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O'Reilly KR, Yeh PT, Kennedy CE, Fonner VA, Sweat MD. Family Planning Counseling for Women Living with HIV in Low- and Middle-Income Countries: A Systematic Review of the Impact on Contraceptive Uptake, Intention to Use Contraception and Pregnancy Incidence, 2011 to 2022. AIDS Behav 2024; 28:2477-2491. [PMID: 38662281 PMCID: PMC11286672 DOI: 10.1007/s10461-024-04319-w] [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] [Accepted: 03/11/2024] [Indexed: 04/26/2024]
Abstract
Women's ability to control their fertility and have the number of children they want when they want them is an internationally recognized human right. This right has been the driving force behind family planning programs in low- and middle-income countries for more than five decades. The HIV epidemic added greater urgency to those efforts once the risk of vertical transmission of the virus from mothers to their infants was recognized. In 2013, we published a systematic review of the evidence of effectiveness of family planning counseling for women living with HIV, emphasizing HIV related behaviors. In this updated review, we examined 23 studies, primarily from sub-Saharan Africa. The evidence we uncovered reflected efforts to integrate services provided to women. These showed that providing contraceptive services, including intensified counseling and support, in the HIV clinics where women living with HIV received their care increased the likelihood of subsequent use of modern contraception by as much as fourfold. These studies reflected a greater focus on women's family planning decisions and behaviors and less focus on HIV-related behaviors. Among the possible causes of this noted difference we include the widespread coverage of antiretroviral treatment for HIV. This advance has apparently changed the rationale and the approach to integrating family planning and HIV services in ways that may not have been fully appreciated. The results, however, are beneficial: greater coverage of family planning for women who wish to control their fertility and a more equal partnership between family planning services and HIV services in pursuit of the mutual goal of providing integrated services to meet women's needs.
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Affiliation(s)
- Kevin R O'Reilly
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, 176 Croghan Spur Rd, Suite 104, Charleston, SC, 29407, USA.
| | - Ping Teresa Yeh
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia A Fonner
- FHI 360, Global Health and Population Research, Durham, NC, 27701, USA
| | - Michael D Sweat
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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Revathy R, Chaurasia H, Shetty S, Joshi B. Health facility-based interventions and the uptake of contraception among people living with HIV: A systematic review & meta-analysis. Indian J Med Res 2023; 158:483-493. [PMID: 38143434 PMCID: PMC10878490 DOI: 10.4103/ijmr.ijmr_2471_22] [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: 11/30/2022] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND OBJECTIVES The prong 2 of 4 prong strategy introduced by the World Health Organization aims at averting unintended pregnancies among people living with HIV (PLHIV). This systematic review aimed to generate evidence on the effectuality of facility-based interventions in improving uptake of modern and dual contraception, for reducing unmet family planning (FP) needs and unintended pregnancies among PLHIV. METHODS Articles evaluating facility-based interventions to integrate human immunodeficiency virus (HIV) and FP published in English language were included. Eligible studies were identified from electronic and lateral search from three databases (PubMed, Cochrane Library and Web of Science) and grey literature. HIV care with no/minimal focus on FP was considered a comparator. Quality was assessed using design-appropriate tools. Descriptive analysis was presented in tables. Uptake of dual methods, unmet FP needs and unintended pregnancies were included in the meta-analysis to estimate pooled odds ratio (OR) with random effect model, P and I2 values. RESULTS The search yielded 2112 results. After excluding duplicates and unfit articles, 17 were found eligible for review and nine for meta-analysis. The pooled OR for uptake of dual contraception was 1.69 (1.14, 2.5) ( P =0.008; I2 =90%), for unmet FP needs was 0.58 (0487, 0.69) ( P <0.00001; I2 =0%) and for unintended pregnancies was 0.6 (0.32, 1.1) ( P =0.1, I2 =38%). INTERPRETATION CONCLUSIONS The results of this meta-analysis suggest that health facility-based interventions to integrate HIV and FP services do result in improved uptake of dual methods and reduce unmet need for contraception along with a protective trend on incidence of unintended pregnancies. Such facility-based integration would ensure universal access to effective contraception and facilitate in achieving Sustainable Development Goals that aim at ending epidemics like HIV.
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Affiliation(s)
- R Revathy
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Sey-Sawo J, Adeyemo FO, Okojie OH. Effects of Postpartum Family Planning Counselling on Contraceptives Knowledge, Attitude and Intention Among Women Attending a General Hospital in The Gambia: A Randomized Controlled Trial. Open Access J Contracept 2023; 14:61-72. [PMID: 36987511 PMCID: PMC10040163 DOI: 10.2147/oajc.s388882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/18/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose This study aimed to evaluate the effectiveness of PPFP counselling on contraceptives knowledge, attitudes and intention among women attending a general hospital in The Gambia. Materials and Methods A quasi-experimental design with an intervention and comparison group was used. The intervention was PPFP counselling using the GATHER approach. A sample size of 674 participants was determined by a formula for comparison between the two groups. The questionnaire was developed based on a literature review and was pre-tested on 10% of the total study sample size (68). A reliability of 0.731 was obtained. A systematic random sampling method was employed to select study participants who met the inclusion criteria. Data were collected during face-to-face interviews in local languages with a 100% response rate at baseline and 96% at post-test. Data were analysed using the SPSS version 21.00 and the statistical analysis included both descriptive and inferential methods. An ethical approval was obtained from the Research and Ethics Committee, School of Basic Medical Sciences, College of Medicine, University of Benin (CMS/REC/2017/017) and the Gambia Government/Medical Research Council Laboratories Joint Ethics Committee (R017016Av1.1). Results Baseline respondents' socio-demographic characteristics revealed that the two groups had similar characteristics. A statistically significant difference existed on knowledge, attitude, and intention to use contraceptive methods between the intervention and comparison groups at post-intervention (p<0.05) while no significant difference was observed at baseline. Significant gains were achieved in the intervention group in terms of knowledge, attitude, and intention post-intervention. Conclusion PPFP counselling during the postpartum period and before the discharge of women from the hospital may improve knowledge, attitude and intention to use contraceptives and, therefore, increase the likelihood of contraceptive uptake and thus prevent unwanted and closely spaced pregnancies.
