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Hassan KS, Coon DW. The Provider's Role in Retaining Black Women With HIV in Care: A Scoping Review. J Int Assoc Provid AIDS Care 2024; 23:23259582231224232. [PMID: 38225200 DOI: 10.1177/23259582231224232] [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] [Indexed: 01/17/2024] Open
Abstract
Black/African American women represent 54% of new HIV cases among all women in the United States, face higher rates of morbidity and mortality, and are often understudied. The patient-provider relationship is an important motivator to keeping people who live with HIV retained in care and adherent to a medical regimen, thereby improving chances for viral suppression and maintaining overall better health. This scoping review sought to determine the extent of documented provider actions that encourage Black women with HIV to stay engaged in care. The review investigated five databases for peer-reviewed studies in the United States that included Black women from 2009 to 2023 and specifically described beneficial provider actions or behaviors. Of 526 records, 12 met the criteria. Studies revealed that women are motivated by providers who create a respectful, nonjudgmental emotionally supportive relationship with them rather than those who rely on an authoritative transactional exchange of information and orders.
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Affiliation(s)
- Kenja S Hassan
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - David W Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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Skerritt L, de Pokomandy A, O'Brien N, Sourial N, Burchell AN, Bartlett G, Schuster T, Rouleau D, Proulx-Boucher K, Pick N, Money D, Gormley R, Carter A, Yudin MH, Loutfy M, Kaida A. Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort. Sex Reprod Health Matters 2021; 29:1932702. [PMID: 34165395 PMCID: PMC8231384 DOI: 10.1080/26410397.2021.1932702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2017), a community-based participatory study, restricting the analysis to participants aged 16-45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.
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Affiliation(s)
- Lashanda Skerritt
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia Sourial
- Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Ann N Burchell
- Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Bartlett
- Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tibor Schuster
- Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danielle Rouleau
- Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Karène Proulx-Boucher
- Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Neora Pick
- Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Money
- Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada
| | - Rebecca Gormley
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allison Carter
- Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark H Yudin
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:
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Mirabal-Beltran R, Anderson J, Dariotis JK, Finocchario-Kessler S. A Checklist to Assess Childbearing Intentions and Promote Referral to Preconception Care or Contraception: A Multi-Site Study. Matern Child Health J 2021; 25:786-795. [PMID: 33389454 DOI: 10.1007/s10995-020-03051-w] [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] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. METHODS Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. RESULTS Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. DISCUSSION Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.
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Affiliation(s)
- Roxanne Mirabal-Beltran
- Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC, USA.
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jean Anderson
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacinda K Dariotis
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Human Development & Family Studies, The Family Resiliency Center, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Cernigliaro D, Barrington C, Donastorg Y, Perez M, Kerrigan D. Patient-provider communication about pregnancy and HIV among female sex workers living with HIV in Santo Domingo, Dominican Republic. BMC Pregnancy Childbirth 2019; 19:427. [PMID: 31752743 PMCID: PMC6868801 DOI: 10.1186/s12884-019-2482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background Health providers can play an important role in communication about pregnancy, particularly for women at increased risk for pregnancy complications, including female sex workers (FSWs) living with HIV. This study explored factors related to patient-provider communication about pregnancy among 253 FSWs living with HIV of reproductive age in Santo Domingo, Dominican Republic. Methods A cross-sectional design was employed including structured socio-behavioral surveys. Data were analyzed utilizing bivariate and multivariate logistic regression. Results Of the 253 FSWs living with HIV in this study, 95.7% had been pregnant at least once (median: 4; IQR: 3,6), 28.0% wanted more children and 36% reported a pregnancy after HIV diagnosis. Over half of participants (58.0%) reported having ever spoken to a health provider about pregnancy while living with HIV. Multivariate logistic regression found significant associations between having spoken to a health provider about HIV in pregnancy and a more positive perception of their provider (AOR: 2.0; 95% CI: 1.0, 2.5) and years since HIV diagnosis (AOR: 1.1; 95% CI: 1.0, 1.1). Participants were less likely to speak with a provider if they had a history of drug use (AOR: 0.4; 95% CI: 0.2, 0.9) or current alcohol use (AOR: 0.5; 95% CI: 0.3, 0.9). Conclusion Findings highlight the importance of non-judgmental and tailored provider-initiated conversations surrounding pregnancy. Future research is needed to better understand how and when pregnancy communication is initiated, as well as the content of clinical care conversations, to address the reproductive health of FSWs living with HIV.
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Affiliation(s)
- Dana Cernigliaro
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Rosenau Hall 319B, CB#7440, Chapel Hill, NC, 27599, USA
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de la Piel, Albert Thomas, 66, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatologico y Cirugia de la Piel, Albert Thomas, 66, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA. .,Center on Health, Risk & Society, American University, 4400 Massachusetts Avenue, Washington, DC, NW, 20016, USA.
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5
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Aepfelbacher JA, Chaudhury CS, Mee T, Purdy JB, Hawkins K, Curl KA, Dee N, Hadigan C. Reproductive and sexual health knowledge, experiences, and milestones in young adults with life-long HIV. AIDS Care 2019; 32:354-361. [PMID: 31640401 DOI: 10.1080/09540121.2019.1679711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reproductive and sexual health outcomes of adults with perinatal human immunodeficiency virus (PHIV) have not been well-characterized. This prospective cross-sectional study of 35 adult persons living with HIV (PLWH) from early life and 20 matched HIV-negative controls assessed quality of life, depressive symptoms, HIV transmission knowledge, and sexual/reproductive behaviors through self-report questionnaires. PLWH scored significantly worse than controls on depressive symptoms (p = 0.04) and two of six quality of life domains (p = 0.03, p = 0.0002). In contrast, PLWH scored significantly higher on transmission knowledge in the context of family planning (p = 0.002). PLWH were more likely to learn about sex from healthcare providers (p = 0.002) and were more confident in their sexual/reproductive health knowledge (p < 0.05). Both groups reported inconsistent condom use, but PLWH were more likely to have planned pregnancies (p = 0.005) and to share pregnancy planning with their partners (p < 0.05). Despite the challenges of living with a chronic stigmatized condition, adults with PHIV were knowledgeable about HIV transmission and family planning and demonstrated sexual practices and reproductive outcomes similar to age-matched controls. However, sub-optimal rates of viral suppression, inconsistent condom use, and the psychosocial impact of living with HIV continue to require the attention of healthcare provides for young adults with PHIV.
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Affiliation(s)
- Julia A Aepfelbacher
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Chloe S Chaudhury
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Thomas Mee
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Julia B Purdy
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Karyn Hawkins
- Nursing Department, NIH Clinical Center, Bethesda, MD, USA
| | - Kara-Anne Curl
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Nicola Dee
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
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Abstract
Although HIV diagnoses among women have declined in recent years in the United States (U.S.), women accounted for 19% of new HIV diagnoses in 2016. In addition, women comprise 24% of the 973,846 persons living with HIV infection in the U.S. However, HIV prevention interventions targeting women are limited. We performed a review on HIV infection in women to increase awareness, improve overall care, and inform intervention development. A systematic literature review was conducted using literature published in PubMed, PsychINFO (EBSCO), and Scopus from July 2000 and June 2017. We included studies that: (1) were conducted in the U.S., (2) enrolled at least 50 HIV-positive women, and (3) utilized a case-control, cohort, or surveillance study design. Of 7497 articles, 48 articles met inclusion criteria. HIV diagnoses among women declined 32% between 2001 and 2016. In 2016, 61% of diagnoses in women were among African American women, and 56% were in the South. Women reported barriers to HIV care largely due to psychosocial challenges and social/structural determinants of health (SDH) barriers. Though new diagnoses among women have declined, racial and regional disparities remain. HIV prevention and research efforts with women are vital to inform interventions and reduce disparities.
