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Smith-Jeffcoat SE, Biddle JE, Talbot HK, Morrisey KG, Stockwell MS, Maldonado Y, McLean HQ, Ellingson KD, Bowman NM, Asturias E, Mellis AM, Johnson S, Kirking HL, Rolfes MA, Olivo V, Merrill L, Battan-Wraith S, Sano E, McLaren SH, Vargas CY, Goodman S, Sarnquist CC, Govindaranjan P, Petrie JG, Belongia EA, Ledezma K, Pryor K, Lutrick K, Bullock A, Yang A, Haehnel Q, Rao S, Zhu Y, Schmitz J, Hart K, Grijalva CG, Salvatore PP. Symptoms, Viral Loads, and Rebound Among COVID-19 Outpatients Treated With Nirmatrelvir/Ritonavir Compared With Propensity Score-Matched Untreated Individuals. Clin Infect Dis 2024; 78:1175-1184. [PMID: 37963102 PMCID: PMC11090981 DOI: 10.1093/cid/ciad696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Nirmatrelvir/ritonavir (N/R) reduces severe outcomes from coronavirus disease 2019 (COVID-19); however, rebound after treatment has been reported. We compared symptom and viral dynamics in individuals with COVID-19 who completed N/R treatment and similar untreated individuals. METHODS We identified symptomatic participants who tested severe acute respiratory syndrome coronavirus 2-positive and were N/R eligible from a COVID-19 household transmission study. Index cases from ambulatory settings and their households contacts were enrolled. We collected daily symptoms, medication use, and respiratory specimens for quantitative polymerase chain reaction for 10 days during March 2022-May 2023. Participants who completed N/R treatment (treated) were propensity score matched to untreated participants. We compared symptom rebound, viral load (VL) rebound, average daily symptoms, and average daily VL by treatment status measured after N/R treatment completion or 7 days after symptom onset if untreated. RESULTS Treated (n = 130) and untreated participants (n = 241) had similar baseline characteristics. After treatment completion, treated participants had greater occurrence of symptom rebound (32% vs 20%; P = .009) and VL rebound (27% vs 7%; P < .001). Average daily symptoms were lower among treated participants without symptom rebound (1.0 vs 1.6; P < .01) but not statistically lower with symptom rebound (3.0 vs 3.4; P = .5). Treated participants had lower average daily VLs without VL rebound (0.9 vs 2.6; P < .01) but not statistically lower with VL rebound (4.8 vs 5.1; P = .7). CONCLUSIONS Individuals who completed N/R treatment experienced fewer symptoms and lower VL but rebound occured more often compared with untreated individuals. Providers should prescribe N/R, when indicated, and communicate rebound risk to patients.
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Affiliation(s)
- Sarah E. Smith-Jeffcoat
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jessica E. Biddle
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons
- Department of Population and Family Health Columbia University Mailman School of Public Health
- New York-Presbyterian Hospital, New York, NY
| | | | | | | | | | | | | | - Sheroi Johnson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hannah L. Kirking
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Ellen Sano
- New York-Presbyterian Hospital, New York, NY
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Son H. McLaren
- New York-Presbyterian Hospital, New York, NY
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Celibell Y. Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons
| | - Sara Goodman
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Karla Ledezma
- University of Arizona College of Medicine, Tucson, AZ
| | | | - Karen Lutrick
- University of Arizona College of Medicine, Tucson, AZ
| | | | - Amy Yang
- University of North Carolina, Chapel Hill, NC
| | | | | | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Phillip P. Salvatore
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, GA
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Serenska A, Sarnquist CC, Darmstadt GL. Variation in rates of sexual assault crisis counsellor usage during forensic examination in California: an observational study. BMJ Open 2023; 13:e072635. [PMID: 37865414 PMCID: PMC10603459 DOI: 10.1136/bmjopen-2023-072635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023] Open
Abstract
