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Begg L, Brodsky R, Friedland B, Mathur S, Sailer J, Creasy G. Estimating the market size for a dual prevention pill: adding contraception to pre-exposure prophylaxis (PrEP) to increase uptake. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:166-172. [PMID: 32737137 PMCID: PMC8292580 DOI: 10.1136/bmjsrh-2020-200662] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Uptake of oral pre-exposure prophylaxis (PrEP) remains low. The objective of this analysis was to estimate the potential market size in priority sub-Saharan African countries for a 28-day dual prevention pill (DPP) regimen containing the active pharmaceutical ingredients in oral PrEP and oral contraceptive pills (OCPs) for the prevention of HIV and unintended pregnancy. METHODS We selected 15 countries in sub-Saharan Africa for analysis. Population estimates were based on United Nations Population Division data from 2017. Low, medium and high rates (range 0.25% to 25%) of estimated conversion from current contraceptive method to the DPP were applied by country based on HIV prevalence (≥10% vs <10%), current contraceptive method (OCP, condom or unmet need for contraception) and age group (15-24 or 25-49 years). RESULTS In these 15 countries, between 250 000 and 1.25 million women could switch from their current contraceptive method to the DPP. Given that current PrEP use in the 15 countries combined is estimated to be 113 250 (women and men), the most conservative market size estimate would more than double the number of women currently using PrEP. CONCLUSIONS By leveraging the existing market for OCPs and assuming modest conversion from condom users and women with an unmet need for contraception, the DPP could lead to a 2- to 10-fold increase in PrEP usage in these 15 sub-Saharan African countries, expanding the broader public health benefit of this proven HIV prevention strategy.
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Affiliation(s)
- Lorna Begg
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Rebecca Brodsky
- Center for Biomedical Research, Population Council, New York, New York, USA
| | | | - Sanyukta Mathur
- HIV and AIDS, Population Council, Washington, District of Columbia, USA
| | - Jim Sailer
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - George Creasy
- Center for Biomedical Research, Population Council, New York, New York, USA
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Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa. PLoS One 2018; 13:e0209114. [PMID: 30571702 PMCID: PMC6301780 DOI: 10.1371/journal.pone.0209114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Fertility intentions and contraceptive use are often not assessed in the context of clinical HIV care, representing a possible programming gap if women's family planning needs change over time. We aimed to identify longitudinal patterns of unmet need for contraception over a 12-month period among women living with HIV taking antiretroviral therapy (ART). STUDY DESIGN 850 non-pregnant, HIV-positive women aged 18-35 on or initiating ART in Johannesburg, South Africa, were enrolled into a prospective cohort study in 2009-2010. Fertility intentions and contraceptive use were assessed during routine HIV care visits via an interviewer-administered questionnaire, and women were referred for on-site contraceptive counseling. We used group-based trajectory modeling to identify patterns of unmet need for contraception over 12 months, first in the entire population and then in a subset of recent ART initiators. RESULTS In the full population we identified four patterns of unmet need for contraception over one year. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9% a consistently low probability, 16.7% a decreasing probability, and 10.4% an increasing probability over time. Contraceptive method discontinuation and rapidly changing fertility intentions were the primary drivers of changing (increasing or decreasing) unmet need over follow-up. Results were similar in recent ART initiators. CONCLUSIONS Half of women were estimated to have a high probability of unmet need that persisted over time, and more than a quarter were estimated to experience patterns of changing unmet need over 12 months. Family planning needs should be assessed more regularly in HIV-positive women to prevent unintended pregnancies and support safer conception among women trying to conceive.
