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O'Reilly KR, Yeh PT, Kennedy CE, Fonner VA, Sweat MD. Family Planning Counseling for Women Living with HIV in Low- and Middle-Income Countries: A Systematic Review of the Impact on Contraceptive Uptake, Intention to Use Contraception and Pregnancy Incidence, 2011 to 2022. AIDS Behav 2024; 28:2477-2491. [PMID: 38662281 PMCID: PMC11286672 DOI: 10.1007/s10461-024-04319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/26/2024]
Abstract
Women's ability to control their fertility and have the number of children they want when they want them is an internationally recognized human right. This right has been the driving force behind family planning programs in low- and middle-income countries for more than five decades. The HIV epidemic added greater urgency to those efforts once the risk of vertical transmission of the virus from mothers to their infants was recognized. In 2013, we published a systematic review of the evidence of effectiveness of family planning counseling for women living with HIV, emphasizing HIV related behaviors. In this updated review, we examined 23 studies, primarily from sub-Saharan Africa. The evidence we uncovered reflected efforts to integrate services provided to women. These showed that providing contraceptive services, including intensified counseling and support, in the HIV clinics where women living with HIV received their care increased the likelihood of subsequent use of modern contraception by as much as fourfold. These studies reflected a greater focus on women's family planning decisions and behaviors and less focus on HIV-related behaviors. Among the possible causes of this noted difference we include the widespread coverage of antiretroviral treatment for HIV. This advance has apparently changed the rationale and the approach to integrating family planning and HIV services in ways that may not have been fully appreciated. The results, however, are beneficial: greater coverage of family planning for women who wish to control their fertility and a more equal partnership between family planning services and HIV services in pursuit of the mutual goal of providing integrated services to meet women's needs.
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Affiliation(s)
- Kevin R O'Reilly
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, 176 Croghan Spur Rd, Suite 104, Charleston, SC, 29407, USA.
| | - Ping Teresa Yeh
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia A Fonner
- FHI 360, Global Health and Population Research, Durham, NC, 27701, USA
| | - Michael D Sweat
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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Kennedy CE, Yeh PT, Fonner VA, Armstrong KA, Denison JA, O'Reilly KR, Sweat MD. The Evidence Project: Protocol for Systematic Reviews of Behavioral Interventions and Behavioral Aspects of Biomedical Interventions for HIV Prevention, Treatment, and Health Service Delivery in Low- and Middle-Income Countries. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:87-102. [PMID: 38648175 DOI: 10.1521/aeap.2024.36.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The Evidence Project conducts systematic reviews and meta-analyses of HIV behavioral interventions, behavioral aspects of biomedical interventions, combination prevention strategies, modes of service delivery, and integrated programs in low- and middle-income countries. Here, we present the overall protocol for our reviews. For each topic, we conduct a comprehensive search of five online databases, complemented by secondary reference searching. Articles are included if they are published in peer-reviewed journals and present pre/post or multi-arm data on outcomes of interest. Data are extracted from each included article by two trained coders working independently using standardized coding forms, with differences resolved by consensus. Risk of bias is assessed with the Evidence Project tool. Data are synthesized descriptively, and meta-analysis is conducted when there are similarly measured outcomes across studies. For over 20 years, this approach has allowed us to synthesize literature on the effectiveness of interventions and contribute to the global HIV response.