OBJECTIVES A critical asset to post-assault care of survivors is support from sexual assault crisis counsellors (SACCs). We sought to elucidate variation in implementation between California counties in SACC accompaniment during Sexual Assault Forensic Examination (SAFE). METHODS SACC attendance data from 2019 was obtained from the California Governor's Office of Emergency Services (CalOES). To assess SACC attendance rates during SAFEs, we requested SAFE quantity data from sheriffs and public health departments, the State Forensic Bureau, and the California Department of Justice (DOJ), but all requests were unanswered or denied. We also sought SAFE data from District Attorneys (DAs) in each county, and received responses from Marin and Contra Costa Counties. To estimate numbers of SAFEs per county, we gathered crime statistics from the Federal Bureau of Investigation's (FBI's) Uniform Crime Reporting Program and OpenJustice, a transparency initiative by the California DOJ. For each data source, we compared SACC attendance to SAFE quantities and incidences of sexual assault statewide. RESULTS At the state level, data on SACC attendance per CalOES and DOJ archival data on sexual assault were used to approximate relative rates of SACC accompaniment at SAFEs; 83% (30 of 36) of counties had values <50%. The joint sexual assault crisis centre for Contra Costa and Marin Counties reported that 140 SACCs were dispatched in 2019, while DAs in Contra Costa and Marin reported completion of 87 SAFEs in 2019, for a calculated SACC accompaniment rate of 161%. Proxy data sourced from FBI and DOJ crime statistics displayed significant inconsistencies, and DOJ data was internally inconsistent. CONCLUSIONS SACC accompaniment at SAFEs appears to be low in most California counties, however, limited data accessibility and data discrepancies and inaccuracies (e.g., rates over 100%) prevented reliable determination of SACC accompaniment rates during SAFEs. Substantial improvements in data accuracy and transparency are needed to ensure survivors' adequate access to resources.
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Affiliation(s)
- Alice Serenska
- Program in Human Biology, Stanford University, Stanford, California, USA
| | - Clea C Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Altamirano J, Odero IA, Omollo M, Awuonda E, Ondeng’e K, Kang JL, Behl R, Ndivo R, Baiocchi M, Barsosio HC, Sarnquist CC. Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators. Int J Environ Res Public Health 2023; 20:6922. [PMID: 37887660 PMCID: PMC10606388 DOI: 10.3390/ijerph20206922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND HIV remains a leading cause of death for adolescent girls and young women (AGYW) in sub-Saharan Africa. This population has a high incidence of HIV and other comorbidities, such as experiencing violence, and low antiretroviral therapy (ART) adherence. To reach global HIV goals, data are needed on the specific adherence barriers for AGYW living with HIV, so interventions can be targeted effectively. METHODS Cross-sectional data were collected at urban and rural health facilities in and around Kisumu County, western Kenya, from January to June 2022, from AGYW 15-24 years of age who were living with HIV. Surveys included questions on intimate partner violence, mental health issues, food security, and orphanhood. Adherence was categorized using viral load testing where available and the Center for Adherence Support Evaluation (CASE) adherence index otherwise. Logistic regression was used to assess associations between potential explanatory variables and adherence. FINDINGS In total, 309 AGYW participated. AGYW with experiences of emotional violence (Odds Ratio [OR] = 1.94, 95% Confidence Interval [CI] = 1.03-3.66), moderate or severe depression (OR = 3.19, 95% CI = 1.47-6.94), and/or substance use (OR = 2.71, 95% CI = 1.24-5.92) had significantly higher odds of poor adherence when compared to AGYW without these respective experiences. Physical and sexual violence, food insecurity, and orphanhood were not associated with poor adherence in this cohort. INTERPRETATION Elucidating the risk factors associated with poor adherence among AGYW living with HIV allows us to identify potential targets for future interventions to improve ART adherence and HIV care outcomes. Mental health and violence prevention interventions, including combination interventions, may prove to be promising approaches.
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Affiliation(s)
- Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Isdorah A. Odero
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Mevis Omollo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Eucabeth Awuonda
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Jennifer L. Kang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
| | - Richard Ndivo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Hellen C. Barsosio
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu 40100, Kenya; (I.A.O.); (M.O.); (E.A.); (K.O.); (R.N.); (H.C.B.)
| | - Clea C. Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.L.K.); (R.B.); (C.C.S.)