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Affiliation(s)
- Symone May
- Public Health Summer Intern Program, Leidos Inc, Atlanta, Georgia.,Emory University Rollins School of Public Health, Atlanta, Georgia.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Murray
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shiferaw T, Kiros G, Birhanu Z, Gebreyesus H, Berhe T, Teweldemedhin M. Fertility desire and associated factors among women on the reproductive age group of Antiretroviral treatment users in Jimma Town, South West Ethiopia. BMC Res Notes 2019; 12:158. [PMID: 30894211 PMCID: PMC6425594 DOI: 10.1186/s13104-019-4190-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives HIV remained the major cause of death in women of reproductive age worldwide. There is limited evidence regarding the fertility desire of HIV positive women receiving HIV care in the study area. Therefore, facility based cross-sectional study was conducted from March to April 2017 to assess fertility desire of HIV positive women and associated factors among mothers in receiving HIV care Jimma town, Southwest Ethiopia. Simple random sampling technique was taken to draw the sample after stratification. Data were analyzed using SPSS version 21 and statistical significance was declared at P value less than 0.05. Results This finding showed that, 175 (46.8%) of the Antiretroviral therapy users had fertility desire with those significantly associated factors; women in the age 18–29 years [AOR = 4.05, 95% CI 1.24–13.33], being married [AOR = 0.32, 95% CI (0.13–0.78)], having diploma educational level [AOR = 5.34, 95% CI 1.10, 15.60], having only boys or girls children [AOR = 2.79, 95% CI (1.24–6.25)], having 18–36$ monthly income [AOR = 1.27, 95% CI (1.56–10.67)], Partner’s HIV status [AOR = 3.56, 95% CI (3.02–9.33)] and non use of contraceptives [AOR = 2.57, 95% CI (1.08–6.13)]. Fertility desire in the study area was high. Strengthening PMTCT service should consider fertility desire of mothers living with HIV. Electronic supplementary material The online version of this article (10.1186/s13104-019-4190-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teshome Shiferaw
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Getachew Kiros
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia
| | - Tesfay Berhe
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia.
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum, Ethiopia
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Bogardus MA. Best Practices and Self-Care to Support Women in Living Well with Human Immunodeficiency Virus/AIDS. Nurs Clin North Am 2019; 53:67-82. [PMID: 29362062 DOI: 10.1016/j.cnur.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women accounted for 20% of the cumulative AIDS cases in the United States as of 2015. Although their incidence of human immunodeficiency virus (HIV) has declined in recent years, the rates of new infections and AIDS diagnoses for women of color have remained high. Women with HIV tend to be more vulnerable than men with this disease. They are more likely to be poor, uninsured, depressed, and homeless; to have experienced interpersonal violence; and to be caregivers. Attention to psychosocial needs and building trust are fundamental to engaging HIV-positive women in care and helping them attain optimal health.
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Affiliation(s)
- Melinda Ann Bogardus
- Walden University, College of Health Sciences, School of Nursing, 100 Washington Avenue South, Suite 900, Minneapolis, MN 55401, USA; East Tennessee State University, College of Nursing, 365 Stout Drive, Johnson City, TN 37614, USA; AppHealthCare, Ashe Health Center, 413 McConnell Street, Jefferson, NC 28640, USA.
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Simone J, Hoyt MJ, Storm DS, Finocchario-Kessler S. Models of HIV Preconception Care and Key Elements Influencing These Services: Findings from Healthcare Providers in Seven US Cities. AIDS Patient Care STDS 2018; 32:272-281. [PMID: 29870269 PMCID: PMC6034389 DOI: 10.1089/apc.2017.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Preconception care can improve maternal and infant outcomes by identifying and modifying health risks before pregnancy and reducing unplanned pregnancies. However, information about how preconception care is provided to persons living with HIV (PLWH) is lacking. This study uses qualitative interviews with HIV care providers to describe current models of preconception care and explore factors influencing services. Single, anonymous, telephone interviews were conducted with 92 purposively selected HIV healthcare providers in Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco in 2013-2014. Content analysis and a grounded theory approach were used to analyze data. Participants included 57% physicians with a median of 10 [interquartile range (IQR) = 5-17] years HIV care experience; the mean proportion of female patients was 45%. Participants described Individual Provider (48.9%), Team-based (43.2%), and Referral-only (7.6%) models of preconception care, with 63% incorporating referrals outside their clinics. Thematic analysis identified five key elements influencing the provision of preconception care within and across models: consistency of delivery, knowledge and attitudes, clinic characteristics, coordination of care, and referral accessibility. Described models of preconception care reflect the complexity of our healthcare system. Qualitative analysis offers insights about how HIV clinicians provide preconception care and how key elements influence services. However, additional research about the models and outcomes of preconception care services are needed. To improve preconception care for PLWH, research and quality improvement initiatives must utilize available strengths and tackle existing barriers, identified by our study and others, to define and implement effective models of preconception care services.
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Affiliation(s)
- Joanne Simone
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Deborah S. Storm
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
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O’Brien N, Hong QN, Law S, Massoud S, Carter A, Kaida A, Loutfy M, Cox J, Andersson N, de Pokomandy A. Health System Features That Enhance Access to Comprehensive Primary Care for Women Living with HIV in High-Income Settings: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2018; 32:129-148. [PMID: 29630850 DOI: 10.1089/apc.2017.0305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Women living with HIV in high-income settings continue to experience modifiable barriers to care. We sought to determine the features of care that facilitate access to comprehensive primary care, inclusive of HIV, comorbidity, and sexual and reproductive healthcare. Using a systematic mixed studies review design, we reviewed qualitative, mixed methods, and quantitative studies identified in Ovid MEDLINE, EMBASE, and CINAHL databases (January 2000 to August 2017). Eligibility criteria included women living with HIV; high-income countries; primary care; and healthcare accessibility. We performed a thematic synthesis using NVivo. After screening 3466 records, we retained 44 articles and identified 13 themes. Drawing on a social-ecological framework on engagement in HIV care, we situated the themes across three levels of the healthcare system: care providers, clinical care environments, and social and institutional factors. At the care provider level, features enhancing access to comprehensive primary care included positive patient-provider relationships and availability of peer support, case managers, and/or nurse navigators. Within clinical care environments, facilitators to care were appointment reminder systems, nonidentifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, comorbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education, and dispelling HIV-related stigma. This review highlights several features of care that are particularly relevant to the care-seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.
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Affiliation(s)
- Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Quan Nha Hong
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Susan Law
- Institute for Better Health—Trillium Health Partners, Mississauga, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah Massoud
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Cox
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Beyeza-Kashesya J, Wanyenze RK, Goggin K, Finocchario-Kessler S, Woldetsadik MA, Mindry D, Birungi J, Wagner GJ. Stigma gets in my way: Factors affecting client-provider communication regarding childbearing among people living with HIV in Uganda. PLoS One 2018; 13:e0192902. [PMID: 29462171 PMCID: PMC5819785 DOI: 10.1371/journal.pone.0192902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/01/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Many HIV-affected couples living in sub-Saharan Africa desire to have children, but few quantitative studies have examined support for their childbearing needs. Our study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda. METHODS 400 Ugandan HIV clients in committed relationships and with intentions to conceive were surveyed. Knowledge, attitudes and practices related to childbearing, and use of safer conception methods were assessed, including communication with providers about childbearing needs, the correlates of which were examined with bivariate statistics and logistic multivariate analysis. RESULTS 75% of the sample was female; 61% were on antiretroviral therapy; and 61% had HIV-negative or unknown status partners. Nearly all (98%) reported the desire to discuss childbearing intentions with their HIV provider; however, only 44% reported such discussions, the minority (28%) of which was initiated by the provider. Issues discussed with HIV providers included: HIV transmission risk to partner (30%), HIV transmission risk to child (30%), and how to prevent transmission to the child (27%); only 8% discussed safer conception methods. Regression analysis showed that those who had communicated with providers about childbearing were more likely to have been diagnosed with HIV for a longer period [OR (95% CI) = 1.09 (1.03, 1.15)], while greater internalized childbearing stigma was associated with lower odds of this communication [OR (95% CI) = 0.70 (0.49, 0.99)], after controlling for all bivariate correlates and basic demographics. CONCLUSIONS Communication between HIV clients and providers about childbearing needs is poor and associated with stigma. Innovations to mitigate stigma among clients as well as training to improve health worker communication and skills related to safer conception counseling is needed.