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Affiliation(s)
- Jainaba Sey-Sawo
- Department of Nursing and Reproductive Health, University of The Gambia, Serekunda, The Gambia
- Correspondence: Jainaba Sey-Sawo, School of Medicine and Allied Health Sciences, University of The Gambia, P. O. Box 1646, Serekunda, The Gambia, Tel +220 3650105, Email
| | | | - Obehi H Okojie
- Department of Community Health, University of Benin, Benin, Edo State, Nigeria
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Wamuti BM, Owour M, Obong'o C, Liu W, Kariithi E, Lagat H, Otieno G, Sharma M, Katz DA, Masyuko S, Farquhar C, Weiner BJ. Integration of assisted partner services within Kenya's national HIV testing services program: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001586. [PMID: 36962930 PMCID: PMC10022023 DOI: 10.1371/journal.pgph.0001586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
Assisted partner service (aPS) augments HIV case-finding among sex partners to individuals newly diagnosed with HIV. In 2016, aPS was incorporated into the national HIV testing services (HTS) program in Kenya. We evaluated the extent of, barriers to, and facilitators of aPS integration into HTS. We conducted semi-structured in-depth interviews (IDIs) with 32 stakeholders selected using purposive sampling at national, county, facility, and community levels. IDIs were conducted at two timepoints, at baseline from August-September 2018 in Kisumu and January-June 2019 in Homa Bay, and at follow-up from May-August 2020 to understand changes in aPS integration over time. We defined integration as the creation of linkages between the new intervention (aPS) and the existing HTS program. Data were analyzed using thematic content analysis. We found varying degrees of aPS integration, highest in procurement/logistics and lowest in HTS provider recruitment/training. At baseline, aPS integration was low and activities were at an introductory phase. At follow-up, aPS was integrated in almost the entire HTS program with the exception of low community awareness, which was noted at both baseline and follow-up. There was increasing routinization with establishment of clear aPS cycles, e.g., quarterly data review meetings, annual budget cycles and work-plans. Major barriers included limited government funding, staff constraints, and inadequate community-level sensitization, while key facilitators included increased resources for aPS, and community health volunteer (CHV) facilitated awareness of aPS. Varying degrees of aPS integration across different units of the national HTS program highlights challenges in funding, human resource, and public awareness. Policymakers will need to address these barriers to ensure optimal provision of aPS.
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Affiliation(s)
- Beatrice M Wamuti
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | | | - Wenjia Liu
- School of Nursing, University of Washington, Seattle, Washington, United States of America
| | | | | | | | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Tougri H, Yameogo ME, Compaoré R, Dahourou D, Belemsaga DY, Meda B, Kpebo D, Ndour M, Kouanda S. Gaps and opportunities for the integrated delivery of mother-child care, postpartum family planning and nutrition services in Burkina Faso, Côte d’Ivoire and Niger. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.57370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Maternal and infant deaths can be prevented through integrated service delivery during pregnancy, postpartum, and early childhood. Our study analyses the gaps and opportunities associated with integrating maternal, newborn, and child health (MNCH) services with postpartum family planning (PPFP) and nutrition services at different points of contact in health facilities in a preintervention context in west Africa. Methods We conducted a qualitative study from June to July 2018 in Burkina Faso, Côte d’Ivoire and Niger. The points of contact studied at the health facility level were the prenatal care, postpartum care and immunisation/growth monitoring services. Individual in-depth interviews were used to collect data from key informants (providers, community health workers and mother-child health programme managers). To measure the degree of service integration, we used the dimensions and indicators included in the Integra Initiative framework concerning four aspects of integration: physical (the availability of multiple services in the health facility), temporal (the availability of care more than one day per week), provider level, and functional (the receipt of integrated services by the client). Results The findings of this study show that the integrated delivery of MNCH, PPFP, and nutrition services is configured in similar ways in Burkina Faso, Côte d’Ivoire and Niger and is insufficient at all points of contact. Physical integration is high. However, the study found important gaps in temporal, functional and provider-level integration. The main barriers to integrated service delivery are the shortage of providers, the lack of training in integrated service delivery, and insufficient service organisation. However, the availability of multiple services throughout the week, the multiple points of contact between the mother-child pair and the health system, and the multiple skills of providers represent opportunities for functional integration through the establishment of a formal referral system between the different care units with follow-up and feedback among service providers. Conclusions The provision of training and the development of a well-organised referral system in different health facilities, taking into account the specific characteristics of each health facility (urban/rural, primary health facility/district hospital), can improve the delivery of integrated MNCH, PPFP, and nutrition care to the mother-child pair.
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Affiliation(s)
- Halima Tougri
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
| | - Maurice E. Yameogo
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso
| | - Rachidatou Compaoré
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
| | - Désiré Dahourou
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Bertrand Meda
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - Denise Kpebo
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
- École de médecine d'Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Marguerite Ndour
- IntraHealth International, bureau regional, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
- Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso
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Laporte M, Peloggia A, Marcelino AC, de Carvalho LS, Bahamondes L. Perspectives of health care providers regarding the levonorgestrel-releasing intrauterine system. EUR J CONTRACEP REPR 2021; 27:208-211. [PMID: 34870546 DOI: 10.1080/13625187.2021.2010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aims of the study were to assess the number of insertions per month of the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) and gauge the knowledge and opinions of health care providers with regard to some of its characteristics and the reasons why women liked using the method. METHODS An online questionnaire survey was conducted between January and July 2021 at the University of Campinas, Brazil. The survey comprised physicians and nurses from centres that had requested and received donated devices. RESULTS A total of 65 health care providers answered the questionnaire (41 physicians and 24 nurses). The main misconceptions were related to insertion after an ectopic pregnancy: 60/65 (92.3%) answered that users with previous ectopic pregnancy must have frequent follow-up. Wrong answers were also given on the occurrence of acne (37/65, 56.9%) and depression (32/65, 49.2%). Participants reported that the LNG-IUS was highly effective (100%), long-acting (93.9%) and an appropriate method for controlling uterine bleeding (90.8%) and that it had few side effects (86.2%). CONCLUSION Our study suggests that health care providers from centres that requested and received LNG-IUS donations, even though they reported adequate knowledge about the device, still had misconceptions with regard to its clinical management.