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Affiliation(s)
- Caitlin E Kennedy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ping Teresa Yeh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Virginia A Fonner
- Global Health and Population Research, FHI360, Durham, North Carolina
| | | | - Julie A Denison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kevin R O'Reilly
- Medical University of South Carolina, Charleston, South Carolina
| | - Michael D Sweat
- Global Health and Population Research, FHI360, Durham, North Carolina
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Revathy R, Chaurasia H, Shetty S, Joshi B. Health facility-based interventions and the uptake of contraception among people living with HIV: A systematic review & meta-analysis. Indian J Med Res 2023; 158:483-493. [PMID: 38143434 PMCID: PMC10878490 DOI: 10.4103/ijmr.ijmr_2471_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND OBJECTIVES The prong 2 of 4 prong strategy introduced by the World Health Organization aims at averting unintended pregnancies among people living with HIV (PLHIV). This systematic review aimed to generate evidence on the effectuality of facility-based interventions in improving uptake of modern and dual contraception, for reducing unmet family planning (FP) needs and unintended pregnancies among PLHIV. METHODS Articles evaluating facility-based interventions to integrate human immunodeficiency virus (HIV) and FP published in English language were included. Eligible studies were identified from electronic and lateral search from three databases (PubMed, Cochrane Library and Web of Science) and grey literature. HIV care with no/minimal focus on FP was considered a comparator. Quality was assessed using design-appropriate tools. Descriptive analysis was presented in tables. Uptake of dual methods, unmet FP needs and unintended pregnancies were included in the meta-analysis to estimate pooled odds ratio (OR) with random effect model, P and I2 values. RESULTS The search yielded 2112 results. After excluding duplicates and unfit articles, 17 were found eligible for review and nine for meta-analysis. The pooled OR for uptake of dual contraception was 1.69 (1.14, 2.5) ( P =0.008; I2 =90%), for unmet FP needs was 0.58 (0487, 0.69) ( P <0.00001; I2 =0%) and for unintended pregnancies was 0.6 (0.32, 1.1) ( P =0.1, I2 =38%). INTERPRETATION CONCLUSIONS The results of this meta-analysis suggest that health facility-based interventions to integrate HIV and FP services do result in improved uptake of dual methods and reduce unmet need for contraception along with a protective trend on incidence of unintended pregnancies. Such facility-based integration would ensure universal access to effective contraception and facilitate in achieving Sustainable Development Goals that aim at ending epidemics like HIV.
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Affiliation(s)
- R Revathy
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Shen Y, Zhang C, Goldsamt LA, Peng W, Wang R, Li X. Condom-Related Stigma Scale among Men Who Have Sex with Men in China: Development and Psychometric Tests. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4779. [PMID: 36981688 PMCID: PMC10048750 DOI: 10.3390/ijerph20064779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Condom-related stigma is a frequently mentioned barrier to consistent condom use among men who have sex with men (MSM). Based on the concept and operational definition of condom-related stigma recently defined by our team, we developed the 20-item condom-related stigma scale (CRSS) and examined its psychometric properties among 433 MSM in China, following DeVellis's scale development guidelines. The content validity, convergent validity, empirical validity, factorial validity, scale score reliability, split-half reliability, and test-retest reliability for the CRSS were all assessed. The scale consists of four domains: perceived distrust, perceived potential HIV/STI risk, perceived embarrassment, and perceived violation of the traditional understanding of sexual intercourse. The CRSS has good validity (the scale-level content validity index was 0.99; the empirical validity was greater than 0.70) and high reliability (the Cronbach's alpha coefficient overall was 0.926; the split-half reliability overall was 0.795; the test-retest reliability overall was 0.950). This scale is recommended for assessing the level of condom-related stigma among Chinese MSM, which can serve as an evaluating indicator for safer-sex interventions to prevent HIV infection among the MSM population in a Chinese cultural context.
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Affiliation(s)
- Yan Shen
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Run Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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Contraception values and preferences of people living with HIV: a systematic review. Contraception 2021; 111:48-60. [PMID: 34748747 DOI: 10.1016/j.contraception.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attention to the contraception values and preferences of those living with HIV is essential to meeting their reproductive rights and health needs. We systematically reviewed the literature on contraception values and preferences among women and men living with HIV. STUDY DESIGN We searched ten electronic databases for articles from 1 January 2005 through 27 July 2020 for qualitative and quantitative studies of the values and preferences for contraceptive methods among individuals living with HIV. RESULTS Twenty-one studies, primarily from sub-Saharan Africa, met the inclusion criteria. Contraception values and preferences were shaped by several factors: availability, accessibility, and convenience; perceived effectiveness; safety and tolerability; dual protection; fertility desires; partnership dynamics; and provider recommendations. Male condoms were a frequently preferred contraceptive method, offering an affordable and accessible form of dual protection against HIV and unwanted pregnancy. Fears of infertility and side effects decreased interest in hormonal contraceptive methods. Financial burdens incurred by HIV management and a desire to reduce dual reproductive health and HIV care burdens influenced preferences. Healthcare providers contributed to contraceptive preferences of women living with HIV, informing perceptions of safety, tolerability, and effectiveness. CONCLUSION Contraception values and preferences among women living with HIV are complex and influenced by factors related and unrelated to their HIV status. Considering contraception values and preferences of people living with HIV will ensure that their autonomy and right to make decisions about the contraceptive methods best for them are upheld.