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Affiliation(s)
- Jolly Beyeza-Kashesya
- Mulago Hospital Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Schools of Medicine and Pharmacy, University of Missouri–Kansas City, Missouri, United States of America
| | - Sarah Finocchario-Kessler
- University of Kansas Medical Center, Department of Family Medicine, Kansas City, Missouri, United States of America
| | | | - Deborah Mindry
- University of California, Los Angeles Center for Culture and Health, Los Angeles, California, United States of America
| | | | - Glenn J. Wagner
- RAND Corporation, Santa Monica, California, United States of America
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O'Brien N, Greene S, Carter A, Lewis J, Nicholson V, Kwaramba G, Ménard B, Kaufman E, Ennabil N, Andersson N, Loutfy M, de Pokomandy A, Kaida A. Envisioning Women-Centered HIV Care: Perspectives from Women Living with HIV in Canada. Womens Health Issues 2017; 27:721-730. [PMID: 28887140 DOI: 10.1016/j.whi.2017.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women comprise nearly one-quarter of people living with human immunodeficiency virus (HIV) in Canada. Compared with men, women living with HIV experience inequities in HIV care and health outcomes, prompting a need for gendered and tailored approaches to HIV care. METHOD Peer and academic researchers from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study conducted focus groups to understand women's experience of seeking care, with the purpose of identifying key characteristics that define a women-centered approach to HIV care. Eleven focus groups were conducted with 77 women living with HIV across Quebec, Ontario, and British Columbia, Canada. RESULTS Women envisioned three central characteristics of women-centered HIV care, including i) coordinated and integrated services that address both HIV and women's health care priorities, and protect against exclusion from care due to HIV-related stigma, ii) care that recognizes and responds to structural barriers that limit women's access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and iii) care that fosters peer support and peer leadership in its design and delivery to honor the diversity of women's experiences, overcome women's isolation, and prioritize women's ownership over the decisions that affect their lives. CONCLUSION Despite advances in HIV treatment and care, the current care landscape is inadequate to meet women's comprehensive care needs. A women-centered approach to HIV care, as envisioned by women living with HIV, is central to guiding policy and practice to improve care and outcomes for women living with HIV in Canada.
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Affiliation(s)
- Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Johanna Lewis
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Gladys Kwaramba
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Brigitte Ménard
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Elaina Kaufman
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Nourane Ennabil
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Mona Loutfy
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Burgess A, Purssell E. What is the relationship between increased access to HAART, relationship status and fertility decisions amongst HIV-positive women? A literature review and meta-analysis. J Clin Nurs 2017; 26:3800-3810. [PMID: 28102939 DOI: 10.1111/jocn.13731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between fertility decisions, to have already had a child or to desire to have one in the future, and the prognostic factors; access to antiretrovirals, the time since these became widely available (year of the study); and relationship status. BACKGROUND There have been significant advances in the treatment of human immunodeficiency virus with the advent of antiretroviral therapy which has been used to successfully reduce the rate of mother to child transmission; leading researchers to hypothesise that human immunodeficiency virus-positive women may desire to have children more so now than in the past. However, this topic is often not discussed in healthcare consultations. DESIGN & METHODS A systematic search was conducted on Cumulative Index of Nursing and Allied Health Literature and Medline, using the key terms 'fertility decisions' and 'human immunodeficiency virus positive'. A meta-analysis of proportions and a meta-regression were conducted using a random-effects model and a logit transformation to normalise the data. Heterogeneity was assessed using Q, I2 and R2 values, and p-values were produced for each regressed variable. RESULTS There was no statistically significant relationship between a desire to have children in the future and any of the prognostic variables. However, there were statistically significant relationships between already having had at least one child; being on antiretroviral therapy; wanting a child in the future; and being in a cohabiting partnership or marriage. CONCLUSION There are no reliable prognostic variables which can be used to predict fertility intentions in human immunodeficiency virus-positive women. There is, however, a significant proportion of women who wish to have children or who have already had children and are in need of reproductive counselling from their healthcare providers. RELEVANCE TO CLINICAL PRACTICE A greater knowledge of factors which may influence reproductive decisions amongst human immunodeficiency virus-positive position will allow healthcare professionals to individualise the care they provide.
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How are women living with HIV in France coping with their perceived side effects of antiretroviral therapy? Results from the EVE study. PLoS One 2017; 12:e0173338. [PMID: 28264016 PMCID: PMC5338806 DOI: 10.1371/journal.pone.0173338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Side effects of antiretroviral therapy (ART) can have a negative impact on health-related quality of life threatening long-term retention in HIV care and adherence to ART. The aim of the French community-based survey EVE was to document personal experiences with side effects, the related physician-patient communication, and solutions found to deal with them. DESIGN Cross-sectional study of women between September 2013 to September 2014. METHODS An anonymous online questionnaire included the HIV Symptom Distress Module, which explores 20 symptoms. RESULTS In all, 301 women on ART participated in the study (median age: 49 years; median duration of ART: 14 years). They reported having experienced a median of 12 symptoms (Q1-Q3: 9-15) during the previous 12 months. Overall, 56% of them reported having found at least a partial solution to dealing with their symptoms. Women reporting financial difficulties were twice less likely to have found solutions to coping with their side effects (AOR: 0.5; 95% CI: 0.3-0.8). Feeling supported by the health-care provider (AOR: 2.1; 95% CI: 1.1-3.9) and being in contact with HIV/AIDS organisations (AOR: 1.9; 95% CI: 1.2-3.2) were positively associated with coping. Seventeen percent reported having modified their ART regimen to improve tolerance, with only 2 in 3 informing their physician afterwards. Reporting financial difficulties and living with more bothersome symptoms increased the risk of ART regimen modification without health-care provider consultation. CONCLUSION The EVE study has called attention to the large number of side effects experienced by WLWHIV, only half of whom have found self-care strategies to manage their symptoms. Modification of ART regimen by the women themselves was not uncommon.
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Darlington CK, Hutson SP. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS Behav 2017; 21:12-26. [PMID: 27492025 DOI: 10.1007/s10461-016-1504-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.
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Affiliation(s)
- Caroline K Darlington
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA.
| | - Sadie P Hutson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA
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16
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Jones DL, Cook R, Potter JE, Miron-Shatz T, Chakhtoura N, Spence A, Byrne MM. Fertility Desires among Women Living with HIV. PLoS One 2016; 11:e0160190. [PMID: 27610626 PMCID: PMC5017599 DOI: 10.1371/journal.pone.0160190] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/14/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Rates of pregnancy among women living with HIV (WLHIV) have increased with the availability of effective HIV treatment. Planning for pregnancy and childbirth is an increasingly important element of HIV care. Though rates of unintended pregnancies are high among women in general, among couples affected by HIV, significant planning and reproductive decisions must be considered to prevent negative health consequences for WLHIV and their neonates. To gain insight into this reproductive decision-making process among WLHIV, this study explored women's knowledge, attitudes and practices regarding fertility planning, reproductive desires, and safer conception practices. It was hypothesized that pregnancy desires would be influenced by partners, families, the potential risk of HIV transmission to infants, and physicians' recommendations. METHODS WLHIV of childbearing age were recruited from urban South Florida, and completed an assessment of demographics (N = 49), fertility desires and a conjoint survey of factors associated with reproductive decision-making. RESULTS Using conjoint analysis, we found that different decision paths exist for different types of women: Younger women and those with less education desired children if their partners wanted children; reproductive desires among those with less education, and with less HIV pregnancy-related knowledge, displayed a trend toward additional emphasis on their family's desires. Conversely, older women and those with more education appeared to place more importance on physician endorsement in their plans for childbearing. CONCLUSIONS Results of this study highlight the importance of ongoing preconception counselling for all women of reproductive age during routine HIV care. Counselling should be tailored to patient characteristics, and physicians should consider inclusion of families and/or partners in the process.