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Affiliation(s)
- Montas Laporte
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Alessandra Peloggia
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Ana C Marcelino
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Larissa S de Carvalho
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
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Roche SD, Odoyo J, Irungu E, Kwach B, Dollah A, Nyerere B, Peacock S, Morton JF, O'Malley G, Bukusi EA, Baeten JM, Mugwanya KK. A one-stop shop model for improved efficiency of pre-exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study. J Int AIDS Soc 2021; 24:e25845. [PMID: 34898032 PMCID: PMC8666585 DOI: 10.1002/jia2.25845] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In public clinics in Kenya, separate, sequential delivery of the component services of pre-exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients' ability and desire to access and continue PrEP. We conducted a mixed methods study in four public clinics in western Kenya to identify strategies for operationalizing a one-stop shop (OSS) model and evaluate whether this model could improve client wait time and care acceptability among clients and providers without negatively impacting uptake or continuation. METHODS From January 2020 through November 2020, we collected and analysed 47 time-and-motion observations using Mann-Whitney U tests, 29 provider and client interviews, 68 technical assistance reports, and clinic flow maps from intervention clinics. We used controlled interrupted time series (cITS) to compare trends in PrEP initiation and on-time returns from a 12-month pre-intervention period (January-December 2019) to an 8-month post-period (January-November 2020, excluding a 3-month COVID-19 wash-out period) at intervention and control clinics. RESULTS From the pre- to post-period, median client wait time at intervention clinics dropped significantly from 31 to 6 minutes (p = 0.02), while median provider contact time remained around 23 minutes (p = 0.4). Intervention clinics achieved efficiency gains by moving PrEP delivery to lower volume departments, moving steps closer together (e.g. relocating supplies; cross-training and task-shifting), and differentiating clients based on the subset of services needed. Clients and providers found the OSS model highly acceptable and additionally identified increased privacy, reduced stigma, and higher quality client-provider interactions as benefits of the model. From the pre- to post-period, average monthly initiations at intervention and control clinics increased by 6 and 2.3, respectively, and percent of expected follow-up visits occurring on time decreased by 18% and 26%, respectively; cITS analysis of PrEP initiations (n = 1227) and follow-up visits (n = 2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on-time returns (all p>0.05). CONCLUSIONS An OSS model significantly improved client wait time and care acceptability without negatively impacting initiations or continuations, thus highlighting opportunities to improve the efficiency of PrEP delivery efficiency and client-centredness.
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Affiliation(s)
| | - Josephine Odoyo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Benn Kwach
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Annabell Dollah
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Bernard Nyerere
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Sue Peacock
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | | | - Elizabeth A. Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Medicine, University of WashingtonSeattleWashingtonUSA
- Department of Epidemiology, University of WashingtonWashingtonSeattleUSA
- Gilead SciencesFoster CityCaliforniaUSA
| | - Kenneth K. Mugwanya
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Epidemiology, University of WashingtonWashingtonSeattleUSA
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Helova A, Onono M, Abuogi LL, Hampanda K, Owuor K, Odwar T, Krishna S, Odhiambo G, Odeny T, Turan JM. Experiences, perceptions and potential impact of community-based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed-methods study. J Int AIDS Soc 2021; 24:e25843. [PMID: 34797955 PMCID: PMC8604379 DOI: 10.1002/jia2.25843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Community‐based mentor mothers (cMMs) are women living with HIV who provide peer support to pregnant/postpartum women living with HIV (PWLWH) to enhance antiretroviral therapy (ART) adherence, retention in care and prevent perinatal transmission of HIV. The goal of this study was to explore the experiences, perceptions, mechanisms and health impact of cMMs on PWLWH in Kenya from the perspective of cMMs. Methods We conducted a prospective mixed‐methods study in southwestern Kenya in 2015–2018. In the qualitative phase, we completed in‐depth interviews with cMMs to explore their perceptions and experiences in supporting PWLWH. Transcripts were broad‐coded according to identified themes, then fine‐coded using an inductive approach. In the quantitative phase, we analysed medical record data from PWLWH who were randomized in the cMM intervention to examine the impact of cMM visits on optimal prevention of mother‐to‐child transmission (PMTCT). We used cluster‐adjusted generalized estimating equation models to examine relationships with a composite outcome (facility delivery, infant HIV testing, ART adherence and undetectable viral load at 6 weeks postpartum). Finally, qualitative and quantitative results were integrated. Results Convergence of findings from cMM interviews (n = 24) and PWLWH medical data (n = 589) revealed: (1) The cMM intervention was utilized and perceived as acceptable. PWLWH received, on average, 6.2 of 8 intended home visits through 6 weeks postpartum. (2) The cMMs reported serving as role models and confidantes, supporting PWLWH's acceptance of their HIV status, providing assurances about PMTCT and assisting with male partner disclosure and communication. cMMs also described benefits for themselves, including empowerment and increased income. (3) The cMM visits supported PWLWH's completion of PMTCT steps. Having ≥4 cMM home visits up to 6 weeks postpartum, as compared to <4 visits, was associated with higher likelihood of an optimal PMTCT composite outcome (adjusted relative risk 1.42, p = 0.044). Conclusions We found that peer support from cMMs during pregnancy through 6 weeks postpartum was associated with improved uptake of critical PMTCT services and health behaviours and was perceived as beneficial for cMMs themselves. CMM support of PWLWH may be valuable for other low‐resource settings to improve engagement with lifelong ART and HIV services among PWLWH.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin Owuor
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sandhya Krishna
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Masiano S, Machine E, Mphande M, Markham C, Tembo T, Chitani M, Mkandawire A, Mazenga A, Ahmed S, Kim M. Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041737. [PMID: 33579047 PMCID: PMC7916796 DOI: 10.3390/ijerph18041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Affiliation(s)
- Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Correspondence: (S.M.); (M.K.)
| | - Edwin Machine
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Christine Markham
- Center for Health Promotion and Preventive Research, Department of Health Promotion and Behavioral Sciences, The University of Texas, Houston, TX 77030, USA;
| | - Tapiwa Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Kim
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.M.); (M.K.)
