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Mavodza CV, Mackworth-Young CRS, Nyamwanza R, Nzombe P, Dauya E, Dziva Chikwari C, Tembo M, Ferrand RA, Bernays S. Fertility preservation and protection: young women's decision-making about contraceptive use in Zimbabwe. CULTURE, HEALTH & SEXUALITY 2024; 26:824-838. [PMID: 37729466 DOI: 10.1080/13691058.2023.2258175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
The study explored social and health system influences on young women's decision-making about family planning in a community setting with low uptake. Seventy-two semi-structured interviews were conducted between April 2020 and November 2021, with both young women accessing, and healthcare workers providing, a community-based integrated package of HIV and sexual and reproductive health services (CHIEDZA) in Zimbabwe. Data were thematically analysed. Although long-acting contraception was freely available as part of the CHIEDZA initiative, uptake was low. Young women's contraception choices were influenced by a desired reproductive sequence, which reflected prevailing social norms and was conveyed by peers and female relatives. Nulliparous young women preferred short-term contraception and avoided hormonal contraceptives prepartum to 'preserve' their fertility. Once fertility had been confirmed within marriage through the birth of a child, hormonal contraceptive use became socially permissible. Healthcare workers, cognisant of community discourse, sensitively proposed alternative approaches. Increasing the availability of correct and adequate information and commodities is critical to improving the uptake of contraceptives for young women, but it is insufficient alone. Recognising and responding to local contextual understandings which frame considerations of appropriateness is paramount. Successful implementation of family planning interventions requires engaging with social norms and the influential groups that perpetuate them.
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Affiliation(s)
- Constancia V Mavodza
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rangarirayi Nyamwanza
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Portia Nzombe
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mandikudza Tembo
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Tembo M, Simms V, Weiss HA, Bandason T, Redzo N, Larsson L, Dauya E, Nzanza T, Ishumael P, Gweshe N, Nyamwanza R, Ndlovu P, Bernays S, Chikwari CD, Mavodza CV, Renju J, Francis SC, Ferrand RA, Mackworth-Young C. High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe. Reprod Health 2024; 21:56. [PMID: 38649934 PMCID: PMC11036648 DOI: 10.1186/s12978-024-01789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Despite being integral to women's well-being, achieving good menstrual health (MH) remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe. METHODS This mixed-methods study was nested within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) for youth in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from 27,725 female clients aged 16-24 years, who accessed CHIEDZA from April 2019 - March 2022. Using a biometric (fingerprint recognition) identification system, known as SIMPRINTS, uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers' and participants' experiences of the MH service and CHIEDZA intervention. RESULTS Overall, 36,991 clients accessed CHIEDZA of whom 27,725 (75%) were female. Almost all (n = 26,448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23,346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20-24 years old were more likely to choose cups than reusable pads compared with those aged 16-19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services. CONCLUSIONS High uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.