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Mphamba D, Solomon FR, Nyairo G, Kim CJ, Krishnamoorthi M, Edem B, Amuyunzu-Nyamongo M, Kang J, Baiocchi M, Sarnquist CC. Youth voices from an informal settlement of Nairobi, Kenya: Engaging adolescent perspectives on violence to inform prevention. Glob Public Health 2022; 17:3686-3699. [PMID: 35579915 DOI: 10.1080/17441692.2022.2076895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the experiences of violence and self-reported behavioural and community changes as a result of participation in a sexual assault prevention intervention in an informal settlement in Nairobi, Kenya. We conducted longitudinal qualitative in-depth interviews with 20 adolescent girls and 11 adolescent boys at baseline, 12, and 24 months. Analysis was thematic with two investigators coding and reaching consensus about the themes. Participants' ages ranged from 10 to 13 at baseline; girls' mean age was 11.9, boys' mean age was 11.6. Participants reported experiencing high levels of violence at all stages of the study. Most reported feeling more empowered to protect themselves and others from sexual assault because of the intervention. While participants had mixed responses about change in sexual assault incidence, most perceived an improvement in inter-gender relationships after the intervention. Participants at midline and endline cited acquaintances and friends as potential perpetrators of sexual violence more often than at baseline and were more open to reporting violent incidents. The very young adolescents in this setting perceived that this sexual assault prevention intervention led to improvements in gender relations, adolescent girls' empowerment and, recognition of harmful rape myths.Trial registration: ClinicalTrials.gov identifier: NCT02771132.
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Affiliation(s)
- Dumisile Mphamba
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Gavin Nyairo
- African Institute for Health and Development, Nairobi, Kenya
| | - Candice Jeehae Kim
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Blessing Edem
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jennifer Kang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Clea C Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Sarnquist CC, Ouma L, Lang'at N, Lubanga C, Sinclair J, Baiocchi MT, Cornfield DN. The Effect of Combining Business Training, Microfinance, and Support Group Participation on Economic Status and Intimate Partner Violence in an Unplanned Settlement of Nairobi, Kenya. J Interpers Violence 2021; 36:3903-3921. [PMID: 29862883 DOI: 10.1177/0886260518779067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intimate partner violence (IPV) has myriad negative health and economic consequences for women and families. We hypothesized that empowering women through a combination of formal business training, microfinance, and IPV support groups would decrease IPV and improve women's economic status. The study included adult female survivors of severe IPV. Women living in Korogocho received the intervention and women in Dandora served as a standard of care (SOC) group, but received the intervention at the end of the follow-up period. Women in the intervention groups (n = 82, SOC group, n = 81) received 8 weeks of business training, assistance creating a business plan, a small initial loan (about US$60), and weekly business and social support meetings. The two primary outcome measures included change in: (a) average daily profit margin, and (b) incidence of severe IPV. Exploratory analysis also looked at incidence of violence against children and women's self-efficacy. Average daily profit margin in the intervention group increased by 351 Kenyan Shillings (about US$3.5) daily (95% CI = [172, 485]). IPV directed against participating women decreased from a baseline of 2.1 to 0.26 incidents, a difference of 1.84 incidents (95% CI = [1.32, 2.36]). Violence against children in the household in the prior 3 months decreased from 1.1 to 0.55 incidents, a difference of 0.55 incidents (95% CI = [0.16, 1.03]). Finally, the intervention appears to have increased self-efficacy scores by 0.42 points (95% CIs 0.13, 0.71). In a low-resource urban environment, employing three complementary interventions resulted in higher daily profit margins and lower IPV in the intervention compared with the SOC group. These data support the notion that employing multiple interventions concomitantly might possess synergistic, beneficial effects, and hold promise to address profound poverty and interrupt the devastating cycle of IPV.