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N’guessan E, Gbeli F, Dia JM, Guie P, Roseline NK. Immediate Postpartum Intrauterine Device in HIV-Infected Women: Experience from a Tertiary Care Center in Côte d'Ivoire. J Obstet Gynaecol India 2020; 70:64-68. [PMID: 32030008 PMCID: PMC6982613 DOI: 10.1007/s13224-019-01268-6] [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: 02/07/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Immediate postpartum intrauterine device (PPIUD) is a good solution for reducing low contraceptive coverage in developing countries. However, its use in HIV-infected women is poorly documented. The objective of this study was to assess whether the risk of PPIUD complications was higher in HIV-infected women. METHODS A retrospective cohort study compared 64 HIV-infected women to 128 HIV-negative women who had had a PPIUD at the University Hospital of Treichville between January 2016 and March 2017, with a match at the insertion time of the PPIUD. The complications considered were pelvic pain, metrorrhagia and genital infections. Chi-squared test and relative risk were used to investigate the association between HIV infection and PPIUD complications. RESULTS HIV-infected patients had an average age of 33.1 years, and 85.9% of them were on antiretroviral therapy. PPIUD was inserted during cesarean section in 66.1% of cases. There was no significant association between HIV infection and PPIUD complications (RR = 0.7, 95% CI [0.4-1.3], p = 0.3). The risk of genital infections was not increased in HIV-infected women (RR = 0.6 [0.1-2.7], p = 0.7). CONCLUSION HIV infection does not increase the risk of PPIUD complications. This effective contraceptive strategy can be offered to HIV-infected women. It is therefore necessary to strengthen the training of maternity staff in the installation of PPIUD.
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Affiliation(s)
- Edouard N’guessan
- Department of Obstetrics and Gynecology, University Hospital of Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d’Ivoire
| | - Franck Gbeli
- Department of Obstetrics and Gynecology, University Hospital of Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d’Ivoire
| | - Jean-Marc Dia
- Department of Obstetrics and Gynecology, University Hospital of Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d’Ivoire
| | - Privat Guie
- Department of Obstetrics and Gynecology, University Hospital of Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d’Ivoire
| | - Nguessan Kouame Roseline
- Department of Obstetrics and Gynecology, University Hospital of Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d’Ivoire
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N'guessan E, Gbeli F, Dia JM, Guie P. [Contraceptive practices of HIV-infected women followed up on an ambulatory basis at the Treichville University Hospital (Abidjan, Ivory Coast)]. Pan Afr Med J 2019; 33:79. [PMID: 31448041 PMCID: PMC6689841 DOI: 10.11604/pamj.2019.33.79.16435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/24/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Family planning is a high impact strategy to reduce maternal mortality and to prevent mother-to-child transmission of HIV. This study aims to describe contraceptive practices of HIV-infected women followed upon an ambulatory basis at the Treichville University Hospital. Methods We conducted a cross-sectional descriptive multicenter survey of people living with HIV in the ambulatory care units of the Treichville University Hospital from 1 April to 30 June 2016. During this period, all HIV positive patients of childbearing age attending the Department of Obstetrics and Gynecology, the Pneumophtisiology Department, the Department of Dermatovenereology and the Department of internal medicine were invited to complete a standardized questionnaire on the sociodemographic, medical characteristics and the contraceptive practices. Results In total, 283 women agreed to participate in the study, their median age was 36 years with an average parity of 1.7. Patients were nulliparous in only 22.3% of cases and lived with a partner in 54.8% of cases. They had no child with the current partner in 68.2% of cases. The partner was informed about their HIV status in 51.6% of cases. They were under antiretroviral treatment in 92.9% of cases with a median mean CD4 of 382 cells/mL. The majority of patients (62.9%) declared that they were using a modern contraceptive method. They mainly used progestin injectable (45.5%) and contraceptive implant (32.6%). The practice of dual protection was reported by only 17.4% of them. Secondary and higher education (OR=2.23 [1,35-3,69], p=0.01), multiparity (OR=1.84 [1,11-3,06], p=0.002) and revelation of HIV positive status to the partner (OR=1.86 [1,14-3,03], p<0.01) were factors significantly associated with the use of contraception. Conclusion Based on our experience, contraceptive practices in women infected with HIV are generally discouraging. It is essential to develop strategies to improve the integration of family planning into the management of HIV-infected women.
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Affiliation(s)
- Edouard N'guessan
- Service de Gynéco-obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Franck Gbeli
- Service de Gynéco-obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Jean Marc Dia
- Service de Gynéco-obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Privat Guie
- Service de Gynéco-obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
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Schmitz K, Basera TJ, Egbujie B, Mistri P, Naidoo N, Mapanga W, Goudge J, Mbule M, Burtt F, Scheepers E, Igumbor J. Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review. PLoS One 2019; 14:e0211439. [PMID: 30703152 PMCID: PMC6355001 DOI: 10.1371/journal.pone.0211439] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known. Objectives To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs). Methods A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were “lay health worker”, “community health worker”, “peer mentor”, “mentor mother,” “Maternal and Child health worker”, “HIV positive mothers”, “HIV exposed infants” and PMTCT. Results Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes. Conclusion LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.