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Damian DJ, George JM, Martin E, Temba B, Msuya SE. Prevalence and factors influencing modern contraceptive use among HIV-positive women in Kilimanjaro region, northern Tanzania. Contracept Reprod Med 2018; 3:7. [PMID: 29796296 PMCID: PMC5963155 DOI: 10.1186/s40834-018-0060-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background Mother-to-Child-Transmission (MTCT) of HIV is still a public health problem in sub-Saharan Africa. The region has a high unmet need for family planning and high unplanned pregnancy rates among HIV-positive women. Most efforts to prevent MTCT of HIV have focused on the third prong, a strategy which offers antiretroviral (ARV) drugs to HIV-infected pregnant women and their exposed infants. However, the effective use of contraceptives to prevent unplanned pregnancies among women living with HIV is more effective in reducing HIV MTCT. This study aimed at determining the prevalence and factors influencing modern contraceptive use among HIV-positive women in northern Tanzania. Methods This was a cross-sectional study conducted between January and June 2014 in three selected districts of Kilimanjaro region, Tanzania. Data were collected during face-to-face interviews with HIV-positive women attending Care and Treatment Clinics (CTC) in the selected districts. Multivariate logistic regression analysis was used to determine independent predictors of modern contraceptive use. Results In total 672 HIV-positive women were enrolled. Their mean age was 36.4 years (±7.7). Fifty four percent (362) were currently using modern contraceptives, and the most common method used was male condoms 76% (275) followed by Depo-Provera 28% (101). A total of 33% (121) of the users reported dual contraceptive use. Women with primary education [Adjusted Odds Ratio (AOR) = 7.54, 95% Confidence Interval (CI): 1.51–17.48, P = 0.014]; post-secondary [AOR = 6.23, 95% CI: 1.14–14.07, P = 0.035]; not currently on ARVs [AOR = 11.29, 95% CI: 2.60–19.94, P = 0.001]; currently sexually active [AOR = 8.40, 95% CI: 4.47–15.78, P < 0.001]; ever discussed contraceptive use with partner [AOR = 3.68, 95% CI: 1.67–8.11, P = 0.001]; and being counseled on dual contraceptive use at CTC [AOR = 2.94, 95% CI: 1.66–5.23, P < 0.001]; had significantly higher odds of currently using modern contraceptive methods. Conclusions Given the population studied, the prevalence of modern contraceptive use was low. Strategies are required to increase the use of dual and long-term contraceptive methods among women who do not want more children in order to reduce MTCT, and to improve maternal and child health in the region. Programme managers and health care providers need to identify counseling strategies that are specific to HIV-positive women that not only impart knowledge on contraceptives, but also address the issue of responsibility for influencing HIV transmission in the community.
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Affiliation(s)
- Damian J Damian
- 1Department of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.,Department of Epidemiology & Biostatistics, Institute of Public Health, KCMUCo, P. O. Box 2240, Moshi, Tanzania
| | - Johnston M George
- 3Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Department of Community Health, Institute of Public Health, KCMUCo, Moshi, Tanzania
| | - Erick Martin
- 3Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Beatrice Temba
- 3Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sia E Msuya
- 1Department of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.,Department of Epidemiology & Biostatistics, Institute of Public Health, KCMUCo, P. O. Box 2240, Moshi, Tanzania.,Department of Community Health, Institute of Public Health, KCMUCo, Moshi, Tanzania
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A systematic review of contraceptive continuation among women living with HIV. Contraception 2018; 98:8-24. [PMID: 29432719 DOI: 10.1016/j.contraception.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and unintended pregnancy. Contraceptive method-specific continuation rates and associated factors are critical for guiding providers tasked with both reproductive health (RH) and HIV care. We conducted this systematic review to determine whether contraceptive continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether differences are impacted by method type, antiretroviral therapy use or other factors. METHODS We searched Ovid MEDLINE, POPLINE and PubMed.gov for studies published between January 1, 2000, and August 31, 2016. Inclusion criteria comprised prospective data of WLHIV, nonbarrier method continuation as an outcome measure, and recorded method switching and/or discontinuation. RESULTS Of 939 citations screened, 22 articles from 18 studies were eligible. For studies with comparator groups, data quality was moderate overall based on Grading of Recommendations, Assessment, Development and Evaluations and Newcastle-Ottawa Quality Assessment scales. Of four studies comparing women by HIV serostatus, two showed higher rates of contraceptive continuation among WLHIV versus uninfected women, while two others detected lower continuation rates for the same comparison. Generally, baseline method continuation exceeded 60% for studies with >12months of follow-up. Studies providing contraception had higher continuation rates than studies not providing contraception, while women allocated to contraceptive methods in trials had similar continuation rates to those choosing contraceptive methods. Across all studies, continuation rates differed by method and context, with the copper intrauterine device showing greatest variability between sites (51%-91% continuation rates at ≥12months). Implant continuation rates were ≥86%, though use was low relative to other methods and limited to few studes. CONCLUSIONS Contraceptive continuation among WLHIV differs by method and context. More longitudinal studies with contraceptive continuation as a measured outcome following ≥12months are needed to strengthen integration of RH and HIV care.
