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Munakampe MN, Ngoma-Hazemba A, Sampa M, Jacobs CN. Understanding inequalities in the coverage of adolescent sexual and reproductive health services: a qualitative case study of the selected regions of Zambia. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1399289. [PMID: 39166176 PMCID: PMC11333446 DOI: 10.3389/frph.2024.1399289] [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: 03/11/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. Materials and methods In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. Results We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. Conclusion While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.
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Affiliation(s)
- Margarate Nzala Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
| | - Alice Ngoma-Hazemba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mutale Sampa
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Choolwe N. Jacobs
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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Cetinkaya E, Saribas D. Turkish middle school students' evaluation of fallacious claims about vaccination. CULTURAL STUDIES OF SCIENCE EDUCATION 2023; 18:1-26. [PMID: 36845561 PMCID: PMC9938733 DOI: 10.1007/s11422-022-10144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 11/10/2022] [Indexed: 05/25/2023]
Abstract
In today's world, there is too much information pollution and people circulate it without questioning, and the claims on controversial issues often contain fallacies and conspiracy theories. Considering this point of view, it is necessary to create citizens who critically evaluate information. In order to achieve this goal, science educators need to address students' evaluation of fallacies on controversial issues. The aim of the present study, thus, is to explore eighth graders' evaluation of fallacies about vaccination. We used case study in the study in which 29 eighth grade students participated. We adapted a rubric that was developed by Lombardi et al. (Int J Sci Educ 38(8):1393-1414, 2016. https://doi.org/10.1080/09500693.2016.1193912) to assess students' evaluation levels between claims and evidence and used it to analyze students' evaluations of each fallacy in groups and individually. The findings of this study indicate that students were mostly unable to evaluate claims and evidence critically. We advocate that attempts should be made so that students cope with misinformation and disinformation, ensuring that they establish a consistent relationship between claim and the evidence, and the social and cultural factors that affect their evaluation of false claims should be identified. The implications of this study suggest to make deliberate attempts in order to enable middle school students to evaluate claims and evidence critically in various science topics, particularly in health issues, due to the COVID-19 pandemic. Implications of the present research include suggestion of a method including discussions of fallacies about controversial issues and utilizing additional data sources such as interviews to reveal student ideas in-depth and analyze students' decision-making skills.
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Affiliation(s)
| | - Deniz Saribas
- Elementary Education Department, Istanbul Aydin University, Besyol Mah. Inonu Cad. No: 38, 34295 Sefakoy-Kucukcekmece, Istanbul Turkey
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Jonas K, Duby Z, Maruping K, Harries J, Mathews C. Rumours, myths, and misperceptions as barriers to contraceptive use among adolescent girls and young women in South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:960089. [PMID: 36406890 PMCID: PMC9673823 DOI: 10.3389/frph.2022.960089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Rumours, myths, and misperceptions about contraceptives are a barrier to contraceptive use in general, but more so among adolescent girls and young women (AGYW). As rumours and misinformation disseminate easily, it is important to explore how they affect the uptake of contraceptives among AGYW at risk of unintended pregnancies. This study used qualitative methods to explore whether rumours, myths, and misperceptions about contraceptives remain barriers to modern contraceptive use among AGYW who were beneficiaries of a combination HIV prevention intervention in South Africa. Methods Four (4) once-off in-depth interviews, 53 serial in-depth interviews, and 19 focus group discussions (FGDs) with 185 AGYW aged 15–24 years living in 5 of the 10 intervention districts were conducted as part of the HERStory 1 Study. Interviews and FGDs were audio recorded and data were analysed thematically, aided by Nvivo 12 software. Results Rumours, myths, and misperceptions about contraceptives, as well as sociocultural norms regarding contraception seriously hinder AGYWs’ use of modern contraceptives. Peer/friends’ disapproval and parents’ and boyfriend’s lack of support for AGYWs’ use of contraceptives, based on rumours and perceived side effects, also impede AGYWs’ access and use of contraceptives. Conclusion Sexual and reproductive health programmes could address social norms that disapprove of contraception and target rumours, myths, and misperceptions regarding modern contraceptive methods through educational campaigns and community engagements. Promoting the use of contraception in the community and men’s acceptance of contraceptive use, in particular, may increase their understanding of modern contraceptives and, subsequently, their approval for their partners to use them.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Adolescent Health Research Unit, Division of Child / Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
- Correspondence: Kim Jonas
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jane Harries
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Adolescent Health Research Unit, Division of Child / Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Zhao X, Milford C, Smit J, Zulu B, Boyd P, Malcolm RK, Beksinska M. Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings. AIDS Behav 2022; 26:2954-2968. [PMID: 35294694 PMCID: PMC8924943 DOI: 10.1007/s10461-022-03596-7] [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] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Steroid-releasing vaginal rings are available for contraception and estrogen replacement therapy, and a new antiretroviral-releasing ring was recently approved for HIV prevention. Marketed rings are white or transparent in appearance, non-scented, and supplied as one-size-fits-all devices with diameters ranging from 54 to 56 mm. In this study, drug-free silicone elastomer rings were manufactured in different sizes, colors and scents, and the opinions/preferences of 16 women (eThekwini District, South Africa; 20-34 years) assessed through focus group discussions and thematic analysis. Opinions varied on ring color and scent, with some women preferring specific colors or scent intensities, while for others these attributes were unimportant. Concerns about color and scent were linked to perceptions around vaginal health and safety related to chemical composition. There was greater agreement on preferred ring size; flexibility and width were considered important factors for insertion and comfort. Greater choice with ring products could facilitate acceptability and overall uptake.