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Affiliation(s)
- Mandikudza Tembo
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Victoria Simms
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nicol Redzo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Leyla Larsson
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tafadzwa Nzanza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Pauline Ishumael
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nancy Gweshe
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rangarirai Nyamwanza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Precious Ndlovu
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sarah Bernays
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Chido Dziva Chikwari
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constancia Vimbayi Mavodza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Constance Mackworth-Young
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Lariat J, Chikwari CD, Dauya E, Baumu VT, Kaisi V, Kafata L, Meza E, Simms V, Mackworth-Young C, Rochford H, Machiha A, Bandason T, Francis SC, Ferrand RA, Bernays S. "It's not safe for me and what would it achieve?" Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe. Sex Reprod Health Matters 2023; 31:2220188. [PMID: 37565610 PMCID: PMC10424614 DOI: 10.1080/26410397.2023.2220188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Partner notification (PN) is considered integral to the management of sexually transmitted infections (STI). Patient-referral is a common PN strategy and relies on index cases notifying and encouraging their partners to access treatment; however, it has shown limited efficacy. We conducted a mixed methods study to understand young people's experiences of PN, particularly the risks and challenges encountered during patient-referral. All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. PN slip uptake and partner treatment were recorded. Among 1807 young people (85.0% female) offered PN slips, 745 (41.2%) took up ≥1 PN slip and 103 partners (5.7%) returned for treatment. Most participants described feeling ill-equipped to counsel and persuade their partners to seek treatment. Between June and August 2021, youth researchers conducted in-depth interviews with 41 purposively selected young people diagnosed with an STI to explore their experiences of PN. PN posed considerable social risks, threatening their emotional and physical safety. Except for a minority in long-term, publicly acknowledged relationships, participants did not expect PN would achieve successful outcomes. Public health discourse, which constructs PN as "the right thing to do", influenced participants to adopt narratives that concealed the difficulties of PN and their unmet needs. Urgent interrogation is needed of whether PN is a suitable or constructive strategy to continue pursuing with young people. To improve the outcomes of preventing reinfection and onward transmission of STIs, we must consider developing alternative strategies that better align with young people's lived experiences.Plain language summary Partner notification is a public health strategy used to trace the sexual partners of people who have received a sexually transmitted infection (STI) diagnosis. It aims to interrupt the chains of STI transmission and prevent reinfection by treating both the person diagnosed and their sexual partners. The least effective but most common partner notification strategy used in many resource-limited settings is called "patient referral". This involves a sexual healthcare provider encouraging the person diagnosed to give a "partner notification slip" to their potentially exposed sexual partner/s and persuading them to access treatment. This research sought to better understand young people's experiences of partner notification, particularly the risks and challenges they faced during patient-referral.All young people (16-24 years) attending a community-based sexual and reproductive health service in Zimbabwe who were diagnosed with an STI were counselled and offered PN slips, which enabled their partners to access free treatment at the service. Young people trained as researchers interviewed 41 young people who had received a STI diagnosis to explore their experiences of partner notification.Only a small number (5.7%) of the partners of those who took a slip attended the service for treatment. Most participants felt they did not have the preparation, skills, or resources to persuade their partners to seek treatment. Many described negative experiences during and after partner notification, including relationship breakdown, reputation damage, and physical violence.These findings suggest that we should reconsider if partner notification is suitable or effective for use with young people. We should explore alternative approaches that do not present risks to young people's social, emotional, and physical safety and well-being.
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Affiliation(s)
- Joni Lariat
- Associate Lecturer, School of Public Health, University of Sydney, Sydney, Australia
| | - Chido Dziva Chikwari
- Assistant Professor, THRU Zim, Harare, Zimbabwe; Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Study Coordinator, THRU Zim, Harare, Zimbabwe
| | | | | | | | - Esnath Meza
- Youth Researcher, THRU Zim, Harare, Zimbabwe
| | - Victoria Simms
- Associate Professor. THRU Zim, Harare, Zimbabwe; Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Anna Machiha
- STI Coordinator, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Suzanna C. Francis
- Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Professor, THRU Zim, Harare, Zimbabwe; Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- Associate Professor, School of Public Health, University of Sydney, Sydney, Australia; Associate Professor, London School of Hygiene and Tropical Medicine, London, UK
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Ndlovu S, Ross A, Mulondo M. Interventions to improve young men's utilisation of HIV-testing services in KwaZulu-Natal, South Africa: perspectives of young men and health care providers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:316-326. [PMID: 38117741 DOI: 10.2989/16085906.2023.2276897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Introduction: HIV-testing services (HTS) are an important point of entry to prevention and treatment of HIV in South Africa. Despite the availability of HTS across the region and in SA, the uptake among men remains low, especially young men residing in rural and peri-urban communities. This study aimed to explore interventions that could improve the uptake of HTS among young men in KwaZulu-Natal.Methods: A descriptive exploratory qualitative study was conducted in which 17 young men and two health care providers in Ladysmith were purposively and conveniently sampled. Data were collected through semi-structured interviews using WhatsApp and landline audio calls between September and December 2021 and thematically analysed.Results: An improvement in the health care provider attitudes and service delivery, establishment of adherence clubs for young people living with HIV, ensuring a diverse and balanced health care provider staff composition at primary health care facilities, and increased demand creation in spaces frequented by men are vital for enhancing access and utilisation of HTS among young men. Additionally, health care providers believe that the presence of male health care providers, investment in health education, prioritising men in the morning at the primary health care facilities, and the establishment of male clinics within communities as key factors in improving the uptake of HTS among young men.Conclusion: To attract and retain young men in HTS and in HIV treatment and care, several improvements at primary health care facilities need to be implemented. These should focus on addressing the specific needs and preferences of young men, ensuring their comfort and engagement in health care.