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Affiliation(s)
| | - Tariro Jayson Basera
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Bonaventure Egbujie
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Preethi Mistri
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nireshni Naidoo
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jude Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Diamond-Smith N, Warnock R, Sudhinaraset M. Interventions to improve the person-centered quality of family planning services: a narrative review. Reprod Health 2018; 15:144. [PMID: 30153846 PMCID: PMC6114885 DOI: 10.1186/s12978-018-0592-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
Person-centered care, a key component of quality of care, is receiving increased attention for maternal and reproductive health. While many interventions have aimed to improve person-centered care for family planning, there is no known narrative review of person-centered-focused interventions in family planning and the outcomes of these interventions. This narrative review fills this gap by conducting a rigorous analysis of interventions that address person-centered care and measure family planning related outcomes, including quality, knowledge and use/continuation. The search of the published and grey literature, from 1990 to 2015 identified 5530 papers, of which 25 were ultimately included in the analysis (after exclusion criteria was applied). We grouped these interventions under seven domains of person-centered care: dignity, autonomy, privacy/confidentiality, communication, social support, supportive care, and trust. We find that person-centered interventions had high success in improving perceptions of quality and knowledge of family planning among clients; however, results were less consistent in improving family planning uptake and continuation. These findings will help program and policy makers develop interventions that incorporate person-centered components to have the highest likelihood for success in improving clients' experiences and family planning use.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ruby Warnock
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
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Daniele MAS, Cleland J, Benova L, Ali M. Provider and lay perspectives on intra-uterine contraception: a global review. Reprod Health 2017; 14:119. [PMID: 28950913 PMCID: PMC5615438 DOI: 10.1186/s12978-017-0380-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion. METHODS A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications. RESULTS Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes. CONCLUSION Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries.
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Affiliation(s)
- Marina A. S. Daniele
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Robinson JL, Narasimhan M, Amin A, Morse S, Beres LK, Yeh PT, Kennedy CE. Interventions to address unequal gender and power relations and improve self-efficacy and empowerment for sexual and reproductive health decision-making for women living with HIV: A systematic review. PLoS One 2017; 12:e0180699. [PMID: 28837562 PMCID: PMC5570301 DOI: 10.1371/journal.pone.0180699] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many women living with HIV experience gendered power inequalities, particularly in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to make SRH decisions through a systematic review. METHODS AND FINDINGS We included peer-reviewed articles indexed in PubMed, PsycINFO, CINAHL, Embase, and Scopus published through January 3, 2017, presenting multi-arm or pre-post intervention evaluations measuring one of the following outcomes: (1) self-efficacy, empowerment, or measures of SRH decision-making ability, (2) SRH behaviors (e.g., condom use, contraceptive use), or (3) SRH outcomes (e.g., sexually transmitted infections [STIs]). Twenty-one studies evaluating 11 intervention approaches met the inclusion criteria. All were conducted in the United States or sub-Saharan Africa. Two high-quality randomized controlled trials (RCTs) showed significant decreases in incident gonorrhea and chlamydia. Sixteen studies measuring condom use generally found moderate increases associated with the intervention, including in higher-quality RCTs. Findings on contraceptive use, condom self-efficacy, and other empowerment measures (e.g., sexual communication, equitable relationship power) were mixed. Studies were limited by small sample sizes, high loss to follow-up, and high reported baseline condom use. CONCLUSIONS While more research is needed, the limited existing evidence suggests that these interventions may help support the SRH and rights of women living with HIV. This review particularly highlights the importance of these interventions for preventing STIs, which present a significant health burden for women living with HIV that is rarely addressed holistically. Empowerment-based interventions should be considered as part of a comprehensive package of STI and other SRH services for women living with HIV.
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Affiliation(s)
- Jennifer L. Robinson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Avni Amin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sophie Morse
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura K. Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Cleland J, Ali M, Benova L, Daniele M. The promotion of intrauterine contraception in low- and middle-income countries: a narrative review. Contraception 2017; 95:519-528. [PMID: 28365165 DOI: 10.1016/j.contraception.2017.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken. OBJECTIVE To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs. METHODS We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations. RESULTS We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered. CONCLUSION The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies.
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Affiliation(s)
- John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Marina Daniele
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Haberlen SA, Narasimhan M, Beres LK, Kennedy CE. Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review. Stud Fam Plann 2017; 48:153-177. [PMID: 28337766 PMCID: PMC5516228 DOI: 10.1111/sifp.12018] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Evidence on the feasibility, effectiveness, and cost‐effectiveness of integrating family planning (FP) and HIV services has grown significantly since the 2004 Glion Call to Action. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in 2013. Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective (noncondom) modern methods among women who wanted to prevent pregnancy. Integration efforts, particularly in contexts where contraceptive use is low, must address community‐wide and HIV‐specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care.
