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Brooks HL, Graves E, De Schacht C, Emílio A, Matino A, Aboobacar A, Audet CM. "If It Weren't for This, We'd Be Sick"-Perspectives From Participants of a Couple-Based HIV Treatment and Support Program During Prenatal and Postpartum Periods in Zambézia Province, Mozambique. J Acquir Immune Defic Syndr 2024; 96:304-310. [PMID: 38032747 PMCID: PMC11128476 DOI: 10.1097/qai.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Engagement in HIV care and treatment services during pregnancy is key to eliminating vertical transmission. One barrier to retention of pregnant and lactating women is insufficient support from male partners. Reframing HIV services as couple-based may increase adherence among men and women. As part of a cluster randomized trial evaluating an intervention offering seroconcordant couples living with HIV joint follow-up in HIV services and sessions with a health counselor and couple peer educators, we assessed participants' perspectives and experiences regarding the intervention. SETTING Zambézia Province is a rural, low-income, and medically underserved region of central Mozambique. METHODS We conducted semistructured interviews with a subset of participants enrolled in the intervention arm. The objectives were to explore participants' (1) experiences with couples-based HIV care and the educational/support sessions; (2) perceived impacts of the intervention; and (3) suggestions for intervention improvement. Interviews conducted by experienced interviewers were audio-recorded, transcribed, and deductively coded. RESULTS Sixty-four participants were interviewed. Participants described the counselor and the peer educators as trustworthy and the sessions as improving their HIV-related knowledge. Receiving joint HIV services was convenient and motivated some participants to remain adherent to care. Participants provided few suggestions to improve the intervention, although a few female participants did state that they wished their male partners had participated more readily in the joint sessions and medication pick-ups at the health facilities. CONCLUSIONS Participants described positive experiences with and perceived benefits from the intervention, making this intervention acceptable within the local context.
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Affiliation(s)
- Hannah L Brooks
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique; and
| | - Carolyn M Audet
- Departments of Health Policy and Epidemiology, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Graves E, Brooks HL, De Schacht C, Emílio A, Matino A, Aboobacar A, Audet CM. Healthcare Providers' Perspectives on a Novel Couple-Based HIV Treatment Intervention: A Qualitative Assessment of the Facilitators, Barriers, and Proposed Improvements to Implementation in Zambézia Province, Mozambique. AIDS Behav 2024; 28:1370-1383. [PMID: 38151664 PMCID: PMC11197054 DOI: 10.1007/s10461-023-04224-8] [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: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Mozambique has one of the world's highest HIV/AIDS burdens. Despite significant investment in HIV care and treatment, pregnant and lactating women's retention in care remains suboptimal. One reason for poor maternal retention is lack of male partner support. We tested an interventional couple-based HIV care and treatment, including joint clinical appointments and couple-based educational and support sessions provided by a health counselor and peer educators, respectively. Healthcare providers delivering care for seroconcordant individuals were interviewed regarding their perspectives on facilitators and barriers to the couple-based intervention implementation. Analysis of interview responses was done using MAXQDA. Results pertaining to providers' perspectives on implementation and intervention characteristics were organized, interpreted, and contextualized using the Consolidated Framework for Implementation Research (CFIR 2.0), while providers' suggestions for improvements were coded and organized apart from CFIR. Providers felt the intervention was largely compatible with the local culture, and offered a significant advantage over standard individual-based care by facilitating patient follow-up and reducing wait times by prioritizing couples for services. They also believed it facilitated HIV treatment access through the provision of couple-based counseling that encouraged supportive behaviors towards retention. However, providers reported insufficient privacy to deliver couple-based care at some health facilities and concerns that women in difficult relationships may struggle to meaningfully participate. They suggested providing sessions in alternate clinic settings and offering a limited number of women-only visits. The facilitators and barriers described here contribute to informing the design and implementation of future couple-based interventions to improve HIV care for seroconcordant expectant couples.
