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Kownaklai J, Graham M, Hayter M. Pregnancy decision making among Thai women living with HIV: a grounded theory study: Pregnancy decision making amongst Thai women living with HIV. Midwifery 2022; 115:103490. [PMID: 36155391 DOI: 10.1016/j.midw.2022.103490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE this qualitative research study aims to understand and generate a model of the pregnancy decision-making process in Thai women living with HIV. METHOD the constructivist grounded theory of Charmaz was chosen as the research approach and method to generate a pregnancy decision-making process which is shaped and constructed by personal and social processes. DATA COLLECTION was undertaken in antenatal clinics (ANCs) at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making. FINDINGS the substantive model consists of 6 categories; 1) concealing HIV positive status from partner; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting the decision; and 6) adapting to the decision. This research finds that the main concerns women living with HIV have in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found amongst these women that relates to personal and Thai social beliefs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the concept illustrates not only the process of decision making but also highlights the main stages, issues and concerns of women living with HIV wanting a child. This study recommends that health care providers need to pay more attention to counselling women and couples living with HIV by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy, in advance of this happening, and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.
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Affiliation(s)
- Jaruwan Kownaklai
- Department of Maternal-Child Health and Midwifery, Faculty of Nursing, Mahasakham University, Thailand.
| | - Moira Graham
- Co-adviser and Lecturer in Public Health / Graduate Research Director in the School of Health and Social Work, University of Hull, UK.
| | - Mark Hayter
- Principal adviser and Head of Nursing, Manchester Metropolitan University, Manchester, UK.
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Kang JS, Lee SH, Lee S, Lee JE, Lee SO, Kim SC, Kim KH. Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience. Infect Chemother 2019; 51:28-34. [PMID: 30941935 PMCID: PMC6446014 DOI: 10.3947/ic.2019.51.1.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The reports about fertility desire and pregnancy outcome among women infected with human immunodeficiency virus (HIV) in Korea are scarce. This study aimed to determine the changing trend in pregnancy incidence among women infected with HIV in Korea. MATERIALS AND METHODS We retrospectively reviewed the medical records of women infected with HIV visiting Pusan National University Hospital between January 1990 and October 2018. RESULTS A total of 149 women with HIV infection visited the study hospital. Among them, 33 pregnancies in 24 (16.1%) women were identified. There were 17 live births (51.5%) and 13 abortions (39.4%), whereas 3 women (9.1%) were transferred to another hospital or were lost to follow-up. The number of live birth rose from 0 in 1990-1998 to 17 in 1999-2018. The proportion of repeated pregnancies after HIV diagnosis also increased steeply, from 14.3% in 1999-2008 to 50% in 2009-2018. However, the number of abortions also increased over time. There were 8 induced abortions, 7 (87.5%) of them were diagnosed with HIV infection during pregnancy and 3 (37.5%) were unplanned pregnancies. Eighteen babies, including 1 twin case, were born from 17 births. There was no mother-to-child HIV transmission in our study. CONCLUSION The number of pregnancies among women with HIV infection and repeated pregnancies after HIV diagnosis has been increasing in Korea, probably due to the desire of HIV patients to have more children. However, the number of abortions also increased, probably due to health concerns and uncertain pregnancy outcome.
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Affiliation(s)
- Jin Suk Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik hospital, Busan, Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soon Ok Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Chul Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
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HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112404. [PMID: 30380715 PMCID: PMC6267013 DOI: 10.3390/ijerph15112404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in ≤1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs.
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Mayondi GK, Wirth K, Morroni C, Moyo S, Ajibola G, Diseko M, Sakoi M, Magetse JD, Moabi K, Leidner J, Makhema J, Kammerer B, Lockman S. Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study. BMC Public Health 2016; 16:44. [PMID: 26774918 PMCID: PMC4715872 DOI: 10.1186/s12889-015-2498-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. Methods We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. Results The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). Conclusions The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.
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Affiliation(s)
- Gloria K Mayondi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | | | - Chelsea Morroni
- EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. .,University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. .,Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana.
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Gbolahan Ajibola
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Maureen Sakoi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jane Dipuo Magetse
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Kebaiphe Moabi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jean Leidner
- Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA.
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA.
| | - Betsy Kammerer
- Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA. .,Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA.
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Abstract
The impact of antiretroviral therapy (ART) on the natural history of HIV-1 infection has resulted in dramatic reductions in disease-associated morbidity and mortality. Additionally, the epidemiology of HIV-1 infection worldwide is changing, as women now represent a substantial proportion of infected adults. As more highly effective and tolerable antiretroviral regimens become available, and as the prevention of mother-to-child transmission becomes an attainable goal in the management of HIV-infected individuals, more and more HIV-positive women are choosing to become pregnant and have children. Consequently, it is important to consider the efficacy and safety of antiretroviral agents in pregnancy. Protease inhibitors are a common class of medication used in the treatment of HIV-1 infection and are increasingly being used in pregnancy. However, several studies have raised concerns regarding pharmacokinetic alterations in pregnancy, particularly in the third trimester, which results in suboptimal drug concentrations and a theoretically higher risk of virologic failure and perinatal transmission. Drug level reductions have been observed with each individual protease inhibitor and dose adjustments in pregnancy are suggested for certain agents. Furthermore, studies have also raised concerns regarding the safety of protease inhibitors in pregnancy, particularly as they may increase the risk of pre-term birth and metabolic disturbances. Overall, protease inhibitors are safe and effective for the treatment of HIV-infected pregnant women. Specifically, ritonavir-boosted lopinavir- and atazanavir-based regimens are preferred in pregnancy, while ritonavir-boosted darunavir- and saquinavir-based therapies are reasonable alternatives. This paper reviews the use of protease inhibitors in pregnancy, focusing on pharmacokinetic and safety considerations, and outlines the recommendations for use of this class of medication in the HIV-1-infected pregnant woman.
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Affiliation(s)
- Nisha Andany
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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