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Affiliation(s)
- Deborah Lynne Jones
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ryan Cook
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - JoNell Efantis Potter
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Talya Miron-Shatz
- Ono Academic College, Kiryat Ono, Israel
- Center for Medicine in the Public Interest, New York, New York, United States of America
| | - Nahida Chakhtoura
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Andrew Spence
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Margaret M. Byrne
- Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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17
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Monteiro S, Villela W, Soares P, Pinho A, Fraga L. 'Protective' silence surrounding AIDS: Reasons and implications of non-disclosure among pregnant women living with HIV in Rio de Janeiro (Brazil). Glob Public Health 2016; 13:51-64. [PMID: 27455879 DOI: 10.1080/17441692.2016.1211163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The persistence of stigma surrounding AIDS remains a challenge in the epidemic's fourth decade. Based on qualitative research, this study analyses how pregnant women living with HIV/AIDS (PWLHA) experience and cope with AIDS stigma. A total of 29 semi-structured interviews were conducted with PWLHA focusing on socioeconomic profiles, the contexts in which they discovered HIV infection, experiences with health-care sites and ways of dealing with AIDS-related stigma. We recruited PWLHA at two prevention of mother-to-child transmission sites in Rio de Janeiro, Brazil. The PWLHA's testimony indicates that access to care and treatment has a profound effect on the deconstruction of their understanding of AIDS as a fatal disease. However, fear of AIDS stigma is still predominant. The law guarantees HIV non-disclosure, and women see it as a way to protect themselves from discrimination. We argue, however, that the silence surrounding HIV diagnosis perpetuates the psychosocial and structural mechanisms that reproduce stigma. We conclude that diverse sectors of society, including health-care facilities, must be involved in confronting stigma by demystifying AIDS, improving patients' knowledge of their rights, and increasing their access to material and symbolic goods.
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Affiliation(s)
- Simone Monteiro
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Wilza Villela
- b Department of Preventive Medicine , Federal University of São Paulo , São Paulo , Brazil
| | - Priscilla Soares
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Adriana Pinho
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
| | - Livia Fraga
- a Laboratory of Environmental and Health Education , Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) , Rio de Janeiro , Brazil
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18
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Rodriguez VJ, Spence A, Monda M, Potter J, Jones D. Couples Living with HIV. J Int Assoc Provid AIDS Care 2016; 16:133-139. [PMID: 26467783 DOI: 10.1177/2325957415612127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Desires to have children are not lessened by a woman's HIV status. Couples may lack information to conceive safely, and men may be especially uninformed. This study examined reproductive intentions, practices, and attitudes among men in HIV-infected couples, including attitudes regarding the perceived risk of vertical and horizontal transmission, safer conception, and preconception planning. METHODS Men ( n = 12) in HIV-infected couples were interviewed regarding reproductive intentions, attitudes, and knowledge and qualitative assessments were coded for dominant themes. RESULTS Themes primarily addressed concerns about the health of the baby, men's involvement in pregnancy, safer conception, concerns about HIV transmission and antiretroviral therapy, and HIV infection. Men lacked information on safer conception and newer HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). DISCUSSION Gaps in knowledge regarding preconception practices among men in HIV-infected couples were identified. Results highlight men's desire for involvement in preconception planning, and opportunities for providers to facilitate this practice and to increase patient education and the use of PrEP are discussed.
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Affiliation(s)
- Violeta J Rodriguez
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew Spence
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mallory Monda
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - JoNell Potter
- 2 Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Jones
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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19
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Fletcher F, Ingram LA, Kerr J, Buchberg M, Richter DL, Sowell R. "Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV. J Assoc Nurses AIDS Care 2016; 27:381-91. [PMID: 26781931 PMCID: PMC4903940 DOI: 10.1016/j.jana.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022]
Abstract
HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.
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Affiliation(s)
- Faith Fletcher
- Assistant Professor, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Lucy Annang Ingram
- Assistant Professor, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jelani Kerr
- Assistant Professor, University of Louisville School of Public Health & Information Sciences, Louisville, Kentucky, USA
| | - Meredith Buchberg
- Regional Coordinator, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Donna L. Richter
- Distinguished Professor Emeritus, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Richard Sowell
- Professor Nursing, Kennesaw State University Wellstar College of Health & Human Services, Kennesaw, Georgia, USA
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20
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Hatfield-Timajchy K, Brown JL, Haddad LB, Chakraborty R, Kourtis AP. Parenting Among Adolescents and Young Adults with Human Immunodeficiency Virus Infection in the United States: Challenges, Unmet Needs, and Opportunities. AIDS Patient Care STDS 2016; 30:315-23. [PMID: 27410495 PMCID: PMC5335748 DOI: 10.1089/apc.2016.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Given the realistic expectations of HIV-infected adolescents and young adults (AYA) to have children and start families, steps must be taken to ensure that youth are prepared to deal with the challenges associated with their HIV and parenting. Literature reviews were conducted to identify published research and practice guidelines addressing parenting or becoming parents among HIV-infected AYA in the United States. Research articles or practice guidelines on this topic were not identified. Given the paucity of information available on this topic, this article provides a framework for the development of appropriate interventions and guidelines for use in clinical and community-based settings. First, the social, economic, and sexual and reproductive health challenges facing HIV-infected AYA in the United States are summarized. Next, family planning considerations, including age-appropriate disclosure of HIV status to those who are perinatally infected, and contraceptive and preconception counseling are described. The impact of early childbearing on young parents is discussed and considerations are outlined during the preconception, antenatal, and postnatal periods with regard to antiretroviral medications and clinical care guidelines. The importance of transitioning AYA from pediatric or adolescent to adult-centered medical care is highlighted. Finally, a comprehensive approach is suggested that addresses not only medical needs but also emphasizes ways to mitigate the impact of social and economic factors on the health and well-being of these young parents and their children.
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Affiliation(s)
- Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L. Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa B. Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Athena P. Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Squires K, Kityo C, Hodder S, Johnson M, Voronin E, Hagins D, Avihingsanon A, Koenig E, Jiang S, White K, Cheng A, Szwarcberg J, Cao H. Integrase inhibitor versus protease inhibitor based regimen for HIV-1 infected women (WAVES): a randomised, controlled, double-blind, phase 3 study. Lancet HIV 2016; 3:e410-e420. [PMID: 27562742 DOI: 10.1016/s2352-3018(16)30016-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women are under-represented in HIV antiretroviral therapy (ART) studies. Guidelines for selection of ART as initial therapy in patients with HIV-1 infection do not contain sex-specific treatment. We aimed to assess the safety and efficacy of the single tablet integrase inhibitor regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate compared with a boosted protease inhibitor regimen of ritonavir-boosted atazanavir with emtricitabine and tenofovir disoproxil fumarate. METHODS In this international, randomised, controlled, double-blind, phase 3 study (Women AntiretroViral Efficacy and Safety study [WAVES]), we recruited treatment-naive HIV-infected women with an estimated creatinine clearance of 70 mL/min or higher from 80 centres in 11 countries. Women were randomly assigned (1:1) to receive elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (integrase inhibitor regimen) or ritonavir-boosted atazanavir with emtricitabine and tenofovir disoproxil fumarate (protease inhibitor based regimen); regimens were masked with matching placebos. Randomisation was done by a computer-generated allocation sequence (block size four) and was stratified by HIV-1 RNA viral load and race. Investigators, patients, study staff, and those assessing outcomes were masked to treatment group. All participants who received one dose of study drug were included in the primary efficacy and safety analyses. The main outcome was the proportion of patients with plasma HIV-1 RNA less than 50 copies per mL at week 48 as defined by US Food and Drug Administration snapshot algorithm (prespecified non-inferiority margin of 12%). This study is registered with ClinicalTrials.gov, number NCT01705574. FINDINGS Between Nov 28, 2012, and March 12, 2014, 575 women were enrolled. 289 were randomly assigned to receive the integrase inhibitor regimen and 286 to receive the protease inhibitor based regimen. 252 (87%) women in the integrase inhibitor group had plasma HIV-1 RNA less than 50 copies per mL at week 48 compared with 231 (81%) women in the protease inhibitor group (adjusted difference 6·5%; 95% CI 0·4-12·6). No participant had virological failure with resistance in the integrase inhibitor group compared with three participants ([1%]; all Met184Val/Ile) in the protease inhibitor group. 19 women in the protease inhibitor group discontinued because of adverse events compared with five in the integrase inhibitor group. INTERPRETATION WAVES shows that clinical trials of ART regimens in global and diverse populations of treatment-naive women are possible. The findings support guidelines recommending integrase inhibitor based regimens in first-line antiretroviral therapy. FUNDING Gilead Sciences.