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Affiliation(s)
- Xinyu Zhao
- School of Pharmacy, Queen’s University Belfast, Belfast, BT9 7BL UK
| | - Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jenni Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Bongiwe Zulu
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Peter Boyd
- School of Pharmacy, Queen’s University Belfast, Belfast, BT9 7BL UK
| | - R. Karl Malcolm
- School of Pharmacy, Queen’s University Belfast, Belfast, BT9 7BL UK
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
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Browne EN, Brown ER, Palanee-Phillips T, Reddy K, Naidoo L, Jeenarain N, Nair G, Husnik MJ, Singh D, Scheckter R, Soto-Torres L, Baeten JM, van der Straten A. Patterns of Adherence to a Dapivirine Vaginal Ring for HIV-1 Prevention Among South African Women in a Phase III Randomized Controlled Trial. J Acquir Immune Defic Syndr 2022; 90:418-424. [PMID: 35344520 PMCID: PMC9342948 DOI: 10.1097/qai.0000000000002990] [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] [Received: 04/26/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persistent use of HIV prevention methods can be a challenge, particularly for some younger women. The long-acting, discreet, woman-centric dapivirine vaginal ring offers promise as a prevention method with less user burden, which could support continued use. We assessed dapivirine vaginal ring use to understand adherence patterns and identify characteristics influencing patterns. SETTING Participants enrolled in South Africa in the MTN-020/ASPIRE randomized placebo-controlled trial. METHODS We used group-based trajectory modeling to identify clusters of participants with similar longitudinal patterns of adherence in the last year of participation and potential predictors of group membership. Women with at least 1 year of follow-up were included (n = 626). RESULTS Five adherence patterns were identified: (1) consistently high, 34%, (2) consistently moderate, 34%, (3) consistently low, 16%, (4) decreasing, 9%, and (5) increasing, 7%. Women younger than 22 years [adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.0 to 3.0], using an intrauterine device (AOR 3.3, 95% CI: 1.4 to 7.8) or oral contraceptives (AOR 3.9, 95% CI: 1.7 to 8.9), experiencing menses (AOR 1.8, 95% CI: 1.1 to 3.0), and who reported inconsistent condom use (AOR 1.8, 95% CI: 1.0 to 3.3) were more likely to be classified as consistently low compared to consistently high (referent). CONCLUSIONS Most South African women successfully persisted with a moderate or high level of use. Encouraging ring replacement with completion of menses may help to decrease concerns about hygiene and improve persistence. Associations between contraception and persistent low adherence suggest efforts may be needed to ensure contraceptive method choice does not interfere with ring use.
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Affiliation(s)
- Erica N Browne
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Elizabeth R Brown
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health, Sciences, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; and
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health, Sciences, Johannesburg, South Africa
| | | | | | | | | | - Devika Singh
- University of Pittsburgh, and Magee-Women's Research Institute, Pittsburgh, PA
| | | | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jared M Baeten
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA
- Current, Gilead Sciences, Foster City, CA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA
- ASTRA consulting, Kensington, CA
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Ring-ing in the Future: Participant and Male Partner Perspectives Regarding Future Use of the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 2022; 26:1923-1932. [PMID: 35064389 DOI: 10.1007/s10461-021-03542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
Women account for a disproportionate percentage of new HIV infections in sub-Saharan Africa indicating a need for female-initiated HIV prevention options congruent with their lifestyles. The dapivirine vaginal ring for HIV prevention is one such option. We explored the interest of women, who used this ring during the Microbicide Trials Network's ASPIRE and HOPE studies, in using the ring post-licensure and what they perceived as important considerations for future use. We also explored perspectives of HOPE participants' male partners on their involvement in their partners' future ring use. Women appeared keen to use the ring in the future and expressed desires for easy access, support for both ongoing and new users and intense community engagement. In parallel, male partners indicated high levels of interest in supporting their partners' ring use and being involved in ring use decision making. These data offer important insights for ring rollout planning and engagement activities.
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Does the Ring Work? Perceptions and Understanding of the Efficacy of a Dapivirine Vaginal Ring for HIV Prevention Amongst Women in a Placebo-Controlled Trial. AIDS Behav 2022; 26:1597-1606. [PMID: 34727272 DOI: 10.1007/s10461-021-03512-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
As demonstrated by the Phase III clinical trial, MTN-020/ASPIRE, the monthly dapivirine vaginal ring is well tolerated and reduces the risk of HIV-1 as a woman-initiated prevention option. This analysis uses data from the follow-on MTN-032/Assessment of ASPIRE and HOPE Adherence (AHA) qualitative study to understand how perceptions (or misperceptions) of ring efficacy may have influenced behavior during ASPIRE, and affected intention to use the ring in future ring projects, specifically HOPE, the planned open-label extension study. Single in-depth interviews (n = 98) and 12 focus group discussions (n = 89) were conducted with women at seven sites in Malawi, South Africa, Uganda and Zimbabwe. Eligibility included participation in the ASPIRE active arm, and ring use for ≥ 3 months or at least 1 month if seroconversion occurred. Interviews were audio-recorded, transcribed into English, coded in Dedoose and thematically analyzed. Demographic and behavioral questionnaire data were summarized in Stata. Most AHA participants perceived the ring to be effective, and described simply trusting it or having confidence in it because they, or other participants in risky situations, remained HIV-uninfected. Participants described ring efficacy after receiving ASPIRE results as a binary assessment: the ring worked or not. Many did not remember exact efficacy percentages because of lack of comprehension or memory but recalled key details about age differences. The majority expressed interest in future ring use. There is a need to investigate improved ways of explaining placebo-controlled trials and efficacy to women in Sub-Saharan Africa. Now that ring efficacy, is known, these benefits must be well communicated, and understood by end-users and key stakeholders. Engagement with end-users to construct effective messages and to develop tools to measure understanding of partial efficacy will be essential.