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Demissie DB, Mmusi-Phetoe R. Integration of family planning services with HIV treatment for women of reproductive age attending ART clinic in Oromia regional state, Ethiopia. Reprod Health 2021; 18:102. [PMID: 34022885 PMCID: PMC8141201 DOI: 10.1186/s12978-021-01157-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In settings where HIV prevalence is high, management of sexual and reproductive health is critical to reducing HIV transmission and maternal mortality. Integration of family planning with HIV services is appropriate for HIV therapy, HIV prevention, and care in a resource-limited country s like Ethiopia. The study aimed at examining the status of integration of family planning services with HIV treatment and factors associated with successful integration of family planning and HIV services for women of reproductive age in Oromia, Ethiopia for better health outcomes. METHODS The research design of this study was a quantitative survey, non-experimental, explorative and descriptive. A questionnaire was used to collect data from women living with HIV attending ART clinics in the special zone of surrounding Finfinne, Oromia Region in five health centers. Simple random sampling was used to select 654 respondents. Data was analysed through the use of Statistical Package for Social Sciences version 23.0. Bivariate and multivariate logistic regressions were performed to identify factors associated integration of family planning with HIV services with the significant association at an adjusted odds ratio (AOR) with a 95% confidence interval (CI) to controlled effects of possible confounders from the final model. RESULT The response rate of this study was 97.6% (654/670). The ages of those who responded to the administered questionnaires ranged between 18 and 49 years. The mean age of the respondents was 31.86 years with an SD of ± 6.0 years. Most of the respondents in the sample were in the age group 26-35 (n = 374, 57%), and only 96 (14.7%) were in the age group 18-25. This overall integration of FP-HIV services among reproductive-age women living with HIV in Oromia regional state of special zone health centers was found to be 55.8%. Almost all respondents (n = 635, 97.1%) preferred integrated family planning and HIV services from the same facility and the same providers. the study found that 622 (95%) were most satisfied with the utilization of integrated family planning/HIV services. CONCLUSION This study established that in overall, the integration of family planning/HIV services was relatively moderate among women of reproductive age living HIV. The identified factors that affected the integration of family planning with HIV services were the level of education, occupational status, residence, discussion of family planning with healthcare providers, fertility desire and CD4 counts.
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Affiliation(s)
- Dereje Bayissa Demissie
- Department of Health Studies, College of Human Science, University of South Africa, Pretoria, South Africa. .,St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Rose Mmusi-Phetoe
- Department of Public Health, College of Human Science, University of South Africa, Pretoria, South Africa
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The paradox of HIV prevention: did biomedical prevention trials show how effective behavioral prevention can be? AIDS 2020; 34:2007-2011. [PMID: 32910064 DOI: 10.1097/qad.0000000000002682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Magadi MA. HIV and Unintended Fertility in Sub-Saharan Africa: Multilevel Predictors of Mistimed and Unwanted Fertility Among HIV-Positive Women. POPULATION RESEARCH AND POLICY REVIEW 2020. [DOI: 10.1007/s11113-020-09620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yam EA, Kahabuka C, Mbita G, Winani K, Apicella L, Casalini C, Mbuguni Z. Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services. PLoS One 2020; 15:e0235739. [PMID: 32692777 PMCID: PMC7373272 DOI: 10.1371/journal.pone.0235739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire. Conclusions Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
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Affiliation(s)
- Eileen A. Yam
- Population Council, Washington, DC, United States of America
- * E-mail:
| | | | | | - Koheleth Winani
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Zuhura Mbuguni
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Narasimhan M, Yeh PT, Haberlen S, Warren CE, Kennedy CE. Integration of HIV testing services into family planning services: a systematic review. Reprod Health 2019; 16:61. [PMID: 31138307 PMCID: PMC6538541 DOI: 10.1186/s12978-019-0714-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. METHODS We conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017. RESULTS Of 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes. CONCLUSIONS Global progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Gómez‐Suárez M, Mello MB, Gonzalez MA, Ghidinelli M, Pérez F. Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature. J Int AIDS Soc 2019; 22:e25273. [PMID: 30958638 PMCID: PMC6452919 DOI: 10.1002/jia2.25273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/07/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC. METHODS Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta-analysis was not considered appropriate given the level of heterogeneity of the studies. RESULTS A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non-permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV. CONCLUSIONS This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.