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Affiliation(s)
- Sithembiso Ndlovu
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Andrew Ross
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mutshidzi Mulondo
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Cruz AXFD, Neto JC, Araújo AAC, Sousa ARD, Oliveira LBD, Sena IVDO, Sena Sousa L, Santos JD, Batista OMA, Mendes IAC, Fronteira I, Sousa ÁFLD. HIV testing among immigrant men who have sex with men in Brazil. Public Health Nurs 2023; 40:826-835. [PMID: 37526386 DOI: 10.1111/phn.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence of non-testing for HIV among immigrant men who have sex with men (MSM) residing in Brazil and identify associated factors. DESIGN An analytical web-survey study was conducted across all Brazilian states from January 2020 to May 2021. SAMPLE The study included 804 MSM immigrants from Portuguese-speaking countries. MEASUREMENTS Odds ratio (OR) and adjusted Odds Ratio (AOR) were utilized to determine the strength of the association between non-HIV testing and associated factors. RESULTS Among the participants, 63.7% had never undergone HIV testing. Multivariate analysis revealed several factors associated with a higher likelihood of not being tested for HIV: having a steady/monogamus partner (AOR: 1.5; 95%CI: 1.1-2.3) or both casual and steady partners (AOR: 1.8; 95%CI: 1.2-3.4), not engaging in bareback sex (AOR: 1.91; 95%CI: 3-3.5), being an immigrant in the country for less than 12 months (AOR: 3.7; 95%CI: 2.5-9.7), and having a preference for insertive (AOR: 1.5; 95%CI: 1.1-2.5) or receptive (AOR: 2.9; 95%CI: 1.4-5.7) roles. However, practicing chemsex was found to be a protective factor for testing (AOR: 4). CONCLUSION To enhance HIV prevention strategies, it is crucial to implement specific measures that ensure accessibility, confidentiality, and a reduction in stigma associated with HIV testing.