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Gichane MW, Katz AWK, Ngure K, Scheckter R, Woeber K, Reddy K, Tauya T, Zimba C, Etima J, Mangxilana N, Palanee-Phillips T, van der Straten A. Impact of Women's Home Environment on Use of the Dapivirine Vaginal Ring for HIV Prevention in Sub-Saharan Africa. AIDS Behav 2021; 25:3847-3857. [PMID: 34009480 PMCID: PMC8602444 DOI: 10.1007/s10461-021-03311-y] [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: 05/12/2021] [Indexed: 11/27/2022]
Abstract
The monthly dapivirine vaginal ring has proven efficacious in reducing HIV incidence in two Phase 3 clinical trials. When considering the potential future availability of the ring to the public, key questions remain about the feasibility of integrating the ring as an HIV prevention intervention into women's lives. We conducted qualitative mapping interviews (n = 66) among women enrolled in MTN-025/HOPE, an open-label trial conducted in Malawi, South Africa, Uganda and Zimbabwe, to examine how home environments influenced use of the dapivirine vaginal ring. Most women had secure places to store their rings including wardrobes, suitcases, and bags. The primary concerns for ring storage were potential tampering from children or rodents. Household overcrowding limited the privacy some women had which made removal and insertion of vaginal rings challenging. Despite these challenges, ring storage, insertion, and removal was feasible across social and living contexts.
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Affiliation(s)
- Margaret W Gichane
- Substance Use Gender, and Applied Research Group, RTI International, Research Triangle Park, Durham, NC, USA
| | - Ariana W K Katz
- Women's Global Health Imperative, RTI International, Berkley, CA, USA.
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Kubashni Woeber
- South African Medical Research Council, Durban, Kwazulu Natal, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Thelma Tauya
- University of Zimbabwe College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University, Research Collaboration, Kampala, Uganda
| | - Nomvuyo Mangxilana
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Bhavaraju N, Shears K, Schwartz K, Mullick S, Jeckonia P, Murungu J, Persaud U, Vij A, Torjesen K. Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP? Curr HIV/AIDS Rep 2021; 18:508-517. [PMID: 34910276 PMCID: PMC8671875 DOI: 10.1007/s11904-021-00577-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Clinical trials have found that the dapivirine vaginal ring (DVR) is safe to use and effective at reducing women's risk of acquiring HIV infection. As countries prepare for the introduction of this novel long-acting, woman-controlled prevention method, an examination of key learnings from oral pre-exposure prophylaxis (PrEP) delivery will help programs leverage successful innovations and approaches to support DVR scale-up and expand the method mix for HIV prevention. RECENT FINDINGS Intensive efforts over the past 5 years have yielded lessons on how to facilitate access to oral PrEP; expand service delivery for PrEP; address the knowledge, attitudes, and skills providers need to support PrEP initiation and effective use; develop messaging that builds community and partner support and combats stigma; and understand the cyclical nature of PrEP use. Evidence from oral PrEP introduction and scale-up can help inform and expedite DVR introduction.
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Affiliation(s)
| | - Kathleen Shears
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009 USA
| | | | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, 8 Blackwood Avenue, Parktown, Johannesburg, South Africa
| | - Patriciah Jeckonia
- LVCT Health, Batian Lane, Off Argwings Kodhek Road, Hurlingam, Nairobi, Kenya
| | - Joseph Murungu
- Pangaea Zimbabwe AIDS Trust, 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Udita Persaud
- United States Agency for International Development, 1300 Pennsylvania Avenue NW, Washington, DC 20523 USA
| | - Ashley Vij
- United States Agency for International Development, 1300 Pennsylvania Avenue NW, Washington, DC 20523 USA
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Garcia M, Luecke E, Mayo AJ, Scheckter R, Ndase P, Kiweewa FM, Kemigisha D, Musara P, Mansoor LE, Singh N, Woeber K, Morar NS, Jeenarain N, Gaffoor Z, Gondwe DK, Makala Y, Fleurs L, Reddy K, Palanee-Phillips T, Baeten JM, van der Straten A, Soto-Torres L, Torjesen K. Impact and experience of participant engagement activities in supporting dapivirine ring use among participants enrolled in the phase III MTN-020/ASPIRE study. BMC Public Health 2021; 21:2041. [PMID: 34749675 PMCID: PMC8576984 DOI: 10.1186/s12889-021-11919-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low adherence to investigational products can negatively impact study outcomes, limiting the ability to demonstrate efficacy. To continue advancing potential new HIV prevention technologies, efforts are needed to improve adherence among study participants. In MTN-020/ASPIRE, a phase III randomized, double-blind, placebo-controlled study of the dapivirine vaginal ring carried out across 15 sites in sub-Saharan Africa, a multifaceted approach to adherence support was implemented, including a strong focus on participant engagement activities (PEAs). In this manuscript, we describe PEAs and participant attendance, and analyze the potential impact of PEAs on ring use. METHODS All sites implemented PEAs and submitted activity and attendance reports to the study management team throughout the study. Participant demographics were collected via case report forms. Residual dapivirine remaining in the last ring returned by each participant was used to estimate drug released from the ring, which was then adjusted for time participants had the ring to calculate probable use categorized into three levels (low/intermittent/high). Product use was connected to PEA attendance using participant identification numbers. We used multivariate Poisson regression with robust standard errors to explore differences in ring use between PEA attendance groups and reviewed qualitative reports for illustrative quotes highlighting participant experiences with PEAs. RESULTS 2312 of 2629 study participants attended at least one of 389 PEAs conducted across sites. Participant country and partner knowledge of study participation were most strongly associated with PEA attendance (p < 0.005) with age, education, and income status also associated with event attendance (p < 0.05). When controlling for these variables, participants who attended at least one event were more likely to return a last ring showing at least some use (RR = 1.40) than those who never attended an event. There was a stronger correlation between a last returned ring showing use and participant attendance at multiple events (RR = 1.52). CONCLUSIONS Our analysis supports the growing body of work illustrating the importance of meaningfully engaging research participants to achieve study success and aligns with other analyses of adherence support efforts during ASPIRE. While causation between PEA attendance and product use cannot be established, residual drug levels in returned rings strongly correlated with participant attendance at PEAs, and the benefits of incorporating PEAs should be considered when designing future studies of investigational products.