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Affiliation(s)
- Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | - Hannah L Brooks
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | | | | | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique
| | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Lin D, Zhang C, Shi H. Adverse Impact of Intimate Partner Violence Against HIV-Positive Women During Pregnancy and Post-Partum: Results From a Meta-Analysis of Observational Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:1624-1639. [PMID: 35258353 DOI: 10.1177/15248380211073845] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives: Intimate partner violence (IPV) against pregnant or human immunodeficiency virus (HIV)-positive women have been previously studied. However, data on the impact of IPV on HIV-positive pregnant women have not been systematically synthesized. We performed a meta-analysis to explore this issue and provide evidence regarding IPV prevention and HIV infection control. Method: The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched. Studies that quantitatively assessed the association between IPV and its adverse impact on HIV-positive women during pregnancy and post-partum were eligible for inclusion. Pooled odds ratios (ORs) were calculated. Findings: Eight studies were identified to meet our eligibility criteria. The adverse impacts of IPV against HIV-positive pregnant women mainly included nonadherence to maternal antiretroviral treatment during pregnancy, nondisclosure of HIV-positive status to male partners, nonadherence to infant antiretroviral prophylaxis, and antenatal depression. IPV caused a 180% and 145% increase in the odds of antenatal depression and nonadherence to infant antiretroviral prophylaxis, respectively, among HIV-positive women, compared to the odds of their IPV-free counterparts [OR = 2.80, 95% confidence interval (CI): 1.66-4.74; OR = 2.45, 95% CI: 1.40-4.27]. Conclusion: Limited evidence has suggested that IPV against HIV-positive pregnant women caused maternal depression during pregnancy and led to the possible failure of HIV prophylaxis adherence in infants. Interventions to address IPV may ultimately reduce the risk of depression-related adverse birth outcomes and vertical transmission in infants exposed to maternal HIV. Prevention and control against IPV should be developed for HIV-positive pregnant women.
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Affiliation(s)
- Dan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Chunyang Zhang
- Fujian Centre for Disease Control and Prevention, Fuzhou, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
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Triulzi I, Somerville C, Sangwani S, Palla I, Orlando S, Mamary HS, Ciccacci F, Marazzi MC, Turchetti G. Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis. Glob Health Action 2022; 15:2051223. [PMID: 35416763 PMCID: PMC9009925 DOI: 10.1080/16549716.2022.2051223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. OBJECTIVE This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. METHODS We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. RESULTS This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. CONCLUSIONS This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claire Somerville
- Gender Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Lång U, Yates K, Leacy FP, Clarke MC, McNicholas F, Cannon M, Kelleher I. Systematic Review and Meta-analysis: Psychosis Risk in Children and Adolescents With an At-Risk Mental State. J Am Acad Child Adolesc Psychiatry 2022; 61:615-625. [PMID: 34363965 DOI: 10.1016/j.jaac.2021.07.593] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The "At Risk Mental State" (ARMS) approach to psychosis, also called "Clinical/Ultra High Risk," has had a major impact on psychosis services internationally. Despite well-established developmental differences in the prevalence and expression of psychotic symptoms from childhood into adulthood, there has been no systematic review of psychosis transitions specifically in children and adolescents up to age of 18 years. Evidence for this age group is crucial for developmentally appropriate clinical decisions by child and adolescent psychiatrists. METHOD Systematic review and meta-analysis of psychosis risk among children diagnosed with ARMS up to age 18 years, with pooled transition rates after 1-year, 2-year and ≥5-year follow-up. RESULTS We retrieved 1,107 records and identified 16 articles from 9 studies reporting transition rates on 436 individuals with ARMS aged 9 to 18 years. The pooled transition rate to psychosis at 1 year was 9.5% (95% CI = 5.5%-14.2%, 7 studies included), at 2-years 12.1% (95% CI = 6.7%-18.6%, 4 studies included), and at ≥5 years 16.1% (95% CI = 5.6%-30.0%, 4 studies included). We did not find evidence that the diagnosis of ARMS was associated with increased risk of psychosis once risk-enriching recruitment strategies were taken into account. CONCLUSION At 5-year follow-up, 1 in 6 youths diagnosed with an ARMS had transitioned to psychosis, but we did not find evidence that this risk was related to ARMS diagnosis as opposed to sampling/recruitment strategies. Our findings indicate a need for caution in applying ARMS methodology to children and adolescents. and highlight the need for developmentally sensitive approaches when considering psychosis risk.
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Affiliation(s)
- Ulla Lång
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathryn Yates
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Mary C Clarke
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona McNicholas
- School of Medicine, University College Dublin, Ireland; Lucena Clinic Child and Adolescent Mental Health Service, Dublin, Ireland; Our Lady's Hospital for Sick Children, Dublin, Ireland
| | - Mary Cannon
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ian Kelleher
- RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Medicine, University College Dublin, Ireland; Lucena Clinic Child and Adolescent Mental Health Service, Dublin, Ireland.