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Magadi MA, Magadi WA. HIV/AIDS and contraceptive use: factors associated with contraceptive use among sexually active HIV-positive women in Kenya. Contraception 2016; 95:312-321. [PMID: 27836587 DOI: 10.1016/j.contraception.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES With increased availability of antiretroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya. STUDY DESIGN The study is based on secondary analysis of cross-sectional data of a sample of 9132 sexually active women of reproductive age from the Kenya Demographic and Health Surveys collected in 2003 and 2008. Multilevel logistic regression models are used to examine individual and contextual community-level factors associated with current contraceptive use. RESULTS The study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities. It further reveals striking differences in factors associated with contraceptive uptake between HIV-positive and HIV-negative women. Education and the desire to stop childbearing are strongly associated with contraceptive uptake among uninfected women, but both factors are not significant among HIV-positive women for whom wealth is the most important factor. While HIV-negative women in the richest wealth quintile are about twice as likely to use contraceptives as their counterparts of similar characteristics in the poorest quintile, this gap is about sevenfold among HIV-positive women. CONCLUSION These findings suggest that having the desire and relevant knowledge to use contraceptives does not necessarily translate into expected contraceptive behavior for HIV-positive women in Kenya and that poor HIV-positive women may be particularly in need of increased access to contraceptive services. IMPLICATIONS • Study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities in Kenya. • Results reveal striking differences in factors associated with contraceptive use between HIV-positive and HIV-negative women. • Poverty may be an impediment to contraceptive uptake among HIV-positive women in Kenya.
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Affiliation(s)
- Monica A Magadi
- School of Education and Social Sciences, University of Hull, HU6 7RX, Hull, UK.
| | - Winnie A Magadi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Dasgupta ANZ, Zaba B, Crampin AC. Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 41:145-54. [PMID: 26600568 DOI: 10.1363/4114515] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance. METHODS A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women's cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence. RESULTS The contraceptive point prevalence of 35% was slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable-the most widely used modern method-received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence. CONCLUSIONS Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.
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Yore J, Dasgupta A, Ghule M, Battala M, Nair S, Silverman J, Saggurti N, Balaiah D, Raj A. CHARM, a gender equity and family planning intervention for men and couples in rural India: protocol for the cluster randomized controlled trial evaluation. Reprod Health 2016; 13:14. [PMID: 26897656 PMCID: PMC4761168 DOI: 10.1186/s12978-016-0122-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/20/2016] [Indexed: 11/16/2022] Open
Abstract
Background Globally, 41 % of all pregnancies are unintended, increasing risk for unsafe abortion, miscarriage and maternal and child morbidities and mortality. One in four pregnancies in India (3.3 million pregnancies, annually) are unintended; 2/3 of these occur in the context of no modern contraceptive use. In addition, no contraceptive use until desired number and sex composition of children is achieved remains a norm in India. Research shows that globally and in India, the youngest and most newly married wives are least likely to use contraception and most likely to report husband’s exclusive family planning decision-making control, suggesting that male engagement and family planning support is important for this group. Thus, the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention was developed in recognition of the need for more male engagement family planning models that include gender equity counseling and focus on spacing contraception use in rural India. Methods/Design For this study, a multi-session intervention delivered to men but inclusive of their wives was developed and evaluated as a two-armed cluster randomized controlled design study conducted across 50 mapped clusters in rural Maharashtra, India. Eligible rural young husbands and their wives (N = 1081) participated in a three session gender-equity focused family planning program delivered to the men (Sessions 1 and 2) and their wives (Session 3) by village health providers in rural India. Survey assessments were conducted at baseline and 9&18 month follow-ups with eligible men and their wives, and pregnancy tests were obtained from wives at baseline and 18-month follow-up. Additional in-depth understanding of how intervention impact occurred was assessed via in-depth interviews at 18 month follow-up with VHPs and a subsample of couples (n = 50, 2 couples per intervention cluster). Process evaluation was conducted to collect feedback from husbands, wives, and VHPs on program quality and to ascertain whether program elements were implemented according to curriculum protocols. Fidelity to intervention protocol was assessed via review of clinical records. Discussion All study procedures were completed in February 2015. Findings from this work offer important contributions to the growing field of male engagement in family planning, globally. Trial registration ClinicalTrial.gov, NCT01593943
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Affiliation(s)
- Jennifer Yore
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
| | - Anindita Dasgupta
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
| | - Mohan Ghule
- National Institute for Research in Reproductive Health, Mumbai, India.
| | | | - Saritha Nair
- National Institute of Medical Statistics, New Delhi, India.