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Affiliation(s)
- Morgan Garcia
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA.
| | - Ellen Luecke
- Women's Global Health Imperative (WGHI) RTI International, Berkeley, CA, USA; ASTRA Consulting, Kensington, CA, USA
| | - Ashley J Mayo
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA
| | - Rachel Scheckter
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA
| | - Patrick Ndase
- Population Services International (PSI), 1120 19th St. NW, Washington, DC, USA
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Doreen Kemigisha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Petina Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, Harare, Zimbabwe
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Nishanta Singh
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kubashni Woeber
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Neetha S Morar
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Nitesha Jeenarain
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Zakir Gaffoor
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Daniel K Gondwe
- College of Medicine - Johns Hopkins Bloomberg School of Public Health, Blantyre, Malawi
| | - Yvonne Makala
- University of North Carolina Project, Lilongwe, Malawi
| | - Llewellyn Fleurs
- Desmond Tutu HIV Foundation, Emavundleni Clinical Research Site, Cape Town, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Ariane van der Straten
- Women's Global Health Imperative (WGHI) RTI International, Berkeley, CA, USA; ASTRA Consulting, Kensington, CA, USA.,Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Mbazzi FB, Nimusiima C, Akellot D, Kawesa E, Abaasa A, Hodges S, Seeley J, Vervoort T. Use of Virtual Reality Distraction to Reduce Child Pain and Fear during Painful Medical Procedures in Children with Physical Disabilities in Uganda: A feasibility study. PAIN MEDICINE 2021; 23:642-654. [PMID: 34185091 DOI: 10.1093/pm/pnab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study explored the acceptability and feasibility of the use of low-cost virtual reality (VR) glasses, and the Wong-Baker Faces Pain Scale and Children's Fear Scale scales, for pain and fear reduction in children admitted at the septic ward of CoRSU Rehabilitation Hospital in Uganda. METHODS In total 79 children aged 4 to 17 years of age were offered to watch cartoons using VR glasses while undergoing painful dressing procedures. Before and after the procedure children were asked to index current pain; children and their caregivers were asked to rate anticipated fear. Focus group discussions with 13 children, 10 caregivers and 9 nurses explored acceptability and feasibility. Quantitative data were analysed using STATA15, NVIVO12 was used for qualitative data analysis. RESULTS The VR glasses were accepted by 76 (96%) of the children. Children, caregivers, and nurses mentioned the glasses were helpful in distracting children from the medical procedure, and felt the use of the glasses helped reduce child fear and pain. Nurses felt it made their work easier. The Wong-Baker Faces Pain Scale was an acceptable and feasible method to measure pain, whilst the Children's Fear Scale was more difficult to interpret for our study population as they felt the faces on the scale were hard to read and identify with. CONCLUSIONS The use of VR glasses may offer an acceptable and effective pain and fear reduction method in resource-constrained settings and should be further explored in a randomized controlled trial.
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Affiliation(s)
- Femke Bannink Mbazzi
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.,London School of Hygiene & Tropical Medicine, Global Health & Development, London, United Kingdom
| | - Claire Nimusiima
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Elizabeth Kawesa
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,CoRSU Rehabilitation Hospital, Kisubi, Uganda
| | - Andrew Abaasa
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, Global Health & Development, London, United Kingdom
| | - Tine Vervoort
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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12
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Men's Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav 2021; 25:1890-1900. [PMID: 33389318 DOI: 10.1007/s10461-020-03119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/20/2023]
Abstract
The dapivirine vaginal ring has been well-tolerated and shown to prevent HIV in clinical trials. The ring is female initiated, yet endorsement for use is sought from male partners in many relationships. In clinical studies, participants have expressed worries about men detecting rings during vaginal sex, which introduces concerns about product use disclosure, sexual pleasure, penile harm, inter-partner dynamics, and ring removals. This study reports African men's firsthand sexual experiences with the ring. Qualitative data were captured through 11 focus group discussions and one in-depth interview with 54 male partners of ring-users at six research sites in Malawi, South Africa, Uganda and Zimbabwe. Following a semi-structured guide, and using demonstration rings, vulva and penis models, men were asked to discuss the ring's impact on sex and views on male engagement and ring use. Interviews were facilitated by local male social scientists, audio-recorded, translated into English, and analyzed thematically. 22 (41%) of the male partners reported feeling the ring during sex, often attributed to perceived incorrect insertion. Many men described the ring as "scratching" the tip of their penises, and sensations of "prodding" something that "blocked" the vagina and prohibited "full entry". In most cases, feelings dissipated with time or when sexual fluids increased. Less common descriptions included perceiving the vaginal texture, wetness and size as different, which increased pleasure for some, and decreased for others. Over half (59%) never noticed the ring; some attempting and failing to feel it during intercourse. A majority of men reported that the ring did not lead to changes in sexual positions, feelings, frequency or experience of sex, although some were initially afraid that the ring was a "magic snake" or "potion". Male partners expressed strong opinions that ring use was a shared prevention responsibility that men should be engaged in, especially for maintaining trust and open communication in relationships. The ring was noticed by many male partners, particularly during women's initial stages of ring use, although this led to few sexual problems or changes. Nevertheless, results suggest that risk of ring discovery should be discussed with women to mitigate any potential negative reactions or social harm. Strategies to increase male partner engagement will enhance support of this prevention method for women.