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Fu R, Altamirano J, Sarnquist CC, Maldonado YA, Andrews JR. Assessing the Risk of Vaccine-derived Outbreaks After Reintroduction of Oral Poliovirus Vaccine in Postcessation Settings. Clin Infect Dis 2018; 67:S26-S34. [PMID: 30376087 PMCID: PMC6206116 DOI: 10.1093/cid/ciy605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The Polio Eradication and Endgame Strategic Plan 2013-2018 calls for the gradual withdrawal of oral poliovirus vaccine (OPV) from routine immunization. We aimed to quantify the transmission potential of Sabin strains from OPV when it is reintroduced, accidentally or deliberately, in a community vaccinated with inactivated poliovirus vaccine alone. Methods We built an individual-based stochastic epidemiological model that allows independent spread of 3 Sabin serotypes and differential transmission rates within versus between households. Model parameters were estimated by fitting to data from a prospective cohort in Mexico. We calculated the effective reproductive number for the Mexico cohort and simulated scenarios of Sabin strain resurgence under postcessation conditions, projecting the risk of prolonged circulation, which could lead to circulating vaccine-derived poliovirus (cVDPV). Results The estimated effective reproductive number for naturally infected individuals was about 1 for Sabin 2 and Sabin 3 (OPV2 and OPV3) in a postcessation setting. Most transmission events occurred between households. We estimated the probability of circulation for >9 months to be (1) <<1% for all 3 serotypes when 90% of children <5 years of age were vaccinated in a hypothetical outbreak control campaign; (2) 45% and 24% for Sabin 2 and Sabin 3, respectively, when vaccine coverage dropped to 10%; (3) 37% and 8% for Sabin 2 and Sabin 3, respectively, when a single active shedder appeared in a community. Conclusions Critical factors determining the risk of cVDPV emergence are the scale at which OPV is reintroduced and the between-household transmission rate for poliovirus, with intermediate values posing the greatest risk.
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Affiliation(s)
- Rui Fu
- Department of Management Science and Engineering, Stanford University, California
| | | | | | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California
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Sarnquist CC, Garcia-Gacia L, Reyes LF, Montero-Campos R, Cruz-Hervert LP, Altamirano J, Holubar M, Talib A, Purington N, Halpern M, Ferreira E, Delgado G, Quintero SC, Maldonado Y. Preventing Polio Post-Eradication: Elucidating Polio Virus Shedding and Transmission Patterns in the Presence of Inactivated Polio Vaccine and Oral Polio Vaccine. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clea C. Sarnquist
- Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | - Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aisha Talib
- Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Natasha Purington
- Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Meira Halpern
- Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | | | - Yvonne Maldonado
- Pediatrics, Stanford University School of Medicine, Stanford, California
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Abstract
This qualitative study aimed to assess factors influencing pregnant women's decision to seek or avoid antenatal care (ANC) in the Andes of Peru. Open-ended, semi-structured interviews were conducted with 24 women utilizing ANC (+) and 10 women avoiding ANC (-). Interviews were translated to English from Quechua and Spanish, transcribed, and analyzed using grounded theory. Factors influencing ANC- women included: expecting criticism for having additional children; long ANC wait time and inconvenient hours of operation; and masculine gender of health workers. For ANC+ women, motivating factors included: maximizing positive health outcomes; past negative maternity experiences; pressure from family members; and avoidance of rumored fines or fees associated with ANC non-attendance and in-hospital deliveries, respectively. Both ANC+ and ANC- women were fearful and embarrassed about possible criticism for having additional children and the gender of the health workers, yet they weighed these factors differently. To better understand how rural women make decisions about ANC attendance, it is important to consider the value they place on the factors influencing their decision, and their emotional assessment of such issues.
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Affiliation(s)
- Laura S Huaman Ayala
- Program in Human Biology, Stanford University, 450 Serra Mall, Building 20, Stanford, CA 94305, USA.
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Sarnquist CC, Moyo P, Stranix-Chibanda L, Chipato T, Kang JL, Maldonado YA. Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe. Contraception 2013; 89:209-14. [PMID: 24332254 DOI: 10.1016/j.contraception.2013.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/23/2013] [Accepted: 11/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health. STUDY DESIGN HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n=33) or intervention (n=65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher's Exact Tests, binomial tests and t tests. RESULTS The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~2% at baseline to >80% at 3 months postpartum (p<.001). CONCLUSIONS FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond. IMPLICATIONS This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.