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Affiliation(s)
| | - Cissy Kityo
- Joint Clinical Research Centre, Clinical Research, Kampala, Uganda
| | | | | | - Evgeny Voronin
- Regional Clinic in Infectious Hospital, St Petersburg, Russia
| | | | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Center and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ellen Koenig
- Zona Universitaria/IDEV, Santo Domingo, Dominican Republic
| | | | | | | | | | - Huyen Cao
- Gilead Sciences, Foster City, CA, USA.
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Currier JS, Lockman S. Making waves: safety and efficacy of ART in women. Lancet HIV 2016; 3:e398-e399. [PMID: 27562733 DOI: 10.1016/s2352-3018(16)30033-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Judith S Currier
- David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
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Amutah NN, Gifuni J, Wesley Y. Shaping the Conversation: A Secondary Analysis of Reproductive Decision-Making Among Black Mothers with HIV. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:1-8. [PMID: 27158227 PMCID: PMC4854307 DOI: 10.4137/cmwh.s34671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/20/2016] [Accepted: 03/16/2016] [Indexed: 11/24/2022]
Abstract
The purpose of this qualitative secondary data analysis is to examine the major influencers on mothers with HIV in their childbearing decisions, as well as how those influencers shape conversations with clinicians and health-care providers regarding HIV treatment and prevention. The original study gained insight into the reproductive decision-making of mothers with HIV. By analyzing a subsample of 15 interviews from an original cohort of 25 participants in the earlier study, three major themes were identified as follows: (1) family members, not health-care providers, influence reproductive decisions; (2) negative attitudes toward subsequent pregnancies are mainly due to HIV transmission; and (3) birth control decisions were predominately supported by family members, while health-care providers were not consulted.
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Affiliation(s)
- Ndidiamaka N Amutah
- Assistant Professor, Department of Health and Nutrition Sciences, College of Education and Human Services, Montclair State University, Montclair, NJ, USA
| | - Jacqueline Gifuni
- Department of Health and Nutrition Sciences, College of Education and Human Services, Montclair State University, Montclair, NJ, USA
| | - Yvonne Wesley
- Independent Health Consultant, Y. Wesley Consulting LLC, Rahway, NJ, USA
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Finocchario-Kessler S, Champassak S, Hoyt MJ, Short W, Chakraborty R, Weber S, Levison J, Phillips J, Storm D, Anderson J. Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities. AIDS Patient Care STDS 2016; 30:125-33. [PMID: 26824425 DOI: 10.1089/apc.2015.0268] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.
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Affiliation(s)
| | - Sofie Champassak
- Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri
| | - Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - William Short
- Division of Infectious Diseases, Perelman Schools of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shannon Weber
- HIVE, University of California San Francisco, San Francisco, California
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Joanne Phillips
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Deborah Storm
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Jean Anderson
- Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Gender Differences in Psychosocial Factors Associated with HIV Viral Suppression Among African-American Injection Drug Users. AIDS Behav 2016; 20:385-94. [PMID: 26143248 DOI: 10.1007/s10461-015-1131-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Research suggests gender differences exist in achieving undetectable viral load (UVL) among persons living with HIV (PLHIV), and that psychosocial health factors may play a role. The present study examined these factors among African-American PLHIV enrolled in the BEACON study. Participants completed self-report surveys and gave biomarker data. Poisson regression with robust standard errors was implemented. Men with moderate religious activity had 1.3 times the likelihood of UVL as men with low religious activity (p < 0.10; N = 199). Men with 1-2 mental illness diagnoses had 1.3 times the likelihood of UVL as men with none (p < 0.05). Women using 1-2 substances had 28 % lower likelihood of UVL than non-using women (N = 122; p < 0.10). Finally, women with frequent doctor-patient communication had 35 % higher likelihood of UVL as women with less doctor-patient communication (p < 0.05). Results suggest that social support, substance use, and mental illness function differently among men and women. Healthcare professionals should employ gender-specific interventions to address and improve HIV health outcomes.
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"Everything I Needed from Her Was Everything She Gave Back to Me:" An Evaluation of Preconception Counseling for U.S. HIV-serodiscordant Couples Desiring Pregnancy. Womens Health Issues 2016; 26:351-6. [PMID: 26775832 DOI: 10.1016/j.whi.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to evaluate preconception counseling (PCC) through a qualitative examination of the experiences of couples with serodiscordant human immunodeficiency virus (HIV) status desiring pregnancy. METHODS Patients involved in HIV-serodiscordant relationships who received PCC between January 2013 and January 2015 were recruited to participate in 40-minute semistructured telephone interviews. Participants were asked about their experiences with PCC and the impact of counseling on their knowledge of safer conception strategies and reproductive decisions. Two researchers independently coded interview transcripts, and delineated common ideas to generate emerging themes from participants' responses. RESULTS Eleven respondents completed the interviews, including nine women and two men. Six respondents were HIV positive. Our thematic analysis revealed that patients gained knowledge and confidence through PCC that conception was both possible and safe. They had varied reactions to assisted reproductive technologies that correlated with income level, and explored complicated weighing of personal risk of HIV transmission. Patients reported major challenges including poor access to PCC, difficulty identifying peak fertility periods, and lack of long-term conception follow-up. DISCUSSION PCC is a valuable resource for patients involved in HIV-serodiscordant relationships. We recommend the following opportunities for improvement: developing practical safer conception clinical and counseling guidelines for HIV-affected couples, increasing patient access to and awareness of PCC services, distributing more helpful resources to identify peak fertility, and providing long-term support for patients.
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Haddad LB, Machen LK, Cordes S, Huylebroeck B, Delaney A, Ofotokun I, Nguyen ML, Jamieson DJ. Future desire for children among women living with HIV in Atlanta, Georgia. AIDS Care 2015; 28:455-9. [PMID: 26702869 DOI: 10.1080/09540121.2015.1114996] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Little is known regarding family planning desires among women living with HIV in the United States. This study aimed to identify factors influencing desire for children in the future among HIV-infected women in Atlanta, Georgia. HIV-infected women ages 18-45 completed an ACASI (audio computer-assisted self-interview) questionnaire. Chi-square, t-tests, and multivariate logistic regression evaluated factors associated with desire for future children. Of 181 participants, 62 (34.3%) expressed desire for children in the future, with increased desire among younger women (age <26) and those with seronegative partners. Concerns for horizontal and vertical HIV transmission were deterrents to future childbearing. Condom use and overall knowledge of transmission risk was low. Over a third of women desiring a child never discussed their desire with a physician. Misinformation regarding HIV transmission risks persists and is a notable concern influencing desire for children. Providers should reassess family planning desires regularly through integrated HIV care.
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Affiliation(s)
- Lisa B Haddad
- a Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA
| | | | - Sarah Cordes
- a Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA
| | - Brian Huylebroeck
- c Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | | | - Igho Ofotokun
- e Department of Medicine, Infectious Disease Division and Grady Health Care System , Emory University School of Medicine , Atlanta , GA , USA
| | - Minh Ly Nguyen
- e Department of Medicine, Infectious Disease Division and Grady Health Care System , Emory University School of Medicine , Atlanta , GA , USA
| | - Denise J Jamieson
- a Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA
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Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review. Infect Dis Obstet Gynecol 2015; 2015:517208. [PMID: 26778910 PMCID: PMC4686718 DOI: 10.1155/2015/517208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 01/20/2023] Open
Abstract
Background. HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. Materials and Methods. A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. Results and Discussion. Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.
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Coll AS, Potter JE, Chakhtoura N, Alcaide ML, Cook R, Jones DL. Providers' perspectives on preconception counseling and safer conception for HIV-infected women. AIDS Care 2015; 28:513-8. [PMID: 26577664 PMCID: PMC4764433 DOI: 10.1080/09540121.2015.1112349] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Unplanned pregnancy among HIV-infected women can have negative health consequences for women, partners, and neonates. Despite recommendations, preconception counseling (PCC) appears to be infrequently addressed in HIV care. This study explored knowledge, attitudes, and practices among health-care providers regarding PCC, safer conception and pregnancy among HIV-infected women. METHODS Physicians, physician assistants, and nurse practitioners (n = 14) providing obstetric/gynecological and HIV care in urban south Florida public and private hospitals completed structured qualitative interviews. Dominant themes arising included provider perceptions of patient knowledge and practices, provider knowledge and attitudes regarding safer conception, and provider practices regarding reproductive health. RESULTS Providers perceived patients to have limited reproductive knowledge. Patients' internalized HIV stigma was a barrier to patient initiation of conception-focused discussions. Provider knowledge and utilization of PCC protocols were limited. PCC barriers included competing medical priorities, failure to address fertility desires, limited knowledge, time limitations, and unclear standard of care. Providers routinely used condom-based HIV prevention as a proxy for addressing reproductive intentions. DISCUSSION Provider, patient, and structural factors prevented implementation of PCC and provision of information on safer conception; neither were routinely discussed during consultations. Both providers and patients may benefit from interventions to enhance communication on conception.