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13
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Leslie J, Kiweewa F, Palanee-Phillips T, Bunge K, Mhlanga F, Kamira B, Baeten J, Katz A, Hillier S, Montgomery E. Experiences with simultaneous use of contraception and the vaginal ring for HIV prevention in sub-Saharan Africa. BMC WOMENS HEALTH 2021; 21:175. [PMID: 33892693 PMCID: PMC8067655 DOI: 10.1186/s12905-021-01321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/19/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Clinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa. However, in order for the ring or other novel prevention methods to have optimal impact, it is necessary to understand and address women's challenges to uptake and adherence. This paper provides insight into a few key challenges noted by women using the ring and contraceptives simultaneously. METHODS The qualitative portion of the MTN-020/ASPIRE study consisted of data collection using single in-depth interviews, serial in-depth interviews, and focus group discussions, conducted with 214 participants across 15 sites in Malawi, South Africa, Uganda and Zimbabwe. A coding team used qualitative analysis software to identify themes within the interviews. RESULTS The primary qualitative themes among participant data pertained to side effects. Participants reported negative side effects related to menses, in some cases attributing these effects to their contraceptives and in others to the vaginal ring. Participants also expressed concern over the long-term impact of contraception and ring use on fertility, including the reversibility of the contraceptive, especially among nulliparous women. CONCLUSIONS Women's attitudes toward contraceptives can impact their willingness to concurrently use and adhere to a novel HIV prevention product. To optimize the potential of both prevention products, researchers should pre-emptively address concerns about contraceptive impact on fertility and counsel women about the expected side effects of contraceptives versus the ring. Clinical trials identifier NCT01617096. Registered on 6-12-2012 at clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT01617096.
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Affiliation(s)
- Jonah Leslie
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA.
| | - Flavia Kiweewa
- Makerere University-Johns Hopkins University Research Unit, Kampala, Uganda
| | | | - Katherine Bunge
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Felix Mhlanga
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - Betty Kamira
- Makerere University-Johns Hopkins University Research Unit, Kampala, Uganda
| | - Jared Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Ariana Katz
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
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14
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van der Straten A, Ryan JH, Reddy K, Etima J, Taulo F, Mutero P, Taylor J, Piper J, Musara P. Influences on willingness to use vaginal or oral HIV PrEP during pregnancy and breastfeeding in Africa: the multisite MAMMA study. J Int AIDS Soc 2021; 23:e25536. [PMID: 32524700 PMCID: PMC7287313 DOI: 10.1002/jia2.25536] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Women in sub‐Saharan Africa spend a substantial portion of their reproductive lives pregnant and/or breastfeeding (P/BF), yet they have limited options to prevent HIV during these maternal stages. In preparation for phase 3b prevention trials in P/BF women, we explored attitudes about using a vaginal ring or oral pills for pre‐exposure prophylaxis (PrEP), perceptions of HIV risk during P/BF and key influences on future PrEP use. Methods In 2018, we conducted 16 single‐sex focus group discussions (FGDs) with community‐ and clinic‐recruited HIV‐uninfected women, currently or recently P/BF, aged 18 to 40, and men with (currently or recently) P/BF partners, aged 18+. Participants completed a behavioural questionnaire, viewed an educational video and handled prototype placebo products. FGDs were conducted in local languages and transcribed, coded and analysed, using a socio‐ecological framework, for key influences on willingness to use products, HIV risk perceptions and opinions on product attributes. Results Of the 128 participants (65 women, 63 men) 75% lived with their partner and 84% had a child. Women reported the most important influencers when P/BF were partners, and all stated that health decisions when P/BF are typically made jointly (e.g. medication use; ante/postnatal and baby care). There was consensus that P/BF women are at high risk for HIV, primarily because of their partner’s infidelities, and new prevention options were welcomed. Participants valued multiple options and stated that woman’s personal preference would be key to product choice. Anticipated concerns about products included risk of miscarriage, impact on infant development, complications during delivery and adequate production or taste of breastmilk. Specific perceived disadvantages emerged for the ring (e.g. vaginal discomfort, difficulty inserting/removing) and for pills (e.g. nausea/vomiting) that may be exacerbated during pregnancy. Health care providers’ (HCPs) knowledge and approval of product use during P/BF was needed to mitigate anticipated fears. Conclusions Participants perceived pregnancy and breastfeeding as high HIV risk periods and valued new prevention options. HIV protection of the mother‐child dyad, safety of the baby, and ultimately, health of the family were paramount. Endorsement by HCPs and support from partners were key to future product acceptance. Participants recommended involving partners and HCPs in sensitization efforts for future trials.