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
| | - Niranjan Saggurti
- Bill and Melinda Gates Foundation (formerly of Population Council), New Delhi, India.
| | - Donta Balaiah
- National Institute for Research in Reproductive Health, Mumbai, India.
| | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Kamalikhah T, Rakhshani F, Rahmati Najarkolaei F, Gholian Avval M. Evaluation of Transtheoretical Model-Based Family Education Among Females of Zahedan (Southeast of Iran). IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e18895. [PMID: 26568846 PMCID: PMC4636756 DOI: 10.5812/ircmj.18895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/05/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
Background: It cannot be denied that many improvements in female and child health have been achieved worldwide through international family planning programs. More than half of the females (57%) with unintended pregnancy admitted that they had not used birth control the month before conception. Objectives: The aim of this study was to promote family planning practice among females of Zahedan (southeast of Iran) through the transtheoretical model (TTM). Patients and Methods: The current quasi-experimental study was conducted on 96 eligible females, who were allocated either to the case or the control group and were selected from homes in the border of Zahedan city (southeast of Iran) during 2010. Convenience sampling by door-to-door visits was used for finding eligible cases. A TTM-based self-administrated family planning questionnaire was used for data collection. Participants in the intervention group received education in two groups, based on their stage of change: precontemplation, contemplation, preparation, action, maintenance, and all groups were followed for three months. Results: The result of the chi-square test did not show any significant difference in the stage of change: precontemplation, contemplation, preparation, action, maintenance before education between the control and intervention groups (P = 0.55). After education, subjects in the intervention group moved forward through stage of change and got at least one step closer to the family planning behavior., with this change being significant (P < 0.001), while the movement of participants through stage of change not being significant in control group (P = 1). The results of statistical tests illustrated that the mean knowledge of the intervention group was 7.5 ± 7.1 versus 0.5 ± 4 for the control group (P < 0.001), mean of attitude of the intervention group was 5.5 ± 5.41 versus 0.09 ± 2.04 for the control group (P < 0.001), and practicing family planning methods (P < 0.007) in the intervention group was higher than the control group after education based on TTM. Conclusions: According to this study, the educational plan based on TTM was effective in changing knowledge, attitude, and practice and directing females towards taking action. Moreover, self-efficacy, perceived barriers and benefits are factors that affect the use of family planning methods.
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Affiliation(s)
- Tahereh Kamalikhah
- Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Fatemeh Rakhshani
- School of Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Fatemeh Rakhshani, School of Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188656205, Fax: +98-2188645499, E-mail:
| | | | - Mehdi Gholian Avval
- Department of Health and Management, Health Sciences Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Belaid L, Dumont A, Chaillet N, De Brouwere V, Zertal A, Hounton S, Ridde V. Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC. Syst Rev 2015; 4:124. [PMID: 26420571 PMCID: PMC4589108 DOI: 10.1186/s13643-015-0102-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions. METHODS/DESIGN We will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR) DISCUSSION: The systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in PROSPERO (CRD 42015017549).
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Affiliation(s)
- Loubna Belaid
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Alexandre Dumont
- UMR 216 IRD-Université Paris Descartes, 4 Avenue de l'Observatoire, 75 006, Paris, France.
| | - Nils Chaillet
- Département d'obstétrique et gynécologie et département de Médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Centre de recherche du CHUS: Axe Santé: populations, organisation, pratiques, Université de Sherbrooke, Sherbrooke, Canada.
| | - Vincent De Brouwere
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Amel Zertal
- Centre de recherche du CHUM, Axe Évaluation, Systèmes de soins et services, Université de Montréal, 850, rue Saint Denis-Tour S, Local S03-814, Montréal, QC, H2X 0A9, Canada.
| | - Sennen Hounton
- Commodity Security Branch, Technical Division, United Nations Population Fund, 605 3rd Avenue, New York, NY, 10158, USA.
| | - Valéry Ridde
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), 7101 Avenue du Parc, bureau 3187-03, Montréal, Québec, H3N1X9, Canada. .,ESPUM (école de santé publique de l'Université de Montréal), Montréal, Canada.
