliation(s)
- Richard Mutemwa
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Susannah H Mayhew
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Avenue NW, Suite 280 Washington, DC 20008 United States
| | - Timothy Abuya
- Population Council, Ralph Bunche Rd, Upper Hill, Nairobi, Kenya
| | - Charity Ndwiga
- Population Council, Ralph Bunche Rd, Upper Hill, Nairobi, Kenya
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Warren CE, Hopkins J, Narasimhan M, Collins L, Askew I, Mayhew SH. Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response. Health Policy Plan 2017; 32:iv102-iv107. [PMID: 29194542 PMCID: PMC5886280 DOI: 10.1093/heapol/czx052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte E Warren
- Population Council, Suite 280, 4301 Connecticut Avenue NW, Washington, DC 20008, USA
| | - Jonathan Hopkins
- International Planned Parenthood Foundation, 4 Newhams Row, London SE1 3UZ, UK
| | | | - Lynn Collins
- UNFPA, 605 Third Avenue, New York, NY 10158, USA and
| | - Ian Askew
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Susannah H Mayhew
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Mayhew SH, Colombini M, Kimani JK, Tomlin K, Warren CE, Mutemwa R. Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study. BMC Public Health 2017; 17:626. [PMID: 28679389 PMCID: PMC5498886 DOI: 10.1186/s12889-017-4514-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventing unwanted pregnancies in Women Living with HIV (WLHIV) is a recognised HIV-prevention strategy. This study explores the fertility intentions and contraceptive practices of WLHIV using services in Kenya. METHODS Two hundred forty women self-identifying as WLHIV who attended reproductive health services in Kenya were interviewed with a structured questionnaire in 2011; 48 were also interviewed in-depth. STATA SE/13.1, Nvivo 8 and thematic analysis were used. RESULTS Seventy one percent participants did not want another child; this was associated with having at least two living children and being the bread-winner. FP use was high (92%) but so were unintended pregnancies (40%) while living with HIV. 56 women reported becoming pregnant "while using FP": all were using condoms or short-term methods. Only 16% participants used effective long-acting reversible contraceptives or permanent methods (LARC-PM). Being older than 25 years and separated, widowed or divorced were significant predictors of long-term method use. Qualitative data revealed strong motivation among WLHIV to plan or prevent pregnancies to avoid negative health consequences. Few participants received good information about contraceptive choices. CONCLUSIONS WLHIV need better access to FP advice and a wider range of contraceptives including LARC to enable informed choices that will protect their fertility intentions, ensure planned pregnancies and promote safe child-bearing. TRIAL REGISTRATION Integra is a non-randomised pre-post intervention trial registered with Current Controlled Trials ID: NCT01694862 .
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - James Kelly Kimani
- Department for International Development (DfID), (at the time of this research, Kimani was with the Population Council, Nairobi), Nairobi, Kenya
| | - Keith Tomlin
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | - Richard Mutemwa
- Centre for Infectious Disease Research (at the time of this research, Mutemwa was with the LSHTM), Lusaka, Zambia
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25
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Development of a mother and baby unit contraception assessment tool. Arch Womens Ment Health 2016; 19:1129-1140. [PMID: 27664103 DOI: 10.1007/s00737-016-0665-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
Unplanned pregnancies are a unique, yet significant risk factor in perinatal mental health. Our aim was to create an assessment tool to assess mother's views on contraception as part of the discharge planning process. We used a quantitative-qualitative approach. A clinician-guided questionnaire was completed by patients prior to their discharge from hospital and analysed using Microsoft Excel. Semi-structured interviews were used to explore views regarding family planning in greater depth. Interviews were recorded and transcribed verbatim onto Microsoft Word. Emerging themes were identified using a grounded theory thematic analysis approach. Eighteen inpatients were assessed at the Bethlem Mother and Baby Unit over a 4-month period (May-August 2015). Half of the women stated that the pregnancy was unplanned. The most common contraception methods used were condoms, followed by no method/natural cycle technique. Forty-four percent felt unsure of contraception options available and were keen for further advice and referral to family planning services. Interestingly, almost all the women interviewed stated that their experience of perinatal mental illness had changed their views on having more children. The contraception assessment tool is a short, simple questionnaire that can be adopted across inpatient and community settings. In cooperating family, planning into the discharge care plan could be protective in preventing future unplanned pregnancies in women at high risk of perinatal mental illness relapse. Performing the assessment also provided an added opportunity for psycho-education regarding reproductive health and medication use during the perinatal period. The tool also encouraged liaison with GPs and local family planning services.
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