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Affiliation(s)
- Alison S Coll
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - JoNell E Potter
- Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nahida Chakhtoura
- Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Cook
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Jean J, Coll A, Monda M, Potter J, Jones D. Perspectives on safer conception practices and preconception counseling among women living with HIV. Health Care Women Int 2015; 37:1096-118. [PMID: 26492078 DOI: 10.1080/07399332.2015.1107068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pregnancies are frequently unplanned, and higher rates of unplanned pregnancies occur among HIV-infected women. Reviewers examined reproductive decision making, conception practices, and patient-provider communication among women living with HIV. Qualitative interviews were conducted with 19 HIV-infected sexually active women aged 18-45 in southern Florida, USA. Using thematic analysis, we found decisions to conceive were influenced by women and partners; knowledge and use of safer conception practices were low. Discussion and support from partners, family, and providers was limited and diminished by stigma and nondisclosure. Preconception counseling discussions in HIV care should be comprehensive and initiated frequently by all health care providers.
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Affiliation(s)
- Jenny Jean
- a University of Rochester School of Medicine , Rochester , New York , USA
| | - Alison Coll
- b Department of Psychiatry & Behavioral Sciences, Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - Mallory Monda
- c Department of Public Health Science, Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - JoNell Potter
- d Department of Obstetrics & Gynecology , Miller School of Medicine, University of Miami , Florida , USA
| | - Deborah Jones
- b Department of Psychiatry & Behavioral Sciences, Miller School of Medicine , University of Miami , Miami , Florida , USA
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Onono M, Owuor K, Turan J, Bukusi EA, Gray GE, Cohen CR. The role of maternal, health system, and psychosocial factors in prevention of mother-to-child transmission failure in the era of programmatic scale up in western Kenya: a case control study. AIDS Patient Care STDS 2015; 29:204-11. [PMID: 25738870 DOI: 10.1089/apc.2014.0181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to identify factors associated with prevention of mother-to-child transmission (PMTCT) in an area of Kenya with widely accessible free PMTCT services. A matched case-control study was conducted at 31 public facilities in western Kenya. HIV-infected mothers with infants aged 6 weeks to 6 months were interviewed and medical charts were reviewed. Cases were mothers of infants with a definitive diagnosis of HIV. Controls were mothers of infants testing HIV negative. Cases and controls were matched in a 1:3 ratio on socio-demographic factors. Fifty cases and 135 controls were enrolled. Conditional (matched) logistic regression analysis was conducted. Odds of being a case were higher for women who first learned their HIV status during pregnancy [OR:2.85, 95%CI:1.41-5.78], did not adhere to antiretroviral therapy (ART) [OR:3.35, 95%CI:1.48-7.58], or had a home delivery [OR:2.42, 95%CI:1.01-5.80]. Based on medical record review, cases had higher odds of their provider not following guidelines for prescription of ART for mothers [OR:8.61, 95%CI:2.83-26.15] and infants [OR:9.72, 95%CI:2.75-34.37]. Stigma from the community [OR:0.37, 95% CI:0.14-1.02] or facility [OR:0.38, 95%CI:0.04-3.41], did not increase the odds of MTCT. Poor adherence to PMTCT guidelines and recommendations by both infected women and health care providers hamper efforts to attain elimination of MTCT.
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Affiliation(s)
- Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Craig R. Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
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Blackstock OJ, Haughton LJ, Garner RY, Horvath KJ, Norwood C, Cunningham CO. General and health-related Internet use among an urban, community-based sample of HIV-positive women: implications for intervention development. AIDS Care 2014; 27:536-44. [PMID: 25411825 DOI: 10.1080/09540121.2014.980215] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Internet-based HIV interventions are increasingly common, although little focus has been on HIV-positive women. To understand the feasibility of using the Internet to deliver behavioral interventions to HIV-positive women, we sought to describe patterns of Internet use for general and health-related purposes and to explore differences between Internet-using and non-using women. From February 2014 to April 2014, 103 women were recruited at six community-based organizations in the Bronx, NY that provide services to HIV-positive persons. Women completed a 30-minute interview and answered a brief survey of socio-demographic factors, risk behavior and clinical characteristics. We performed χ(2) and Kruskal-Wallis tests to compare Internet users and non-users. Sixty-one percent of participants were current Internet users, most of whom used a personal electronic device (e.g., cellphone/smartphone) to access the Internet. While higher proportions of Internet users were passively engaged (e.g., signed up to receive email updates [42.9%] or watched an online video [58.7%] for health-related purposes), smaller proportions (12.7-15.9%) were involved in more interactive activities such as posting comments, questions, or information about health-related issues in an online discussion or a blog. A majority of Internet non-users (60.0%) expressed interest in going online. Lack of computer or Internet access (37.5%) and Internet navigation skills (37.5%) were the primary reasons for non-use. Compared with non-users, Internet users were more likely to be younger, to have higher socioeconomic status, and to report low health-related social support. Despite having a lower proportion of Internet users in our study than the general population, Internet-using women in our study had relatively high levels of online engagement and went online for both general and health-related purposes. However, Internet-based interventions targeting HIV-positive women will likely need to include providing computer and/or Internet access as well as training participants in how to navigate the Internet.
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Affiliation(s)
- Oni J Blackstock
- a Montefiore Medical Center/Albert Einstein College of Medicine , Department of Medicine , Bronx , NY , USA
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Blackstock OJ, Shah PA, Haughton LJ, Horvath KJ, Cunningham CO. HIV-infected Women's Perspectives on the Use of the Internet for Social Support: A Potential Role for Online Group-based Interventions. J Assoc Nurses AIDS Care 2014; 26:411-9. [PMID: 25749532 DOI: 10.1016/j.jana.2014.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Abstract
While the development and implementation of HIV-related online interventions has expanded, few have been tailored for women or have leveraged Web 2.0's capabilities to provide social support. We conducted semi-structured interviews with 27 women with HIV at an urban community health center to understand their perspectives on the potential role of the Internet and the use of an online group format to provide social support. Data were analyzed using the constant comparative method. We identified six themes: a need for groups and increased sense of connectedness, convenience and accessibility, trust as a precondition for participating, online groups as a potential facilitator or barrier to expression, limited digital access and literacy, and privacy concerns. Overall, women were highly supportive of online group-based interventions but acknowledged the need for increased digital access and Internet navigation training. Hybrid (in-person and online) interventions may be most useful for women with HIV.
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Chappell CA, Cohn SE. Prevention of perinatal transmission of human immunodeficiency virus. Infect Dis Clin North Am 2014; 28:529-47. [PMID: 25455313 DOI: 10.1016/j.idc.2014.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The reproductive health needs of all women of childbearing age should routinely address effective and appropriate contraception, safer sex practices, and elimination of alcohol, illicit drugs and tobacco should pregnancy occur. Combined antepartum, intrapartum, and infant antiretroviral (ARV) prophylaxis are recommended because ARV drugs reduce perinatal transmission by several mechanisms, including lowering maternal viral load and providing infant pre- and post-exposure prophylaxis. Scheduled cesarean delivery at 38 weeks with IV AZT decreases the risk of perinatal transmission if the HIV RNA is greater than 1000 copies/mL or if HIV levels are unknown near the time of delivery. Oral AZT should generally be given for at least 6 weeks to all infants perinatally exposed to HIV to reduce perinatal transmission of HIV.
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Affiliation(s)
- Catherine A Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611, USA.