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Rutaremwa G, Kabagenyi A. Utilization of integrated HIV and sexual and reproductive health services among women in Uganda. BMC Health Serv Res 2016; 16:494. [PMID: 27645152 PMCID: PMC5029044 DOI: 10.1186/s12913-016-1761-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While the rationale for integration of HIV and sexual and reproductive health (HIV and SRH) services is strong, there is paucity of information on which population groups most utilize these services. Such studies would inform policy and programs on integration of services. The overall objective of this assessment is to provide information to researchers, planners and policy makers on the best practices for integrated services in order to maximize feasibility of scaling up. Specifically, this research paper identifies demographic and socioeconomic factors that are most related to utilization of integrated services in Uganda. METHODS This manuscript uses data from a sample of 9,691 women interviewed during the Uganda AIDS Indicator Survey (UAIS) of 2011. The selection criteria of the study respondents for this paper included women of reproductive age 15 - 49 years. The dependent variable is whether the respondent utilized integrated HIV and SRH services during pregnancy and delivery of the last child, while independent variables include; region of residence, age-group of woman, marital status, rural-urban residence, wealth indicator and educational level attainment. In the main analysis, a binary logistic regression model was fitted to the data. RESULTS Log-odds of utilizing integrated services were significantly higher among those women with a primary education (OR = 1.2, 95 % CI = 1.0-1.4, p < 0.05) compared to those with no education. Women from the Central part of Uganda were more likely to utilize integrated HIV and SRH services (OR = 1.3, 95 % CI = 1.0-1.7, p < 0.05), further the log-odds of utilizing integrated HIV and SRH services were significantly higher among women residing in Northern region (OR = 1.6, 95 % CI = 1.2-2.2, p < 0.01). The odds of utilization of integrated HIV and SRH services were higher for currently married women (OR = 6.6, 95 % CI = 5.5-8.0, p < 0.01) and the formerly married (OR = 3.4, 95 % CI = 2.7-4.2, p < 0.01), compared to the never married group. The odds of utilizing integrated HIV and SRH services were higher for younger women of ages less than 35 years compared to older women aged 40 - 49 years. CONCLUSIONS Utilization of integrated HIV and SRH services in Uganda is influenced greatly by demographic and socioeconomic characteristics. This study contributes to the current debate as it shows the on how best ways to improve HIV and SRH service delivery to the people.
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Affiliation(s)
- Gideon Rutaremwa
- United Nations Economic Commission for Africa (ECA), Social Development Policy Division, P.O.Box 3001, Addis Ababa, Ethiopia
| | - Allen Kabagenyi
- Center for Population and Applied Statistics (CPAS) and Department of Population Studies, Makerere University, Kampala, Uganda
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Tang JH, Kopp DM, Stuart GS, O'Shea M, Stanley CC, Hosseinipour MC, Miller WC, Mwale M, Kaliti S, Bonongwe P, Rosenberg NE. Association between contraceptive implant knowledge and intent with implant uptake among postpartum Malawian women: a prospective cohort study. Contracept Reprod Med 2016; 1:13. [PMID: 29201402 PMCID: PMC5693581 DOI: 10.1186/s40834-016-0026-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/11/2016] [Indexed: 11/17/2022] Open
Abstract
Background Long-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies. Sub-Saharan Africa has low uptake of the two available methods of LARC, the subdermal implant and intrauterine contraception (IUC). Our primary objectives were to: 1) calculate the incidence of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake. Methods This study was a prospective cohort study of 634 postpartum women who were recruited from the postpartum ward of Bwaila Hospital in Lilongwe, Malawi. Study participants completed a baseline survey in the postpartum ward. Follow-up telephone surveys about contraceptive use were conducted at 3, 6, and 12 months postpartum. Cox proportional hazards regression analysis was performed to evaluate if implant knowledge and intent to use implant were associated with implant uptake. Results One hundred thirty-seven implant and 10 IUC placements were reported over 12 months of follow-up; given the low rate of IUC uptake, further analysis was only done for implant uptake. The incidence rate for implant uptake was 35.6 per 100 person-years (95 % CI 30.0, 42.2). Correct implant knowledge (adjusted HR = 1.69; 95 % CI 1.06, 2.68) and intent to use implant (adjusted HR 1.95; 95 % CI 1.28, 2.98) were both associated with implant uptake. Conclusions More women reported implant use than IUC use in our study. Correct implant knowledge and intent to use implant were both associated with implant uptake, with a stronger association for intent. Interventions to increase LARC uptake should focus on improving LARC knowledge and removing barriers to LARC. Trial registration Clinical Trial Registration #: NCT01893021
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Affiliation(s)
- Jennifer H Tang
- UNC Project-Malawi, 100 Mzimba Road, Private Bag A-104, Lilongwe, Malawi.,Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, CB #7570, Chapel Hill, NC 27599-7570 USA
| | - Dawn M Kopp
- UNC Project-Malawi, 100 Mzimba Road, Private Bag A-104, Lilongwe, Malawi
| | - Gretchen S Stuart
- Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, CB #7570, Chapel Hill, NC 27599-7570 USA
| | - Michele O'Shea
- UNC Project-Malawi, 100 Mzimba Road, Private Bag A-104, Lilongwe, Malawi.,Department of Obstetrics & Gynecology, Northwestern University, 250 East Superior Street, Suite 03-2303, Chicago, IL 60611 USA
| | | | - Mina C Hosseinipour
- UNC Project-Malawi, 100 Mzimba Road, Private Bag A-104, Lilongwe, Malawi.,Department of Medicine, University of North Carolina, 130 Mason Farm Road, CB #7030, Chapel Hill, NC 27599-7030 USA
| | - William C Miller
- Department of Medicine, University of North Carolina, 130 Mason Farm Road, CB #7030, Chapel Hill, NC 27599-7030 USA.,Department of Epidemiology, University of North Carolina, 135 Dauer Drive, CB #7435, Chapel Hill, NC 27599-7435 USA
| | - Mwawi Mwale
- Bwaila Hospital, Old Malangalanga Road, Lilongwe, Malawi
| | - Stephen Kaliti
- Bwaila Hospital, Old Malangalanga Road, Lilongwe, Malawi
| | - Phylos Bonongwe
- Department of Obstetrics & Gynaecology, Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre, Malawi
| | - Nora E Rosenberg
- UNC Project-Malawi, 100 Mzimba Road, Private Bag A-104, Lilongwe, Malawi.,UNC Institute for Global Health and Infectious Diseases, 130 Mason Farm Road, CB #7030, Chapel Hill, NC 27599-7030 USA