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Implementation and Operational Research: A Time-Motion Analysis of HIV Transmission Prevention Counseling and Antiretroviral Adherence Messages in Western Kenya. J Acquir Immune Defic Syndr 2015; 69:e135-41. [PMID: 25950208 DOI: 10.1097/qai.0000000000000666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. METHODS Using time-motion methodology, we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. RESULTS Mean visit length for patients at the rural clinic was 44.5 (SD = 27.9) minutes and at urban clinic was 78.2 (SD = 42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes [interquartile range (IQR), 1.57-7.33] at rural and 3.99 (IQR, 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time, respectively. Median time patients received ART adherence counseling was 1.29 (IQR, 0.77-2.83) minutes at rural and 1.76 (IQR, 1.23-2.83) minutes at urban (P = 0.001 for difference). Patients received a median time of 0.18 (0-0.72) minutes at rural and 0.28 (IQR, 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. CONCLUSIONS Although ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of the patients, and "positive prevention" messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
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Phiri S, Feldacker C, Chaweza T, Mlundira L, Tweya H, Speight C, Samala B, Kachale F, Umpierrez D, Haddad L. Integrating reproductive health services into HIV care: strategies for successful implementation in a low-resource HIV clinic in Lilongwe, Malawi. ACTA ACUST UNITED AC 2015; 42:17-23. [PMID: 25902815 PMCID: PMC4717379 DOI: 10.1136/jfprhc-2013-100816] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/12/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lighthouse Trust operates two public HIV testing, treatment and care clinics in Lilongwe, Malawi, caring for over 26 000 people living with HIV, 23 000 of whom are on antiretroviral treatment (ART). In August 2010, Lighthouse Trust piloted a step-wise integration of sexual and reproductive health (SRH) services into routine HIV care at its Lighthouse clinic site. The objectives were to increase uptake of family planning (FP), promote long-term reversible contraceptive methods, and increase access, screening and treatment for cervical cancer using visual inspection with acetic acid. METHODS AND RESULTS Patients found integrated SRH/ART services acceptable; service availability appeared to increase uptake. Between August 2010 and May 2014, over 6000 women at Lighthouse received FP education messages. Of 859 women who initiated FP, 55% chose depot medroxyprogesterone acetate, 19% chose an intrauterine contraceptive device, 14% chose oral contraceptive pills, and 12% chose an implant. By May 2014, 21% of eligible female patients received cervical cancer screening: 11% (166 women) had abnormal cervical findings during screening for cervical cancer and underwent further treatment. CONCLUSIONS Several lessons were learned in overcoming initial concerns about integration. First, our integrated services required minimal additional resources over those needed for provision of HIV care alone. Second, patient flow improved during implementation, reducing a barrier for clients seeking multiple services. Lastly, analysis of routine data showed that the proportion of women using some form of modern contraception was 45% higher at Lighthouse than at Lighthouse's sister clinic where services were not integrated (42% vs 29%), providing further evidence for promotion of SRH/ART integration.
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Affiliation(s)
- Sam Phiri
- Executive Director, The Lighthouse Trust, Lilongwe, Malawi and Professor, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caryl Feldacker
- Monitoring, Evaluation and Research Technical Advisor, The Lighthouse Trust, Lilongwe, Malawi and International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Thomas Chaweza
- Clinic Coordinator, The Lighthouse Trust, Lilongwe, Malawi
| | | | - Hannock Tweya
- Monitoring Evaluation and Research Manager, The Lighthouse Trust, Lilongwe, Malawi and International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Colin Speight
- Clinical Technical Advisor, The Lighthouse Trust, Lilongwe, Malawi
| | | | - Fannie Kachale
- Director, Reproductive Health Unit, Ministry of Health, Lilongwe, Malawi
| | - Denise Umpierrez
- MD Candidate, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lisa Haddad
- Assistant Professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
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Maslow BSL, Morse CB, Schanne A, Loren A, Domchek SM, Gracia CR. Contraceptive use and the role of contraceptive counseling in reproductive-aged women with cancer. Contraception 2014; 90:79-85. [DOI: 10.1016/j.contraception.2014.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 02/24/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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13
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Singh O, Garg T, Rath G, Goyal AK. Microbicides for the Treatment of Sexually Transmitted HIV Infections. JOURNAL OF PHARMACEUTICS 2014; 2014:352425. [PMID: 26556193 PMCID: PMC4590794 DOI: 10.1155/2014/352425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/20/2013] [Accepted: 12/26/2013] [Indexed: 12/20/2022]
Abstract
Approximately 34 million people were living with human immunodeficiency virus (HIV-1) at the end of 2011. From the last two decades, researchers are actively involved in the development of an effective HIV-1 treatment, but the results intended are still doubtful about the eradication of HIV. The HIV-1 virus has gone from being an "inherently untreatable" infectious agent to the one liable to be affected by a range of approved therapies. Candidate microbicides have been developed to target specific steps in the process of viral transmission. Microbicides are self-administered agents that can be applied to vaginal or rectal mucosal surfaces with the aim of preventing, or reducing, the transmission of sexually transmitted infections (STIs) including HIV-1. The development of efficient, widely available, and low-cost microbicides to prevent sexually transmitted HIV infections should be given high priority. In this review, we studied the various forms of microbicides, their mechanism of action, and their abundant approaches to control the transmission of sexually transmitted infections (STIs).
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Affiliation(s)
- Onkar Singh
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Tarun Garg
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Goutam Rath
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Amit K. Goyal
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India
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