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Affiliation(s)
- Marcela Gómez‐Suárez
- The National University of ColombiaInterfaculty Doctoral Program in Public HealthBogotáColombia
| | - Maeve B Mello
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Mónica Alonso Gonzalez
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Massimo Ghidinelli
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
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Kennedy CE, Fonner VA, Armstrong KA, Denison JA, Yeh PT, O’Reilly KR, Sweat MD. The Evidence Project risk of bias tool: assessing study rigor for both randomized and non-randomized intervention studies. Syst Rev 2019; 8:3. [PMID: 30606262 PMCID: PMC6317181 DOI: 10.1186/s13643-018-0925-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/18/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Different tools exist for assessing risk of bias of intervention studies for systematic reviews. We present a tool for assessing risk of bias across both randomized and non-randomized study designs. The tool was developed by the Evidence Project, which conducts systematic reviews and meta-analyses of behavioral interventions for HIV in low- and middle-income countries. METHODS We present the eight items of the tool and describe considerations for each and for the tool as a whole. We then evaluate reliability of the tool by presenting inter-rater reliability for 125 selected studies from seven published reviews, calculating a kappa for each individual item and a weighted kappa for the total count of items. RESULTS The tool includes eight items, each of which is rated as being present (yes) or not present (no) and, for some items, not applicable or not reported. The items include (1) cohort, (2) control or comparison group, (3) pre-post intervention data, (4) random assignment of participants to the intervention, (5) random selection of participants for assessment, (6) follow-up rate of 80% or more, (7) comparison groups equivalent on sociodemographics, and (8) comparison groups equivalent at baseline on outcome measures. Together, items (1)-(3) summarize the study design, while the remaining items consider other common elements of study rigor. Inter-rater reliability was moderate to substantial for all items, ranging from 0.41 to 0.80 (median κ = 0.66). Agreement between raters on the total count of items endorsed was also substantial (κw = 0.66). CONCLUSIONS Strengths of the tool include its applicability to a range of study designs, from randomized trials to various types of observational and quasi-experimental studies. It is relatively easy to use and interpret and can be applied to a range of review topics without adaptation, facilitating comparability across reviews. Limitations include the lack of potentially relevant items measured in other tools and potential threats to validity of some items. To date, the tool has been applied in over 30 reviews. We believe it is a practical option for assessing risk of bias in systematic reviews of interventions that include a range of study designs.
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Affiliation(s)
- Caitlin E. Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E5547, Baltimore, MD 21205 USA
| | - Virginia A. Fonner
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC 29407 USA
| | - Kevin A. Armstrong
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC 29407 USA
| | - Julie A. Denison
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E5547, Baltimore, MD 21205 USA
| | - Ping Teresa Yeh
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E5547, Baltimore, MD 21205 USA
| | - Kevin R. O’Reilly
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC 29407 USA
| | - Michael D. Sweat
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC 29407 USA
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Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 2018; 391:2642-2692. [PMID: 29753597 DOI: 10.1016/s0140-6736(18)30293-9] [Citation(s) in RCA: 469] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Center for Global Development, Washington, DC, USA
| | | | - Alaka Basu
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Robert Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Monica Roa
- Independent Consultant, Islamabad, Pakistan
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | - Gamal I Serour
- International Islamic Center For Population Studies And Research, Al Azhar University, Cairo, Egypt
| | | | | | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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Mutabazi JC, Zarowsky C, Trottier H. The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review. Public Health Rev 2017; 38:28. [PMID: 29450099 PMCID: PMC5809942 DOI: 10.1186/s40985-017-0072-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems. METHODS Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57. RESULTS The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts. CONCLUSIONS PMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, 3rd Floor, Room: S03.516, 900, Rue St-Denis, Montreal, QC H2X 0A9 Canada
| | - Christina Zarowsky
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, 3rd Floor, Room: S03.516, 900, Rue St-Denis, Montreal, QC H2X 0A9 Canada
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535 South Africa
| | - Helen Trottier