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Abstract
BACKGROUND The number of HIV-infected women giving birth in the United States is increasing. Research on pregnancy planning in HIV-infected women is limited. METHODS Between January 1 and December 30, 2012, pregnant women with a known HIV diagnosis before conception at 12 US urban medical centers completed a survey including the London Measure of Unplanned Pregnancy (LMUP) scale. We assessed predictors of LMUP category (unplanned/ambivalent versus planned pregnancy) using bivariate and multivariable analyses. RESULTS Overall, 172 women met inclusion criteria and completed a survey. Based on self-report using the LMUP scale, 23% women had an unplanned pregnancy, 58% were ambivalent, and 19% reported a planned pregnancy. Women were at lower risk for an unplanned or ambivalent pregnancy if they had previously given birth since their HIV diagnosis [adjusted relative risk (aRR) = 0.67, 95% confidence interval (CI): 0.47 to 0.94, P = 0.02], had seen a medical provider in the year before the index pregnancy (aRR = 0.60, 95% CI: 0.46 to 0.77, P < 0.01), or had a patient-initiated discussion of pregnancy intentions in the year before the index pregnancy (aRR = 0.63, 95% CI: 0.46 to 0.77, P < 0.01). Unplanned or ambivalent pregnancy was not associated with age, race/ethnicity, or educational level. CONCLUSIONS In this multisite US cohort, patient-initiated pregnancy counseling and being engaged in medical care before pregnancy were associated with a decreased probability of unplanned or ambivalent pregnancy. Interventions that promote healthcare engagement among HIV-infected women and integrate contraception and preconception counseling into routine HIV care may decrease the risk of unplanned pregnancy among HIV-infected women in the United States.
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Abstract
OBJECTIVE To examine the prevalence of unplanned pregnancies among HIV-infected women in care in the United States. METHODS We used the 2007-2008 cycles of the Medical Monitoring Project, which collected data on HIV-infected adults in care. Women were included if they had an HIV diagnosis before 45 years of age and responded to questions about pregnancies and pregnancy planning after HIV diagnosis. Logistic regression was used to calculate unadjusted and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for correlates of unplanned pregnancies among women with ≥ 1 pregnancy at or after an HIV diagnosis. RESULTS Of 1492 women, 382 (25.6%) reported ≥ 1 pregnancy after HIV diagnosis (median diagnosis age = 25.0 years; interquartile range = 21.0-30.0); 58% were non-Hispanic black, 22% Hispanic, and 15% non-Hispanic white. Of those, 326 (85.3%) reported ≥ 1 unplanned pregnancy; 124 (32.5%) reported recent unprotected vaginal and/or anal sex with a male partner with either negative or unknown HIV status. Unplanned pregnancies were more likely among women who reported nadir CD4 cell counts <200 cells/μL (AOR = 2.3; 95% CI: 1.2 to 4.8) or did not report nadir CD4 cell counts (AOR = 4.3; 95% CI: 1.9 to 10.5) compared with women who reported nadir CD4 cell counts ≥ 200 cells/μL; and who received public assistance in the most recent year before Medical Monitoring Project interview (AOR = 2.1; 95% CI: 1.1 to 3.8) compared with women who did not receive assistance. CONCLUSIONS Unplanned pregnancies were prevalent among our sample. To avoid unplanned pregnancies, HIV-infected women need access to effective family planning services and risk reduction discussions during routine care visits.
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Nöstlinger C, Rojas Castro D, Platteau T, Dias S, Le Gall J. HIV-Related discrimination in European health care settings. AIDS Patient Care STDS 2014; 28:155-61. [PMID: 24568694 DOI: 10.1089/apc.2013.0247] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2-2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0-2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1-3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0-3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1-3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0-3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0-0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV.
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Affiliation(s)
| | | | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sonia Dias
- Instituto de Higiena e Medicina Tropical, Lisbon, Portugal
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Fertility desires among HIV-infected men and women in Los Angeles County: client needs and provider perspectives. Matern Child Health J 2013; 17:593-600. [PMID: 22562286 DOI: 10.1007/s10995-012-1035-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39% of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.
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MacCarthy S, Rasanathan JJK, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. REPRODUCTIVE HEALTH MATTERS 2013. [PMID: 23177686 DOI: 10.1016/s0968-8080(12)39641-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.
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Affiliation(s)
- Sarah MacCarthy
- The Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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Toth M, Messer LC, Quinlivan EB. Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination. AIDS Patient Care STDS 2013; 27:613-20. [PMID: 24138485 DOI: 10.1089/apc.2013.0030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIV-infected women of color. HIV-infected WOC (N=141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR=0.93, 95% CI: 0.89, 0.96), relatedness (PR=0.92, 95% CI: 0.89, 0.94), competency (PR=0.93, 95% CI: 0.87, 0.98), and social support (PR=0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.
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Affiliation(s)
- Matthew Toth
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Lynne C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon
| | - E. Byrd Quinlivan
- Center for Infectious Diseases, University of North Carolina-Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina-Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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41
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Preconception care for people living with HIV: recommendations for advancing implementation. AIDS 2013; 27 Suppl 1:S113-9. [PMID: 24088677 DOI: 10.1097/qad.0000000000000059] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Globally, research has documented high fertility desires and intentions among HIV-positive women. Improving implementation of preconception care (PCC) for people living with HIV is critical, given estimates that the majority of HIV-positive women who want future biological children have not received reproductive counseling, largely due to a lack of provider-initiated conversations. This article offers initial recommendations and outlines key considerations for a research agenda to advance PCC implementation efforts in both high-resource and low-resource settings. We consider who should provide PCC; where it can be effectively delivered; when it should be offered; and two potential implementation models depending on available resources. We conclude with a call for PCC-specific implementation science and research translation to help people living with HIV achieve their reproductive goals.
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Loutfy MR, Blitz S, Zhang Y, Hart TA, Walmsley SL, Smaill FM, Rachlis AR, Yudin MH, Angel JB, Ralph ED, Tharao W, Raboud JM. Self-Reported Preconception Care of HIV-Positive Women of Reproductive Potential: A Retrospective Study. J Int Assoc Provid AIDS Care 2013; 13:424-33. [PMID: 23918921 DOI: 10.1177/2325957413494238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We determined the proportion and correlates of self-reported pregnancy planning discussions (that is preconception counseling) that HIV-positive women reported to their family physicians (FPs), HIV specialists, and obstetrician/gynecologists (OB/Gyns). METHODS In a cross-sectional substudy, HIV-positive women of reproductive potential were asked whether their care providers discussed pregnancy planning. Logistic regression was used to calculate odds ratios for the correlates of preconception counseling. RESULTS A total of 431 eligible participants (median age 38, interquartile range = 32-43) reported having discussion with a physician (92% FP, 96% HIV specialists, and 45% OB/Gyns). In all, 34%, 41%, and 38% had their pregnancy planning discussion with FP, HIV specialist, and Ob/Gyns, respectively; 51% overall. In the multivariable model, significant correlates of preconception counseling were age (P = .02), marital status (P < .01), number of years living in Canada (P < .001), and age of youngest child (P < .01). CONCLUSIONS Preconception care in our cohort was suboptimal. We recommend that counseling on healthy preconception should be part of routine HIV care.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sandra Blitz
- Toronto General Research Institute, Toronto, Ontario, Canada
| | - Yimeng Zhang
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Trevor A Hart
- Ryerson University, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Faculty of Medicine, University of Toronto, Ontario, Canada Toronto General Research Institute, Toronto, Ontario, Canada
| | | | - Anita R Rachlis
- Faculty of Medicine, University of Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark H Yudin
- Faculty of Medicine, University of Toronto, Ontario, Canada St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jonathan B Angel
- Ottawa Health Research Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward D Ralph
- Infectious Diseases Care Program, St Joseph's Health Care, London, Ontario, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands, Toronto, Ontario, Canada
| | - Janet M Raboud
- Toronto General Research Institute, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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43
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Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, DeSousa N. Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color. AIDS Patient Care STDS 2013; 27:398-407. [PMID: 23829330 PMCID: PMC3704120 DOI: 10.1089/apc.2012.0435] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development.
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Affiliation(s)
- Lynne C Messer
- School of Community Health, Portland State University, Portland, OR 97207, USA.