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Lopez LM, Grey TW, Chen M, Denison J, Stuart G. Behavioral interventions for improving contraceptive use among women living with HIV. Cochrane Database Syst Rev 2016; 2016:CD010243. [PMID: 27505053 PMCID: PMC7092487 DOI: 10.1002/14651858.cd010243.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Contraception services can help meet the family planning goals of women living with HIV as well as prevent mother-to-child transmission. Due to antiretroviral therapy, survival has improved for people living with HIV, and more HIV-positive women may desire to have a child or another child. Behavioral interventions, involving counseling or education, can help women choose and use an appropriate contraceptive method. OBJECTIVES We systematically reviewed studies of behavioral interventions for HIV-positive women intended to inform contraceptive choice, encourage contraceptive use, or promote adherence to a contraceptive regimen. SEARCH METHODS Until 2 August 2016, we searched MEDLINE, CENTRAL, Web of Science, POPLINE, ClinicalTrials.gov and ICTRP. For the initial review, we examined reference lists and unpublished project reports, and we contacted investigators in the field. SELECTION CRITERIA Studies evaluated a behavioral intervention for improving contraceptive use for family planning (FP). The comparison could have been another behavioral intervention, usual care, or no intervention. We also considered studies that compared HIV-positive versus HIV-negative women. We included non-randomized studies as well as randomized controlled trials (RCTs).Primary outcomes were pregnancy and contraception use, e.g. uptake of a new method or improved use or continuation of current method. Secondary outcomes were knowledge of contraceptive effectiveness and attitude about contraception or a specific contraceptive method. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data. One entered the data into RevMan and a second verified accuracy. We evaluated RCTs according to recommended principles. For non-randomized studies, we examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale. Given the need to control for confounding factors in non-randomized studies, we used adjusted estimates from the models when available. Where we did not have adjusted analyses, we calculated the odds ratio (OR) with 95% confidence interval (CI). Due to varied study designs and interventions, we did not conduct meta-analysis. MAIN RESULTS With three new reports, 10 studies from seven African countries met our eligibility criteria. Eight non-randomized studies included 8980 participants. Two cluster RCTs had 7136 participants across 36 sites. Three studies compared a special FP intervention versus usual care, three examined FP services integrated with HIV services, and four compared outcomes for HIV-positive and HIV-negative women.In four studies with high or moderate quality evidence, the special intervention was associated with contraceptive use or pregnancy. A study from Nigeria compared enhanced versus basic FP services. All sites had integrated FP and HIV services. Women with enhanced services were more likely to use a modern contraceptive method versus women with basic services (OR 2.48, 95% CI 1.31 to 4.72). A cluster RCT conducted in Kenya compared integrated FP and HIV services versus standard referral to a separate FP clinic. Women with integrated services were more likely to use more effective contraception (adjusted OR 1.81, 95% CI 1.24 to 2.63). Another cluster RCT compared an HIV prevention and FP intervention versus usual care in Kenya, Namibia, and Tanzania. Women at the special intervention sites in Tanzania were more likely to use highly effective contraception (adjusted OR 2.25, 95% CI 1.24 to 4.10). They were less likely to report unprotected sex (no condom use) at last intercourse (adjusted OR 0.23, 95% CI 0.14 to 0.40). Across the three countries, women at the special intervention sites were less likely to report any unprotected sex in the past two weeks (adjusted OR 0.56, 95% CI 0.32 to 0.99). A study in Côte d'Ivoire integrated HIV and FP services. HIV-positive women had a lower incidence of undesired pregnancy, but not overall pregnancy, compared with HIV-negative women (1.07 versus 2.38; reported P = 0.023). AUTHORS' CONCLUSIONS The studies since 2009 focused on using modern or more effective methods of contraception. In those later reports, training on FP methods and counseling was more common, which may strengthen the intervention and improve the ability to meet clients' needs. The quality of evidence was moderate from the more recent studies and low for those from the 1990s.Comparative research involving contraceptive counseling for HIV-positive women is limited. The FP field needs better ways to help women choose an appropriate contraceptive and continue using that method. Improved counseling methods are especially needed for limited resource settings, such as clinics focusing on people living with HIV.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Julie Denison
- Johns Hopkins University Bloomberg School of Public HealthInternational HealthBaltimoreMarylandUSA
| | - Gretchen Stuart
- University of North Carolina School of MedicineDepartment of Obstetrics and Gynecology3031 Old Clinic Building CB#7570Chapel HillNorth CarolinaUSA27599‐7570
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Blazer C, Prata N. Postpartum family planning: current evidence on successful interventions. Open Access J Contracept 2016; 7:53-67. [PMID: 29386937 PMCID: PMC5683159 DOI: 10.2147/oajc.s98817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations.
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Affiliation(s)
- Cassandra Blazer
- Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Ndola Prata
- Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
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Implementation and Operational Research: Integration of Family Planning Services in a Peer-Managed HIV Care Clinic Serving Most-at-Risk Populations in Phnom Penh, Cambodia. J Acquir Immune Defic Syndr 2015; 69:e120-6. [PMID: 25850605 DOI: 10.1097/qai.0000000000000635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess contraceptive uptake and method choice among women living with HIV (WLHIV) attending an HIV care clinic serving most-at-risk women in Phnom Penh, Cambodia, before and after the implementation of family planning (FP) services. METHODS Semistructured questionnaires were administered to clients before (July, 2011) and after (July, 2012) FP service implementation with provision of contraceptive methods (pills, injectables, implants, and intrauterine device [IUD]). RESULTS Among 250 and 249 clients interviewed before and after implementation respectively, 24.5% of women reported selling sex for money during the last 6 months before and 35.3% after implementation. Awareness about contraceptive methods significantly increased among clients postimplementation. Among sexually active women, male condom remained the contraceptive method of choice with an overall condom use during the last 6 months at 91% postimplementation vs. 95.6% preimplementation (P = 0.11). Although the use of noncondom FP methods increased but not significantly (16.4% after vs. 12.6% before implementation, P = 0.8), the use of dual method (condom plus another method) remained low and did not significantly increase after implementation (14.8% after vs. 11.0% before, P = 0.28). CONCLUSIONS Our results show that FP practices of WLHIV attending an HIV care clinic for most-at-risk populations did not significantly change after integration on-site provision of a wide range of FP methods. Innovative strategies and further research are needed to better understand how to promote the use of noncondom FP methods and prevent unwanted pregnancies and abortions among most-at-risk women and WLHIV.