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Universitaire Sainte Justine, Montréal, QC H3T 1C5 Canada
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Wall KM, Kilembe W, Vwalika B, Haddad LB, Khu NH, Brill I, Onwubiko U, Chomba E, Tichacek A, Allen S. Optimizing Prevention of HIV and Unplanned Pregnancy in Discordant African Couples. J Womens Health (Larchmt) 2017; 26:900-910. [PMID: 28829720 PMCID: PMC5576260 DOI: 10.1089/jwh.2016.6169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dual method use, which combines condoms with a more effective modern contraceptive to optimize prevention of HIV and unplanned pregnancy, is underutilized in high-risk heterosexual couples. MATERIALS AND METHODS Heterosexual HIV-discordant Zambian couples were enrolled from couples' voluntary HIV counseling and testing services into an open cohort with 3-monthly follow-up (1994-2012). Relative to dual method use, defined as consistent condom use plus modern contraception, we examine predictors of (1) condom-only use (suboptimal pregnancy prevention) or (2) modern contraceptive use with inconsistent condom use (effective pregnancy prevention and suboptimal HIV prevention). RESULTS Among 3,049 couples, dual method use occurred in 28% of intervals in M+F- and 23% in M-F+, p < 0.01; condom-only use in 56% in M+F- and 61% in M-F+, p < 0.01; and modern contraceptive use with inconsistent condom use in 16% regardless of serostatus. Predictors (p < 0.05) of condom-only use included the man being HIV+ (adjusted hazard ratio, aHR = 1.15); baseline oral contraceptive pill (aHR = 0.76), injectable (aHR = 0.48), or implant (aHR = 0.60) use; woman's age (aHR = 1.04 per 5 years) and lifetime number of sex partners (aHR = 1.01); postpartum periods (aHR = 1.25); and HIV stage of the index partner III/IV versus I (aHR = 1.10). Predictors (p < 0.05) of modern contraceptive use with inconsistent condom use included woman's age (aHR = 0.94 per 5 years) and HIV+ male circumcision (aHR = 1.51), while time-varying implant use was associated with more consistent condom use (aHR = 0.80). CONCLUSIONS Three-quarters of follow-up intervals did not include dual method use. This highlights the need for counseling to reduce unintended pregnancy and HIV transmission and enable safer conception.
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Affiliation(s)
- Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia
| | - William Kilembe
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bellington Vwalika
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Departments of Gynecology and Obstetrics (BV), Internal Medicine (SL) and Surgery (RC), School of Medicine, University of Zambia, Lusaka, Zambia
| | - Lisa B. Haddad
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia
| | - Naw Htee Khu
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ilene Brill
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Udodirim Onwubiko
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Elwyn Chomba
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Ministry of Home Affairs and University of Zambia School of Medicine Lusaka, Lusaka, Zambia
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Haberlen SA, Narasimhan M, Beres LK, Kennedy CE. Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review. Stud Fam Plann 2017; 48:153-177. [PMID: 28337766 PMCID: PMC5516228 DOI: 10.1111/sifp.12018] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Evidence on the feasibility, effectiveness, and cost‐effectiveness of integrating family planning (FP) and HIV services has grown significantly since the 2004 Glion Call to Action. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in 2013. Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective (noncondom) modern methods among women who wanted to prevent pregnancy. Integration efforts, particularly in contexts where contraceptive use is low, must address community‐wide and HIV‐specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care.
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O'Reilly KR, d'Aquila E, Fonner V, Kennedy C, Sweat M. Can Policy Interventions Affect HIV-Related Behaviors? A Systematic Review of the Evidence from Low- and Middle-Income Countries. AIDS Behav 2017; 21:626-642. [PMID: 27864626 PMCID: PMC5303549 DOI: 10.1007/s10461-016-1615-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In their response to HIV, many countries have adopted and enacted policies to reduce transmission and increase HIV-related service use. Theoretically, policy-level interventions for HIV prevention have the potential to improve health behavior outcomes. These policy interventions vary in their scale, from relatively minor changes in clinical policy to major national legal initiatives. Assessing the effectiveness of HIV policy interventions is a challenging undertaking. While many policies exist and guide HIV programmes, relatively few have specifically been evaluated for their effects on reducing HIV risk taking or increasing HIV health-seeking behaviors. Thus, questions on the effectiveness of policy interventions to prevent HIV and change HIV-related risk behaviors remain largely unanswered. To address this current gap in the literature, we systematically reviewed the existing evidence on the effect of HIV policy interventions on changing HIV-related behaviors in low-and middle-income countries.