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Affiliation(s)
- Ariane van der Straten
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA.,Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
| | - Julia H Ryan
- Women's Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Frank Taulo
- Johns Hopkins Project-College of Medicine, University of Malawi, Blantyre, Malawi
| | - Prisca Mutero
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | - Petina Musara
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
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15
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Britton LE, Williams CR, Onyango D, Wambua D, Tumlinson K. "When it comes to time of removal, nothing is straightforward": A qualitative study of experiences with barriers to removal of long-acting reversible contraception in Western Kenya. Contracept X 2021; 3:100063. [PMID: 33912827 PMCID: PMC8063731 DOI: 10.1016/j.conx.2021.100063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/01/2023] Open
Abstract
Objective Barriers to removal of long-acting reversible contraception (LARC) threaten reproductive self-determination, but their influence on contraceptive behaviors is not well understood. We describe perspectives of women in Western Kenya concerning LARC removal barriers. Study design We used a qualitative descriptive approach with conventional content analysis to analyze transcripts for content and themes from eight focus group discussions (n = 55 participants) and one client journey mapping workshop (n = 9 participants) with women ages 18–49 in Western Kenya who were currently using or had formerly used contraceptives. Findings Our primary themes concerned women's experience of LARC removal barriers and the impact on their behaviors and attitudes towards contraception. Women described providers being unwilling to remove LARC, regardless of rationale (including expiration, seeking pregnancy, or experiencing intolerable side effects) or demanding unaffordable fees. Women were reluctant to try LARC for fear of having to use the method for its entire lifespan even if they did not like it. Women saw LARC removal barriers as increasing their risk of unintended pregnancy through non-replacement of expired devices and fostering distrust in the health system. Conclusion Barriers to LARC removal may discourage utilization of LARC and contraceptive services generally, which can undermine women's efforts to achieve reproductive self-determination. Implications Our findings affirm the importance of timely LARC removal to ensure that family planning programs uphold women's reproductive autonomy.
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Affiliation(s)
- Laura E Britton
- Columbia University School of Nursing, New York City, NY, USA
| | - Caitlin R Williams
- Gillings School of Global Public Health, University of North Carolina, Department of Maternal and Child Health, Chapel Hill, NC, USA.,Institute for Clinical Effectiveness and Health Policy, Department of Mother and Child Health, Buenos Aires, Argentina
| | - Dickens Onyango
- Kisumu County Department of Health, Kisumu, Kenya.,Utrecht University, Utretcht, The Netherlands.,Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Katherine Tumlinson
- Gillings School of Global Public Health, University of North Carolina, Department of Maternal and Child Health, Chapel Hill, NC, USA
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16
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Krogstad EA, Atujuna M, Montgomery ET, Minnis AM, Morroni C, Bekker LG. Perceptions matter: Narratives of contraceptive implant robbery in Cape Town, South Africa. CULTURE, HEALTH & SEXUALITY 2021; 23:383-396. [PMID: 32216584 PMCID: PMC7529647 DOI: 10.1080/13691058.2020.1714739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
Uptake of contraceptive implants has declined in South Africa since their introduction in 2014, with side effects and inadequate health provider training cited as primary contributors underlying a poor community perception of implants. In this paper we explore a theme that emerged unexpectedly during analysis of our research in Cape Town that may be an additional factor in this decline: narratives of women being assaulted by robbers who physically remove the implants for smoking as drugs. Narratives were described consistently across interviews and focus groups with youth (aged 18-24 years) and in interviews with health providers, with six participants (two young people, four health providers) sharing personal experiences of robbery. While there was a range of perspectives on whether narratives are based on real experiences or are myths, there was strong consensus that narratives of implant robbery may be influencing women's decisions around implant use in Cape Town. This is a potent example of how perceptions of new products can affect uptake and offers important lessons for implementers to reflect on in planning for rollout of other health technologies.
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Affiliation(s)
- Emily A. Krogstad
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Chelsea Morroni
- Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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17
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Musara P, Milford C, Shapley-Quinn MK, Weinrib R, Mutero P, Odoom E, Mgodi NM, Chirenje ZM, Hanif H, Clark MR, Smit J, van der Straten A, Montgomery ET. Preferences and Acceptability of Vaginal Delivery Forms for HIV Prevention Among Women, Male Partners and Key Informants in South Africa and Zimbabwe: Qualitative Findings. AIDS Behav 2021; 25:124-138. [PMID: 32588257 DOI: 10.1007/s10461-020-02949-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The attributes of an HIV microbicide may affect its acceptability, uptake and use. Quatro, a clinical study with a qualitative component, was conducted to elicit input from end-users and key informants (KIs) on four different placebo vaginal microbicide delivery forms; fast dissolving insert, ring, film and gel. In-depth interviews and focus group discussions were conducted with young women, their male partners and KIs, to explore acceptability and preferences of the four placebo products, with the intention of improving product attributes, adherence, and consequently, long term effectiveness. None of the four microbicide delivery forms stood well above others as the most preferred. Product attributes; long-action, ease of use, invisibility, female initiated and non-interference during sex were favourable in both countries. Despite preference for the long-action, on-demand products were the most liked by women. Qualitative data from the Quatro study provided rich feedback on specific attributes important to the acceptability of four HIV prevention product platforms currently in development, enabling more informed and guided product development efforts moving forward.
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Affiliation(s)
- Petina Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.
| | - Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | | | - Rachel Weinrib
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Prisca Mutero
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Enyonam Odoom
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Nyaradzo M Mgodi
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Zvavahera M Chirenje
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Homaira Hanif
- Eastern Virginia Medical School, CONRAD, Arlington, VA, USA
| | | | - Jenni Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
- Center for AIDS Prevention Studies, University of San Francisco, San Francisco, CA, USA
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18
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Boivin J, Carrier J, Zulu JM, Edwards D. A rapid scoping review of fear of infertility in Africa. Reprod Health 2020; 17:142. [PMID: 32928239 PMCID: PMC7488744 DOI: 10.1186/s12978-020-00973-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Fear of infertility (FOI) is often reported in studies about reproductive health but this literature not yet mapped. The aim of this rapid scoping review of qualitative studies was to describe the nature of FOI in Africa. Methods Eligibility criteria were qualitative data from Africa reporting views of women and men of any age. MEDLINE and CINAHL databases were searched for English language citations to February 2019 using keywords related to fear, infertility and Africa. Two independent reviewers screened texts for inclusion. Results Of 248 citations identified, 38 qualitative and six review papers were included. FOI was reported in diverse groups (e.g., men, women, fertile, infertile, married, unmarried, teachers, religious leaders). Two types of fears were identified: (1) fear of triggering infertility due to specific reproductive choices and (2) fear of the dire future consequences of infertility. Choices were perceived to affect fertility via internal accumulation and blockage (e.g., of menstrual blood), structural damage (e.g., burnt eggs), internal movement of contraceptive material, deliberate toxicity preventing population growth and behavioral effects impeding sexual activity. Diverse feared consequences of infertility were reported (e.g., polygamy, economic hardships). Fears were reported to affect reproductive behaviour (e.g., stopping contraception), help-seeking and social behaviour. Conclusion FOI is a phenomenon that should be studied in its own right. Fears could originate from genuine threats, incorrect knowledge, distortions of truths, or dissemination of false information. Rigorous studies are needed to better understand FOI and integrate it in health education, client counselling and family planning service provision.
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Affiliation(s)
- Jacky Boivin
- School of Psychology. College of Biomedical and Life Sciences, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, Wales, UK.
| | - Judith Carrier
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Deborah Edwards
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
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19
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The Power of the Shared Experience: MTN-020/ASPIRE Trial Participants' Descriptions of Peer Influence on Acceptability of and Adherence to the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 2020; 24:2387-2399. [PMID: 31980993 DOI: 10.1007/s10461-020-02799-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Women are disproportionately at risk of acquiring HIV in East and Southern Africa, despite global declines in incidence. Female-initiated HIV prevention methods, like the dapivirine vaginal ring, are needed to end the HIV epidemic. In-depth interviews and focus groups retrospectively explored peer influence on acceptability of and adherence to the ring during the ASPIRE trial, a phase III placebo-controlled trial. Results were analyzed using an inductive analytic approach. Study participants (peers) of all ages and adherence groups developed important interpersonal connections and reported being more open and honest with each other than with external peers or study staff. Study peers who knew each other prior to joining appeared to have a stronger influence on each other's adherence than peers who met in the study. External peers provided primarily negative input about the ring and study, which sometimes led to ring removals. Peers' influence on each other's behavior in both prosocial and detrimental manners could have repercussions on adherence to a biomedical intervention, and consequently, individual disease risk and clinical trial outcomes. Future ring demonstration and implementation studies could use peer networks to intentionally influence uptake and adherence to the ring.
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20
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Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, Maeri I, Bakanoma R, Onyango A, Atwine F, Ayieko J, Kabami J, Mwangwa F, Atukunda M, Owaraganise A, Kwarisiima D, Sang N, Bukusi EA, Kamya MR, Petersen ML, Cohen CR, Charlebois ED, Havlir DV. Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study. AIDS Behav 2020; 24:2149-2162. [PMID: 31955361 PMCID: PMC7909847 DOI: 10.1007/s10461-020-02780-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have sought to understand factors influencing uptake and continuation of pre-exposure prophylaxis (PrEP) among young adults in sub-Saharan Africa in the context of population-based delivery of open-label PrEP. To address this gap, this qualitative study was implemented within the SEARCH study (NCT#01864603) in Kenya and Uganda, which achieved near-universal HIV testing, and offered PrEP in 16 intervention communities beginning in 2016-2017. Focus group discussions (8 groups, n = 88 participants) and in-depth interviews (n = 23) with young adults who initiated or declined PrEP were conducted in five communities, to explore PrEP-related beliefs and attitudes, HIV risk perceptions, motivations for uptake and continuation, and experiences. Grounded theoretical methods were used to analyze data. Young people felt personally vulnerable to HIV, but perceived the severity of HIV to be low, due to the success of antiretroviral therapy (ART): daily pill-taking was more threatening than the disease itself. Motivations for PrEP were highly gendered: young men viewed PrEP as a vehicle for safely pursuing multiple partners, while young women saw PrEP as a means to control risks in the context of engagement in transactional sex and limited agency to negotiate condom use and partner testing. Rumors, HIV/ART-related stigma, and desire for "proof" of efficacy militated against uptake, and many women required partners' permission to take PrEP. Uptake was motivated by high perceived HIV risk, and beliefs that PrEP use supported life goals. PrEP was often discontinued due to dissolution of partnerships/changing risk, unsupportive partners/peers, or early side effects/pill burden. Despite high perceived risks and interest, PrEP was received with moral ambivalence because of its associations with HIV/ART and stigmatized behaviors. Delivery models that promote youth access, frame messaging on wellness and goals, and foster partner and peer support, may facilitate uptake among young people.
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Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, ANSIRH Program, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA.