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Affiliation(s)
- Clea C Sarnquist
- Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA.
| | - Precious Moyo
- University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe
| | - Lynda Stranix-Chibanda
- University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe; University of Zimbabwe, College of Health Sciences, Parirenyatwa General Hospital, Harare, Zimbabwe
| | - Tsungai Chipato
- University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe; University of Zimbabwe, College of Health Sciences, Parirenyatwa General Hospital, Harare, Zimbabwe
| | - Jennifer L Kang
- Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA
| | - Yvonne A Maldonado
- Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA
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Sarnquist CC, Rahangdale L, Maldonado Y. Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa. Curr HIV Res 2013; 11:160-8. [PMID: 23432491 DOI: 10.2174/1570162x11311020008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Review key topics and recent literature regarding reproductive health and family planning needs for HIV-infected women in Sub-Saharan Africa. METHODS Electronic searches performed in PubMed, JSTOR, and Web of Science; identified articles reviewed for inclusion. FINDINGS Most HIV-infected women in Sub-Saharan Africa bear children, and access to antiretroviral therapy may increase childbearing desires and/or fertility, resulting in greater need for contraception. Most contraceptive options can be safely and effectively used by HIV-infected women. Unmet need for contraception is high in this population, with 66- 92% of women reporting not wanting another child (now or ever), but only 20-43% using contraception. During pregnancy and delivery, HIV-infected women need access to prevention of mother-to-child transmission (PMTCT) services, a skilled birth attendant, and quality post-partum care to prevent HIV infection in the infant and maximize maternal health. Providers may lack resources as well as appropriate training and support to provide such services to women with HIV. Innovations in biomedical and behavioral interventions may improve reproductive healthcare for HIV-infected women, but in Sub-Saharan Africa, models of integrating HIV and PMTCT services with family planning and reproductive health services will be important to improve reproductive outcomes. CONCLUSIONS HIV-infected women in Sub-Saharan Africa have myriad needs related to reproductive health, including access to high-quality family planning information and options, high-quality pregnancy care, and trained providers. Integrated services that help prevent unintended pregnancy and optimize maternal and infant health before, during and after pregnancy will both maximize limited resources as well as provide improved reproductive outcomes.
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Affiliation(s)
- Clea C Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, 555 Middlefield Road, Menlo Park, CA 94025, USA.
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Abstract
HIV-infected women living in rural areas often have considerably less access to care than their urban and suburban counterparts. In much of the USA, little is known about HIV care among rural populations. This study elucidated barriers to care for rural women in California. Methods included retrospective structured interviews conducted with 64 women living in rural areas and receiving HIV care at 11 California healthcare facilities. Facilities were randomly sampled and all HIV-infected female patients seeking care at those facilities during a specified time period were eligible. The most commonly cited barriers to accessing care included physical health problems that prevented travel to care (32.8%), lack of transportation (31.2%), and lack of ability to navigate the healthcare system (25.0%). Being divorced/separated/widowed (compared to being either married or single) was associated with reporting physical health as a barrier to care (p=0.03); being unemployed (p=0.003) or having to travel 31-90 minutes (p=0.007, compared to less than 31 or greater than 90) were both associated with transportation as a barrier; and speaking English rather than Spanish was associated with reporting "difficulty navigating the system" (p=0.04). Twenty-nine women (45.3%) reported difficulty in traveling to appointments. Overall, 24 (37.5%) women missed an HIV medical appointment in the previous 12-month period, primarily due to their physical health and transportation limitations. Physical health and transportation problems were both the major barriers to accessing health services and the primary reasons for missing HIV care appointments among this population of HIV-infected women living in rural areas. Providing transportation programs and/or mobile clinics, as well as providing support for patients with physical limitations, may be essential to improving access to HIV care in rural areas.
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Affiliation(s)
- Clea C Sarnquist
- Pediatric Infectious Diseases, Stanford University School of Medicine, CA, USA.