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Affiliation(s)
- Kevin R O'Reilly
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- , Rue de Grand Pre 26B, 1299, Crans-pres-Celigny, Switzerland.
| | - Erica d'Aquila
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Sweat
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Belaid L, Dumont A, Chaillet N, De Brouwere V, Zertal A, Hounton S, Ridde V. Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC. Syst Rev 2015; 4:124. [PMID: 26420571 PMCID: PMC4589108 DOI: 10.1186/s13643-015-0102-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions. METHODS/DESIGN We will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR) DISCUSSION: The systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in PROSPERO (CRD 42015017549).
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Affiliation(s)
- Loubna Belaid
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Alexandre Dumont
- UMR 216 IRD-Université Paris Descartes, 4 Avenue de l'Observatoire, 75 006, Paris, France.
| | - Nils Chaillet
- Département d'obstétrique et gynécologie et département de Médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Centre de recherche du CHUS: Axe Santé: populations, organisation, pratiques, Université de Sherbrooke, Sherbrooke, Canada.
| | - Vincent De Brouwere
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Amel Zertal
- Centre de recherche du CHUM, Axe Évaluation, Systèmes de soins et services, Université de Montréal, 850, rue Saint Denis-Tour S, Local S03-814, Montréal, QC, H2X 0A9, Canada.
| | - Sennen Hounton
- Commodity Security Branch, Technical Division, United Nations Population Fund, 605 3rd Avenue, New York, NY, 10158, USA.
| | - Valéry Ridde
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), 7101 Avenue du Parc, bureau 3187-03, Montréal, Québec, H3N1X9, Canada. .,ESPUM (école de santé publique de l'Université de Montréal), Montréal, Canada.
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Wessman M, Aho I, Thorsteinsson K, Storgaard M, Johansen IS, Lunding S, Pedersen G, Lebech AM, Kivelä P, Helleberg M, Katzenstein TL, Weis N. Perception of sexuality and fertility in women living with HIV: a questionnaire study from two Nordic countries. J Int AIDS Soc 2015; 18:19962. [PMID: 26037151 PMCID: PMC4452736 DOI: 10.7448/ias.18.1.19962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/29/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire. METHODS WLWH were recruited at their regular outpatient clinic visits, at the major Departments of Infectious Diseases in Denmark and Finland, from January 2012 to October 2013. A questionnaire was developed, study participants were informed of the nature of study and, if they agreed to participate and signed a consent form, they filled in the questionnaire. Demographic information on the participants was obtained from patient files (in Finland) or from a national HIV cohort (in Denmark). Statistical analysis was performed using STATA, version 11. RESULTS In total, 560 women were included in the study. The median age was 44 years. The majority were of white European origin, with fully suppressed HIV viral load, CD4 cell count >350 µL and mild or no symptoms of their HIV infection. A total of 62% were sexually active, stating condom use as their sole form of contraception. Of the sexually inactive women, one-third were in steady relationships. Eighty percent reported prior pregnancies, of which the majority had one or more children. Most children were born prior to the women's HIV diagnosis and the mode of conception was predominantly natural. One-quarter of the participating women desired pregnancy, while more than half did not. The remaining quarter either stated that they already had the desired number of children or chose not to answer the question. Fourteen percent stated that their HIV diagnosis ended their wish for children; of these women, the median time of diagnosis was between 1995 and 1996. Pregnancy had been attempted unsuccessfully in one-quarter of study participants. The final question inquired what the risk of mother-to-child transmission was, with all precautions taken. Fifteen percent estimated the risk to be above two percent. CONCLUSIONS In conclusion, the majority of WLWH in industrialized settings in Denmark and Finland have few HIV-related symptoms, are sexually active and have a strong desire for children.