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Affiliation(s)
| | - João Cruz Neto
- University of International Integration of Lusophone Afro-Brazilian, Redenção, Ceará, Brazil
| | | | | | - Layze Braz de Oliveira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Jaqueline Dos Santos
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Inês Fronteira
- Public Health Research Centre, Comprehensive Health Research Center, National School of Public Health, New University of Lisbon, Lisbon, Portugal
| | - Álvaro Francisco Lopes de Sousa
- Institute of Teaching and Research, Sírio-Libânes Hospital São Paulo, São Paulo, Brazil
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal
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Nambusi K, Gbolahan A, Maureen SM, Tsholofelo RT, Motswedi AM, Simani G, Joseph M, Una N, Sikhulile MS, Odile S, Lucy M. Youth and healthcare workers' perspectives on the feasibility and acceptability of self-testing for HIV, Hepatitis and Syphilis among young people: Qualitative findings from a pilot study in Gaborone, Botswana. PLoS One 2023; 18:e0288971. [PMID: 37471434 PMCID: PMC10358881 DOI: 10.1371/journal.pone.0288971] [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: 03/22/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Little is known regarding the attitudes and perspectives of young people and healthcare workers in Botswana about dual self-testing for HIV and STIs including its acceptability, or their perceptions of the opportunities and limitations of this approach. METHODS From July to November 2021, 25 young people and 6 healthcare workers were purposively sampled for in-depth telephone interviews conducted in English or Setswana. The interviews followed a semi-structured topic guide, were audio recorded, transcribed, and analysed thematically using deviant case and constant comparative techniques. The study was part of a pilot project evaluating dual self-testing for HIV and STIs among young people in Gaborone. RESULTS We found that most of the young people were already aware of their HIV status and were motivated to participate in self-testing mainly because they were interested in learning their STI status. Whilst most were excited about the autonomy and convenience offered by self-testing, some participants expressed nervousness particularly of the finger-prick process, and preferred healthcare worker-administered tests. Both young people and healthcare workers raised concerns about the potential negative mental health outcomes of unexpected test results and emphasized the importance of pre- and post-test counselling and seamless linkage to care. CONCLUSION Dual self-testing for HIV and STIs has the potential to empower young people to take control of their sexual health. However, it is crucial to ensure that proper support and counselling services are in place, along with effective mechanisms for linkage to care. This study emphasizes the importance of integrating pre- and post-test counselling into self-testing programs to ensure that young people feel adequately supported throughout the testing process. By doing so, self-testing can become a valuable tool for improving the sexual health outcomes of young people in Botswana.
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Affiliation(s)
- Kyegombe Nambusi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Gaseitsiwe Simani
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Makhema Joseph
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ngwenya Una
- Botswana Family Welfare Association, Gaborone, Botswana
| | - Moyo S. Sikhulile
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Sauzet Odile
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Mupfumi Lucy
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Tembo M, Simms V, Weiss HA, Bandason T, Redzo N, Larsson L, Dauya E, Nzanza T, Ishumael P, Gweshe N, Nyamwanza R, Ndlovu P, Bernays S, Chikwari CD, Mavodza CV, Renju J, Francis SC, Ferrand RA, Mackworth-Young C. High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe. RESEARCH SQUARE 2023:rs.3.rs-3058045. [PMID: 37461550 PMCID: PMC10350165 DOI: 10.21203/rs.3.rs-3058045/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background Achieving good menstrual health (MH), integral to women's well-being, remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe. Methods This study was embedded within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from female clients aged 16-24 years, who accessed CHIEDZA from April 2019 - March 2022. Uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers' and participants' experiences of the MH service and CHIEDZA intervention. Results Overall, 36991 clients accessed CHIEDZA of whom 27725 (75%) were female. Almost all (n = 26448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20-24 years old were more likely to choose cups than reusable pads compared with those aged 16-19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services. Conclusions High uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jenny Renju
- London School of Hygiene & Tropical Medicine