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44
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Steiner RJ, Finocchario-Kessler S, Dariotis JK. Engaging HIV care providers in conversations with their reproductive-age patients about fertility desires and intentions: a historical review of the HIV epidemic in the United States. Am J Public Health 2013; 103:1357-66. [PMID: 23763424 DOI: 10.2105/ajph.2013.301265] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients' reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic's impact on reproductive health. We used a historical review of the US epidemic to describe the problem's scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient-provider communication about reproductive intentions.
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Affiliation(s)
- Riley J Steiner
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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45
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Nöstlinger C, Desjardins F, Dec J, Platteau T, Hasker E. Child desire in women and men living with HIV attending HIV outpatient clinics: Evidence from a European multicentre study. EUR J CONTRACEP REPR 2013; 18:251-63. [DOI: 10.3109/13625187.2013.801072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Johnson DC, Feldacker C, Tweya H, Phiri S, Hosseinipour MC. Factors associated with timely initiation of antiretroviral therapy in two HIV clinics in Lilongwe, Malawi. Int J STD AIDS 2013; 24:42-9. [PMID: 23467293 DOI: 10.1177/0956462412472312] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The World Health Organization (WHO) estimates that only 30% of eligible, HIV-infected individuals start antiretroviral therapy (ART). This study seeks to explore the geographic and individual factors associated with starting ART on time. This retrospective study includes 15,734 HIV-positive adults initiating ART at two HIV clinics in Lilongwe, Malawi. The outcome was starting ART within two weeks of meeting ART eligibility as defined by the Malawi ART guidelines. Euclidean distance from patient neighbourhood to their clinic was calculated using Google Earth. Logistic regression models assessed factors influencing starting ART on time. Of 15,734 adults initiating ART, 8178 were from Lighthouse (LH) and 7556 were from Martin Preuss Center (MPC). Combined, 68.7% started treatment on time. Patients who were eligible for ART based on a CD4 cell count <250 cells/mm(3) versus WHO stage were less likely to begin ART on time at both LH (odds ratio [OR] 0.16; 95% CI 0.13-0.19) and MPC (OR 0.24; 95% CI 0.21-0.28). Likelihood of starting on time decreased with each kilometer further from clinic location among LH patients (OR 0.97; 95% CI 0.94-0.99); distance was not significant at MPC. In conclusion, predictors differed by clinic. Distance to clinic and type of eligibility for ART significantly influence starting ART on time.
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47
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Finocchario-Kessler S, Mabachi N, Dariotis JK, Anderson J, Goggin K, Sweat M. "We weren't using condoms because we were trying to conceive": the need for reproductive counseling for HIV-positive women in clinical care. AIDS Patient Care STDS 2012; 26:700-7. [PMID: 23025705 DOI: 10.1089/apc.2012.0232] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although a significant number of HIV-positive women intend to have children in the future, few work with providers to safely plan pregnancy. We conducted 20 semistructured in depth interviews with HIV-positive adolescent and adult women receiving HIV clinical care in an urban setting. Participants were purposively sampled to include diversity in age and childbearing plans. Interview transcripts were analyzed and coded independently by two study team members before reaching consensus on emergent themes. Among this sample of HIV-positive women (mean age=27.9, 95% African American, 50% on antiretroviral therapy [ART], 65% want a biological child), only 25% reported discussing their childbearing goals with their HIV provider. Women actively trying to conceive recognized the risk to themselves and their partner, but had not talked with their provider about safer conception strategies. Data regarding provider communication about childbearing were organized by the following emergent themes: (1) confusion and concern on how to conceive safely, (2) provider characteristics or dynamics that influenced communication, and (3) provider guidance offered regarding childbearing. Even in this unique study setting in which referrals for preconception counseling are possible, women were unaware of this specialized service. Provider initiated reproductive counseling is needed to strategically avoid or plan pregnancy and reduce risk of transmission to partners and infants rather than leaving it to chance, which can have major health implications.
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Affiliation(s)
- Sarah Finocchario-Kessler
- Kansas University Medical Center, Family Medicine, Kansas City, Kansas
- University of Missouri-Kansas City, HIV Research Group, Kansas City, Missouri
| | - Natabhona Mabachi
- Kansas University Medical Center, Family Medicine, Kansas City, Kansas
| | - Jacinda K. Dariotis
- Johns Hopkins Bloomberg School of Public Health, Population, Family and Reproductive Health, Baltimore, Maryland
| | - Jean Anderson
- The Johns Hopkins School of Medicine, Obstetrics & Gynecology, Baltimore, Maryland
| | - Kathy Goggin
- University of Missouri-Kansas City, HIV Research Group, Kansas City, Missouri
| | - Michael Sweat
- Medical University of South Carolina, Psychiatry & Behavioral Sciences, Charleston, South Carolina
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48
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Hoyt MJ, Storm DS, Aaron E, Anderson J. Preconception and contraceptive care for women living with HIV. Infect Dis Obstet Gynecol 2012; 2012:604183. [PMID: 23097595 PMCID: PMC3477542 DOI: 10.1155/2012/604183] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/04/2012] [Indexed: 02/06/2023] Open
Abstract
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
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Affiliation(s)
- Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Blackstock OJ, Beach MC, Korthuis PT, Cohn JA, Sharp VL, Moore RD, Saha S. HIV providers' perceptions of and attitudes toward female versus male patients. AIDS Patient Care STDS 2012; 26:582-8. [PMID: 22978375 DOI: 10.1089/apc.2012.0159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As a first step in understanding the role that health care providers may play in observed gender disparities in HIV care in the United States, we sought to examine whether HIV providers' perceptions of and attitudes toward female and male patients differ. We used data from the Enhancing Communication to Improve HIV Outcomes (ECHO) study, a multisite, cross-sectional study focused on the role of the patient-provider relationship in disparities in HIV care conducted from October 2006 to June 2007. Using separate scales, we assessed HIV providers' perceptions about their patients (e.g., intelligence, compliance, responsibility) as well as providers' attitudes toward their patients (e.g., like, respect, frustrate). We used multivariable linear regression with generalized estimating equations to compare provider scores for female and male patients. Our sample comprised 37 HIV providers and 317 patients. Compared with male patients, HIV-infected females were less likely to be highly educated or employed, and more likely to report nonadherence to antiretroviral medications and depressive symptoms. In unadjusted and adjusted analyses, there was a significant difference in providers' perceptions of female and male patients, with providers having more negative perceptions of female patients. However, there was no significant difference in HIV providers' attitudes toward female and male patients in unadjusted or adjusted analyses. Further study is needed to elucidate the role of providers' perceptions and attitudes about female and male patients in observed gender disparities in HIV care.
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Affiliation(s)
- Oni J. Blackstock
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mary Catherine Beach
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - P. Todd Korthuis
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jonathan A. Cohn
- Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Victoria L. Sharp
- Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center, New York, New York
| | - Richard D. Moore
- Division of Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Somnath Saha
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon
- Section of General Internal Medicine, Portland VA Medical Center, Portland, Oregon
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50
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Prevalence of Drug Resistance and Associated Mutations in a Population of HIV-1(+) Puerto Ricans: 2006-2010. AIDS Res Treat 2012; 2012:934041. [PMID: 22593823 PMCID: PMC3347695 DOI: 10.1155/2012/934041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/30/2012] [Accepted: 02/13/2012] [Indexed: 11/30/2022] Open
Abstract
This is a continuation of our efforts to maintain a record of the evolution of HIV-1 infection in Puerto Rico by monitoring the expression levels of antiretroviral drug-resistance-associated mutations. Samples from 2,500 patients from 2006–2010 were analyzed using the TruGene HIV-1 genotyping kit and the OpenGene DNA sequencing system. Results show that 58.8% of males and 65.3% of females had HIV-1 with resistance to at least one medication. The average number of HIV mutations was 6.0 in males and 6.1 in females. Statistically significant differences between men and women were recorded in the levels of HIV-1 expressed mutations and antiretroviral drug resistance. The most prevalent antiretroviral medication resistance shifted from zalcitabine to nevirapine and efavirenz in the five-year period. M184V and L63P were the dominant mutations for the reverse transcriptase and the protease genes, respectively, but an increase in the incidence of minority mutations was observed.
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