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Affiliation(s)
- Maria Wessman
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark;
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
| | - Kristina Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Suzanne Lunding
- Department of Pulmonary Medicine and Infectious Diseases, North Zealand Hospital, Hillerød, Denmark
| | - Gitte Pedersen
- Department of InfectiousDiseases, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Maraux B, Hamelin C, Bajos N, Dray-Spira R, Spire B, Lert F. Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011. Contraception 2015; 92:160-9. [PMID: 25940932 DOI: 10.1016/j.contraception.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Advances in antiretroviral treatment (ART) have led to improvements in reproductive health for women living with HIV. This paper aims to investigate the pattern of contraceptive use among women living with HIV in France. STUDY DESIGN Data were drawn from the ANRS VESPA2 study, which included a representative sample of HIV-positive people. Contraception methods were documented, including condoms, highly effective contraception methods (HEC) and traditional methods. We measured the frequency of not using any modern contraception (neither condoms nor HEC) and of HEC use and studied their correlates (i.e., geographic origin, age, parity, partnership status, education level, material deprivation, employment status, health insurance, visits to a gynecologist, being on ART, cardiovascular risk) among women at risk of an unintended pregnancy. RESULTS Of the 662 women of reproductive age, 327 were in need of contraception. Overall, 20.5% used HEC, 58.8% used condoms and 20.7% used traditional or no methods, with no difference according to geographic origin [sub-Saharan African (SSA) women vs. French and other migrant women]. Among SSA women, being <30years old [odds ratio (OR) 16.39, 95% confidence interval (95%CI) 2.77-97.01], having had at least one child (OR 3.75, 95%CI 1.75-8.04) and being employed (OR 2.36, 95%CI 0.99-5.61) were associated with HEC use; among French and other migrant women, HEC use was associated with being in a stable partnership (OR 4.5, 95%CI 1.2-17.2) and material deprivation (OR 3.3 95%CI 1.4-9.8). Gynecologist visits, health insurance status and cardiovascular risk were not associated with HEC use. CONCLUSIONS Condoms remained the predominant contraceptive method despite the absence of restrictions on hormonal contraception and intrauterine device use for HIV-positive women. The recent recommendations about dual method protection should be actively promoted, targeting HIV-positive women, HIV specialists and gynecologists to overcome the barriers to effective contraception. IMPLICATIONS The information provided in this study constitutes a major contribution to comprehensively inform the scientific community on contraception practices among women living with HIV in France in the early 2010s. Our results show that the therapeutic advances since the late 1990s and the removal of restrictions on hormonal contraception use have not led to the expected shift in contraception patterns. There is an urgent need to promote dual method protection, as condom use may decrease in the future in the context of the preventive effect of ART.
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Affiliation(s)
- B Maraux
- INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France.
| | - C Hamelin
- INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; Université de Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - N Bajos
- INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; INED, Paris, France; Université Paris Sud, Le Kremlin-Bicêtre, France
| | - R Dray-Spira
- INSERM, UMRS 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - B Spire
- INSERM UMRS 912 (SESSTIM), Marseille, France; Aix Marseille Université, UMRS 912, IRD, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-D'azur, Marseille, France
| | - F Lert
- INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; Université de Versailles Saint-Quentin en Yvelines, Villejuif, France
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Yotebieng M, Norris A, Chalachala JL, Matumona Y, Ramadhani HO, Behets F. Fertility desires, unmet need for family planning, and unwanted pregnancies among HIV-infected women in care in Kinshasa, DR Congo. Pan Afr Med J 2015; 20:235. [PMID: 27386031 PMCID: PMC4919670 DOI: 10.11604/pamj.2015.20.235.5859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/28/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction We assessed the fertility desires, utilization of family planning (FP) methods, and incidence of pregnancies among HIV-infected women receiving care in an HIV clinic with an onsite FP services in Kinshasa, Democratic Republic of Congo. Methods Between November 2011 and May 2012, all HIV-infected women who attended a routine visit at the clinic were interviewed about their fertility desires and utilization of contraceptive methods using a structured questionnaire. Routine follow-up visit data were used to identify pregnancies recorded between the interview and June 2013. Results Overall, of the 699 HIV-infected women interviewed. 249 (35.7%) reported not wanting another child. Of the 499 (72.2%) participants who were sexually active at the time of interview, 177 (35.5%) were using an effective contraceptive method, including 70 (14.0%) women who reported using condoms consistently and 104 (20.8%) who were using injectable contraception. Overall, 88 (17.6%) sexually active participants who did not want another child were not using an effective FP method, and thus are considered to have had unmet need. During the median follow-up time of 22.2 (IQR: 20.2, 23.6) months, among all women interviewed, 96 (14.1%) became newly pregnant [pregnancy rate 9.3 (95%CI: 7.6, 11.4) per 100 women-years] including 21 (8.7%) among women who initially reported not wanting another child [unwanted pregnancy rate 5.8 (95%CI: 3.6, 9.3) per 100 women-years]. Conclusion The persistence of relatively high unmet need among women receiving HIV care in a clinic with onsite FP services suggests the existence of barriers that must be identified and addressed.