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Li H, Shah SK, Healy E, Agot K, Neary J, Wilson K, Badia J, Atieno WO, Moraa H, Meischke H, Kibugi J, Inwani I, Chhun N, Mukumbang FC, John‐Stewart G, Kohler P, Beima‐Sofie K. "[T]he laws need to change to reflect current society": Insights from stakeholders involved in development, review or implementation of policies about adolescent consent for HIV testing, care and research in Kenya. J Int AIDS Soc 2023; 26:e26057. [PMID: 36642867 PMCID: PMC9841068 DOI: 10.1002/jia2.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Engaging adolescents in HIV care and research promotes the development of interventions tailored to their unique needs. Guidelines generally require parental permission for adolescents to receive HIV care/testing or participate in research, with exceptions. Nevertheless, parental permission requirements can restrict adolescent involvement in care and research. To better appreciate prospects for policy reform, we sought to understand the perspectives of stakeholders involved in the development, review and implementation of policies related to adolescents living with HIV. METHODS Semi-structured individual interviews (IDIs) were conducted from October 2019 to March 2020 with 18 stakeholders with expertise in the (1) development of policy through membership in the Law Society of Kenya or work as a health policy official; (2) review of policy through ethics review committee service; or (3) implementation of policy through involvement in adolescent education. IDIs were conducted in English by Kenyan social scientists, audio-recorded and transcribed verbatim. We used thematic analysis to identify themes around how policies can be reformed to improve adolescent engagement in HIV care and research. RESULTS Our analysis identified three major themes. First, policies should be flexible rather than setting an age of consent. Stakeholders noted that adolescents' capacity for engagement in HIV care and research depended on context, perceived risks and benefits, and "maturity"-and that age was a poor proxy for the ability to understand. Second, policies should evolve with changing societal views about adolescent autonomy. Participants recognized a generational shift in how adolescents learn and mature, suggesting the need for a more frequent review of HIV care and research guidelines. Third, adults should empower adolescent decision-making. Stakeholders felt that caregivers can gradually involve adolescents in decision-making to equip them to gain ownership over their health and lives, improving their confidence and capacity. CONCLUSIONS Revising relevant laws to consider context, alternative measures of maturity, and evolving societal views about adolescence, along with supporting caregivers to assist in developing adolescent autonomy may promote more equitable and representative participation of adolescents in HIV care and research. Additional research should explore how to support caregivers and other adults to empower adolescents and improve stakeholder engagement in a more routine process of policy reform.
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Affiliation(s)
- Huangqianyu Li
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - Seema K. Shah
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Bioethics Program at Lurie Children's HospitalChicagoIllinoisUSA
| | - Elise Healy
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Kawango Agot
- Impact Research and Development OrganizationKisumuKenya
| | - Jillian Neary
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Kate Wilson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jacinta Badia
- Impact Research and Development OrganizationKisumuKenya
| | | | - Hellen Moraa
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
| | - Hendrika Meischke
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - James Kibugi
- Impact Research and Development OrganizationKisumuKenya
| | - Irene Inwani
- University of Nairobi/Kenyatta National HospitalNairobiKenya
| | - Nok Chhun
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Pamela Kohler
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of ChildFamily and Population Health NursingUniversity of WashingtonSeattleWashingtonUSA
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Mackworth-Young CRS, Mavodza C, Nyamwanza R, Tshuma M, Nzombe P, Dziva Chikwari C, Tembo M, Dauya E, Apollo T, Ferrand RA, Bernays S. "Other risks don't stop": adapting a youth sexual and reproductive health intervention in Zimbabwe during COVID-19. Sex Reprod Health Matters 2022; 30:2029338. [PMID: 35192449 PMCID: PMC8865116 DOI: 10.1080/26410397.2022.2029338] [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] [Indexed: 11/30/2022] Open
Abstract
COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA's closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras.
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Affiliation(s)
- Constance R S Mackworth-Young
- Assistant Professor, Biomedical Research and Training Institute, Harare, Zimbabwe; Assistant Professor, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Mavodza
- Research Fellow, Biomedical Research and Training Institute, Harare, Zimbabwe; PhD Candidate, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maureen Tshuma
- Research Assistant, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Portia Nzombe
- Research Assistant, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Study Coordinator, Biomedical Research and Training Institute, Harare, Zimbabwe; Assistant Professor, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mandikudza Tembo
- Research Fellow, Biomedical Research and Training Institute, Harare, Zimbabwe; PhD Candidate, MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Study Coordinator, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Apollo
- Deputy Director, AIDS and TB Unit, Ministry of Health and Child Care, Central Avenue, Harare, Zimbabwe
| | - Rashida A Ferrand
- Professor - International Health, Biomedical Research and Training Institute, Harare, Zimbabwe; Professor - International Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- Associate Professor, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Senior Lecturer in Global Health, School of Public Health, University of Sydney, Australia. Correspondence:
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