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Implementation and Operational Research: Scaling Up the Provision of the PMTCT Services, Using the Linked Response Approach in Cambodia From 2008 to 2012. J Acquir Immune Defic Syndr 2015; 69:e66-73. [PMID: 26009837 DOI: 10.1097/qai.0000000000000592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In Cambodia, the Linked Response (LR) approach for strengthening linkages between HIV and reproductive health services, especially for the prevention of mother-to-child transmission of HIV (PMTCT), was scaled up in 2009. This article describes the LR scale-up and the concomitant evolution of key PMTCT indicators at the national level. METHODS A descriptive analysis of routine LR, PMTCT programme data, and national laboratory data from 2008 to 2012 was conducted. RESULTS LR data show that between 2008 and 2012, the number of LR/PMTCT sites increased from 67 to 956 (of 1004) public health facilities to cover 74 (of 77) operational districts. In LR operational districts, the number of pregnant women (PW) tested for HIV increased from 41,800 in 2009 to 269,935 [of whom 375 (0.14%) were newly tested positive for HIV] in 2012; the number of PW living with HIV and exposed infants receiving antiretrovirals increased from 49 and 44 in 2009 to 720 and 551 in 2012, respectively. Concomitantly, national PMTCT programme data showed that the percent of PW tested for HIV increased from 34.4% (117,832 of 342,929 estimated PW) in 2008 to 86.1% (324,996 of 377,340) in 2012. In 2012, 65.3% (862 of 1321) of estimated HIV-positive PW and 72.7% (960 of 1321) of exposed infants received antiretrovirals. By 6-8 weeks postpartum, 7.4% (8 of 108) and 1.5% (6 of 409) of DNA-polymerase chain reaction tested positive in 2008 and in 2012, respectively. CONCLUSIONS The LR approach provided a model, which catalyzed increased access of PW to HIV testing and treatment, thereby contributing to the scale-up of PMTCT service provision and improved coverage in Cambodia.
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Increasing HIV serostatus disclosure in low and middle-income countries: a systematic review of intervention evaluations. AIDS 2015; 29 Suppl 1:S7-S23. [PMID: 26049541 DOI: 10.1097/qad.0000000000000671] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the effectiveness of interventions to increase HIV serostatus disclosure in low and middle-income countries. DESIGN Systematic review of peer-reviewed articles providing prepost or multiarm evaluations of disclosure interventions, defined broadly as any intervention with the goal of increasing rates of voluntary disclosure of HIV serostatus through self-disclosure or partner notification. METHODS Articles were included if they reported postintervention evaluation results and were published between 1 January 1990 and 1 August 2014. Searching was conducted through five electronic databases, secondary searching of four journals, and hand searching reference lists of included articles. Systematic methods were used for screening and data abstraction, which was conducted in duplicate. Study quality (rigor) was assessed with eight items. RESULTS Fourteen articles evaluating 13 interventions met the inclusion criteria, all from sub-Saharan Africa. Most interventions focused on people living with HIV and used cognitive-behavioral group sessions or peer/community health worker support to encourage disclosure to sexual partners, family members, or friends. One focused on maternal disclosure to HIV-uninfected children, whereas two examined voluntary partner notification interventions. Several studies had limitations due to weak designs, small sample sizes, or high attrition. Findings on disclosure were mixed, with most effect sizes being relatively small, and some more rigorous studies showing no effect. Partner notification interventions had the strongest evidence of impact. CONCLUSION The existing evidence base for interventions to increase disclosure is limited and shows variable results. Further research is needed to determine whether current approaches to increasing disclosure are effective or whether new approaches should be considered.
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Medley A, Bachanas P, Grillo M, Hasen N, Amanyeiwe U. Integrating prevention interventions for people living with HIV into care and treatment programs: a systematic review of the evidence. J Acquir Immune Defic Syndr 2015; 68 Suppl 3:S286-96. [PMID: 25768868 PMCID: PMC4666299 DOI: 10.1097/qai.0000000000000520] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This review assesses the impact of prevention interventions for people living with HIV on HIV-related mortality, morbidity, retention in care, quality of life, and prevention of ongoing HIV transmission in resource-limited settings (RLSs). METHODS We conducted a systematic review of studies reporting the results of prevention interventions for people living with HIV in RLS published between January 2000 and August 2014. Standardized methods of searching and data abstraction were used. RESULTS Ninety-two studies met the eligibility criteria: 24 articles related to adherence counseling and support, 13 on risk reduction education and condom provision, 19 on partner HIV testing and counseling, 14 on provision of family planning services, and 22 on assessment and treatment of other sexually transmitted infections. Findings indicate good evidence that adherence counseling and sexually transmitted infection treatment can have a high impact on morbidity, whereas risk reduction education, partner HIV testing and counseling, and family planning counseling can prevent transmission of HIV. More limited evidence was found to support the impact of these interventions on retention in care and quality of life. Most studies did not report cost information, making it difficult to draw conclusions about the cost-effectiveness of these interventions. CONCLUSIONS This evidence suggests that these prevention interventions, if brought to sufficient scale and coverage, can help support and optimize the impact of core treatment and prevention interventions in RLS. Further operational research with more rigorous study designs, and ideally with biomarkers and costing information, is needed to determine the best model for providing these interventions in RLS.
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Affiliation(s)
- Amy Medley
- US Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA
| | - Pamela Bachanas
- US Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA
| | - Michael Grillo
- Naval Health Research Center, Department of Defense, HIV/AIDS Prevention Program, San Diego, CA
| | - Nina Hasen
- U.S. Department of State, Office of the US Global AIDS Coordinator and Health Diplomacy, Washington, DC
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