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Affiliation(s)
- Marcel Yotebieng
- Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC
| | - Alison Norris
- Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH
| | | | - Yori Matumona
- University of Kinshasa, School of Public Health, Kinshasa, DR Congo
| | - Habib Omari Ramadhani
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC
| | - Frieda Behets
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
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Eliminating preventable HIV-related maternal mortality in sub-Saharan Africa: what do we need to know? J Acquir Immune Defic Syndr 2015; 67 Suppl 4:S250-8. [PMID: 25436825 PMCID: PMC4251907 DOI: 10.1097/qai.0000000000000377] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. METHODS This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. RESULTS Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. CONCLUSIONS As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas.
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Fonner VA, Kennedy CE, O’Reilly KR, Sweat MD. Systematic assessment of condom use measurement in evaluation of HIV prevention interventions: need for standardization of measures. AIDS Behav 2014; 18:2374-86. [PMID: 24197972 DOI: 10.1007/s10461-013-0655-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When evaluating HIV prevention interventions, condom use is a common outcome measure used to assess changes in HIV-related behaviors; however, no widely accepted standards exist for its measurement. Using systematic review data on HIV prevention interventions conducted in low- and middle-income countries, we examined trends in condom use measurement since 1990. We abstracted data from standardized forms on six dimensions of condom use: partner type, temporal period, measurement scale, consistency, controlling for abstinence, and type of sex. Of 215 studies reviewed, 109 studies (51 %) measured condom use as a primary outcome. Outcomes were stratified by partner type in 47 studies (43 %). Assessing condom use at last sex was the most common measurement. Consistency of condom use was assessed in 47 studies (43 %). Developing and utilizing standards for condom use measurement would increase comparability of findings across studies and benefit HIV prevention research. Recommendations include measuring condom use at last sex, frequency of condom use, and number of protected sex acts in studies evaluating the efficacy of behavioral interventions on sexual risk behavior.
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Patel R, Baum S, Grossman D, Steinfeld R, Onono M, Cohen C, Bukusi E, Newmann S. HIV-positive men's experiences with integrated family planning and HIV services in western Kenya: integration fosters male involvement. AIDS Patient Care STDS 2014; 28:418-24. [PMID: 24927494 PMCID: PMC4932786 DOI: 10.1089/apc.2014.0046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A growing body of evidence indicates that integrating family planning (FP) services into HIV care is effective at improving contraceptive uptake among HIV-positive women in resource-poor settings, yet little research has examined HIV-positive men's experiences with such integration. We conducted in-depth interviews with 21 HIV-positive men seeking care at HIV clinics in Nyanza, Kenya. All clinics were intervention sites for a FP/HIV service integration cluster-randomized trial. Grounded theory was used to code and analyze the data. Our findings highlight men's motivations for FP, reasons why men prefer obtaining their FP services, which include education, counseling, and commodities, at HIV care clinics, and specific ways in which integrated FP/HIV services fostered male inclusion in FP decision-making. In conclusion, men appear invested in FP and their inclusion in FP decision-making may bolster both female and male agency. Men's positive attitudes towards FP being provided at HIV care clinics supports the programmatic push towards integrated delivery models for FP and HIV services.
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Affiliation(s)
- Rena Patel
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California
| | - Sarah Baum
- Ibis Reproductive Health, Oakland, California
| | - Daniel Grossman
- Ibis Reproductive Health, Oakland, California
- Bixby Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Rachel Steinfeld
- Bixby Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya
| | - Craig Cohen
- Bixby Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya
| | - Sara Newmann
- Bixby Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
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