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Sarnquist CC, Grieb EM, Maldonado YA. How racial and ethnic groupings may mask disparities: the importance of separating Pacific Islanders from Asians in prenatal care data. Matern Child Health J 2009; 14:635-41. [PMID: 19582560 DOI: 10.1007/s10995-009-0494-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 06/17/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand racial/ethnic differences in prenatal care receipt among Pacific Islanders and Asians, who are often combined into a single A/PI category. METHODS Retrospective, population-based data were collected by the Vital Statistics branch of the California Department of Health Services. Approximately 2.6 million records of all live California births with a birth certificate in 2000-2004 were included. Analysis focused on prenatal care receipt and population characteristics associated with lack of adequate prenatal care, especially among Asian and Pacific Islander groups. RESULTS Pacific Islanders (n = 11,962) were the most likely, compared to any other racial/ethnic group, to have inadequate prenatal care (OR = 2.9, 95% CIs 2.8-3.1), even when controlling for factors known to affect care receipt, specifically maternal age, educational attainment, parity, insurance, geographical region of residence, and maternal place of birth. In contrast, Asian women (n = 295,741) received care closer to that of the White reference group (OR = 1.5, 95% CIs 1.5-1.5). Among Pacific Islanders, Samoans (OR = 3.0, 95% CIs 2.7-3.4) were at particular risk of inadequate care compared to other PI sub-groups. CONCLUSION Pacific Islander women received less adequate prenatal care than women of other racial/ethnic groups. The common practice of combining Asians and Pacific Islanders into a single A/PI category may mask needs in the Pacific Islander community. Therefore, in order to continue to reduce health disparities, it may be necessary to collect separate data on these two distinct populations in order to be able to appropriately direct programs and resources.
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Affiliation(s)
- Clea C Sarnquist
- Stanford University School of Medicine, 466 Via Ortega Road, Cypress Hall E Wing, Mail Code 4148, Stanford, CA 94305, USA.
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Sarnquist CC, Cunningham SD, Sullivan B, Maldonado Y. The effectiveness of state and national policy on the implementation of perinatal HIV prevention interventions. Am J Public Health 2007; 97:1041-6. [PMID: 17463383 PMCID: PMC1874218 DOI: 10.2105/ajph.2005.072371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The 1994 and 1995 US Public Health Service Guidelines regarding HIV testing and treatment for pregnant women and the resulting 1995 California law mandating an HIV test and treatment offer to every pregnant woman aim to reduce perinatal HIV transmission. However, the effectiveness of such policies after implementation is often unclear. We analyzed the association between these policies and offers of HIV tests and treatment to HIV-infected women in California. METHODS Data from active, population-based surveillance of 496 HIV-infected women and their infants, collected from 1987 to 2002, were analyzed to compare rates of offers of HIV tests and treatment before and after 1996. RESULTS We found significant increases in offers of HIV tests (P<.001) and offers of treatment (P<.001) when we compared women who delivered between 1987 and 1995 with those who delivered between 1996 and 2002. Receipt of prenatal care was the major predictor of both test and treatment offer. A significant shift in reported HIV risk factors was also evident between the 2 groups. CONCLUSIONS Our findings of increased offers of HIV tests and treatment to HIV-infected pregnant women suggest that the national guidelines and the 1996 California law improved health care for these women, which may lessen the risk of perinatal HIV transmission.
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Affiliation(s)
- Clea C Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif, USA.
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Kropp RY, Sarnquist CC, Montgomery ET, Ruiz JD, Maldonado YA. A comparison of perinatal HIV prevention opportunities for Hispanic and non-Hispanic women in California. AIDS Educ Prev 2006; 18:430-43. [PMID: 17067254 DOI: 10.1521/aeap.2006.18.5.430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Using a semi-structured survey and convenience sample of pregnant/recently delivered Hispanic (n = 453) and non-Hispanic (n = 904) women in four California counties, this study compared rates of timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test acceptance in PNC between Hispanic and non-Hispanic women. Hispanic women were less likely to report timely PNC initiation (69.3% vs. 80.4%, p < .0001), receiving test offer (69.5% vs. 76.7%, p = .002), and ever having been tested (77.3% vs. 87.9%, p < .0001) than non-Hispanic women. Hispanic women were more likely to report not knowing where to go (p = .04) and having no insurance (p < .001), transportation (p = .001), and child care (p = .007) as reasons for late PNC start. Both Hispanic and non-Hispanic women most commonly accepted a test offer for their health/health of their baby; Hispanic women were more likely to accept based on doctor/nurse recommendation (80.1% vs. 62.7%, p < .001). A quarter of Hispanic and non-Hispanic women reported they didn't feel they had a choice or that test was done automatically. Efforts to improve perinatal HIV prevention opportunities for all women in California are required. Furthermore, Hispanic women may have disparities in receipt of prenatal care and HIV test offer that need additional attention.
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Affiliation(s)
- Rhonda Y Kropp
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
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