| | - Catherine A Koss
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, ANSIRH Program, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | | | | | | | - Irene Maeri
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maya L Petersen
- Graduate Group in Biostatistics, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, ANSIRH Program, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Edwin D Charlebois
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA
| | - Diane V Havlir
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
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21
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Roberts ST, Nair G, Baeten JM, Palanee-Philips T, Schwartz K, Reddy K, Kabwigu S, Matovu Kiweewa F, Govender V, Gaffoor Z, Singh N, Siva S, Naidoo K, Montgomery ET. Impact of Male Partner Involvement on Women's Adherence to the Dapivirine Vaginal Ring During a Phase III HIV Prevention Trial. AIDS Behav 2020; 24:1432-1442. [PMID: 31667678 DOI: 10.1007/s10461-019-02707-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although vaginal microbicides for HIV prevention are designed to be female-initiated, male partner influence has been identified as one of the most significant factors impacting women's willingness and ability to use them. As a result, research teams have sought to increase male partner involvement by encouraging disclosure of product use to male partners, promoting male partner engagement in the study through attendance at the study clinic, and helping women to garner male partner support for product use. This paper aims to assess the impact of these three elements of male partner involvement on women's adherence to the dapivirine vaginal ring during MTN-020/ASPIRE, a phase III randomized placebo-controlled clinical trial involving 2629 women in Malawi, South Africa, Uganda, and Zimbabwe. During the study, 64-80% of participants reported disclosure of ring use at each quarterly visit, and 13% reported that their partners had attended the study clinic at some point during the study. At study exit, 66% reported that their partner was supportive, 18% unsupportive, and 17% were unsure. After adjusting for age, site and time in study, women were more likely to have low ring adherence if they had an unsupportive male partner (aRR 1.29, 95% CI 1.03-1.62). Neither disclosure nor clinic attendance directly predicted ring adherence, but disclosure increased the probability of having a supportive partner (aRRR 24.17, 95% CI 16.38-35.66) or an unsupportive partner (aRRR 4.10, 95% CI 2.70-6.24), relative to an unknown level of partner support. Women were also more likely to have a supportive partner if their partner had attended the clinic (aRRR 3.77, 95% CI 1.36-10.42). This study suggests that although the vaginal ring is relatively discreet, lack of support from male partners remains a relevant barrier to use. Though both disclosure and clinic attendance may increase partner support, disclosure may also increase partner opposition. Interventions to reduce male partner opposition are needed to maximize the potential impact of the ring and other PrEP products for HIV prevention.
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Affiliation(s)
- Sarah T Roberts
- Women's Global Health Imperative, RTI International, 351 California Street, Ste. 500, San Francisco, CA, 94104, USA.
| | - Gonasagrie Nair
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
| | - Samuel Kabwigu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Vaneshree Govender
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Zakir Gaffoor
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Nishanta Singh
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Kalendri Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, 351 California Street, Ste. 500, San Francisco, CA, 94104, USA
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First Impressions Matter: How Initial Worries Influence Adherence to the Dapivirine Vaginal Ring. J Acquir Immune Defic Syndr 2020; 81:304-310. [PMID: 30844995 DOI: 10.1097/qai.0000000000002028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In MTN-020/ASPIRE, a dapivirine vaginal ring effectiveness trial in sub-Saharan Africa, we assessed whether worries about ring use changed over time and were associated with adherence. METHODS Participants (N = 2585) were surveyed at baseline and follow-up about worries regarding daily ring use. First, they answered a question about general worries and then responded to 15 items covering specific worries. From a nested qualitative component (N = 214), we extracted themes related to ring worries and adherence. Seven months into the trial, aggregate adherence data were shared with study sites as part of an intervention that included counseling and social support. Nonadherence was defined as dapivirine plasma levels of ≤95 pg/mL. Mixed-effect logistic regression models were used to assess changes in ring worries and nonadherence from baseline to month 3 and later. RESULTS Worry about wearing the ring decreased from 29% at baseline to 4% at month 3 (P < 0.001), while having a specific worry decreased from 47% to 16% (P < 0.001). Among those enrolled before intervention, 29% with baseline worries were nonadherent at month 3 (95% confidence interval: 19% to 39%) compared to 14% without worries (95% confidence interval: 9% to 19%; P = 0.005); the difference persisted through month 6. There was no difference in nonadherence by baseline worry for those enrolled after intervention (P = 0.40). In the qualitative subset, initial ring anxieties reportedly subsided with self-experimentation and practice and the beneficial influence of the intervention. CONCLUSIONS Although worries may be an initial deterrent to correct ring use, intervening early by leveraging social influences from peers and clinicians should facilitate successful adoption and correct ring use.
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23
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Singh K, Sarafianos SG, Sönnerborg A. Long-Acting Anti-HIV Drugs Targeting HIV-1 Reverse Transcriptase and Integrase. Pharmaceuticals (Basel) 2019; 12:E62. [PMID: 31010004 PMCID: PMC6631967 DOI: 10.3390/ph12020062] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022] Open
Abstract
One of the major factors contributing to HIV-1 drug resistance is suboptimal adherence to combination antiretroviral therapy (cART). Currently, recommended cART for HIV-1 treatment is a three-drug combination, whereas the pre-exposure prophylaxis (PrEP) regimens consist of one or two antivirals. Treatment regimens require adherence to a once or twice (in a subset of patients) daily dose. Long-acting formulations such as injections administered monthly could improve adherence and convenience, and thereby have potential to enhance the chances of expected outcomes, although long-lasting drug concentrations can also contribute to clinical issues like adverse events and development of drug resistance. Globally, two long-acting antivirals have been approved, and fifteen are in clinical trials. More than half of investigational long-acting antivirals target HIV-1 reverse transcriptase (HIV-1 RT) and/or integrase (HIV-1 IN). Here, we discuss the status and potential of long-acting inhibitors, including rilpivirine (RPV), dapivirine (DPV), and 4-ethynyl-2-fluoro-2-deoxyadenosine (EFdA; also known as MK-8591), which target RT, and cabotegravir (CAB), which targets IN. The outcomes of various clinical trials appear quite satisfactory, and the future of long-acting HIV-1 regimens appears bright.
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Affiliation(s)
- Kamal Singh
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO 65211, USA.
- Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Huddinge 14186, Stockholm, Sweden.
| | - Stefan G Sarafianos
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Anders Sönnerborg
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO 65211, USA.
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Huddinge 14186, Stockholm, Sweden.
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Huddinge 14186, Stockholm, Sweden.
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