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Hampanda K, Pelowich K, Chi BH, Darbes LA, Turan JM, Mutale W, Abuogi L. A Systematic Review of Behavioral Couples-Based Interventions Targeting Prevention of Mother-to-Child Transmission in Low- and Middle-Income Countries. AIDS Behav 2022; 26:443-456. [PMID: 34415489 DOI: 10.1007/s10461-021-03401-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
There is increasing focus in HIV prevention and treatment on couples-based approaches. No systematic review has synthesized prospective behavioral couples-based HIV trials targeting prevention of mother-to-child transmission (PMTCT) outcomes in low- and middle-income countries (LMICs). We systematically reviewed published abstracts and articles reporting prospective comparative evaluations of behavioral couples-based HIV interventions delivered during pregnancy to both members of a self-identified heterosexual couple in LMICs following PRISMA. Citations, abstracts, and full texts were double screened for eligibility. References meeting eligibility criteria underwent double data abstraction, quality appraisal, and qualitative synthesis. We identified 295 unique publications. Of these, 5 randomized trials were deemed eligible and synthesized. Studies were conducted in 3 different African countries using three overarching intervention approaches: home-based; group workshops; and faith-based. Studies included various PMTCT outcome measures. We found evidence that behavioral couples-based approaches around the time of pregnancy can positively affect HIV testing among pregnant women and their male partners, infant HIV prophylaxis use, and HIV-free infant survival. The effects on other PMTCT outcomes were not well supported. There was a low to moderate risk of bias among the included studies. Few couples-based PMTCT interventions have been tested in LMICs. Of the interventions we located, workshops/group education and home-based couple counseling and testing were most commonly used to promote PMTCT. Research is needed on the role of relationship dynamics within such interventions and whether couples-based approaches during pregnancy can extend to health outcomes across the PMTCT continuum of care.
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Daniele MAS. Male partner participation in maternity care and social support for childbearing women: a discussion paper. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200021. [PMID: 33938279 PMCID: PMC8090816 DOI: 10.1098/rstb.2020.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
Male partners/fathers are key support persons for many childbearing women and their involvement in pregnancy, childbirth and the postpartum/postnatal period has beneficial effects on a wide range of outcomes related to maternal and child health and family wellbeing. Social support is implicated in the relevant causal pathway, but has received largely tangential attention in the public health literature. This discussion paper aims to reframe men's participation in maternity care as an opportunity to enhance their readiness and ability to provide social support to women, contributing to the debate on the definition and rationale for male partner involvement, and paving the way for further empirical work. I begin by presenting a theory of change illustrating the causal pathway leading from male partner participation, through the key intermediate step of social support, to improved health and wellbeing for women and children. I proceed by arguing that many people desire male partner participation in maternity care; however, in practice, this is often limited owing to cultural, social and institutional barriers. I use examples from the intervention literature to demonstrate how participation in care can boost men's motivation to support women and enhance their ability to do so by increasing their knowledge and skills. Finally, I draw up general implications for further male partner involvement programmes, suggesting that in order to achieve meaningful and sustainable gains, attention to design is crucial in order to avoid reinforcing patriarchal gender norms. Programmes should be implemented alongside other efforts to improve quality and promote woman-centred care. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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8
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Hampanda K, Helova A, Odwar T, Odeny T, Onono M, Bukusi E, Turan J, Abuogi L. Male partner involvement and successful completion of the prevention of mother-to-child transmission continuum of care in Kenya. Int J Gynaecol Obstet 2020; 152:409-415. [PMID: 33108671 DOI: 10.1002/ijgo.13442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 07/07/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the relationship between male partner involvement (MPI) in prevention of mother-to-child transmission (PMTCT) activities and successful completion of the PMTCT continuum of care, which remains sub-optimal in settings with high prevalence of HIV. METHODS A cross-sectional survey was administered in June-August 2017 to a sample of 200 postpartum Kenyan women with HIV enrolled in a parent trial. Composite PMTCT and MPI variables were created. Descriptive, simple and multivariable regression, and mediation analyses were performed. RESULTS Of the women, 54% reported successful completion of PMTCT. Depression and internalized HIV stigma were independently associated with lower likelihood of successful completion of PMTCT (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI] 0.94-0.99; aRR 0.92; 95% CI 0.88-0.98, respectively). Each MPI activity was associated with 10% greater likelihood of successful completion of PMTCT (P < 0.05). The relationship between MPI and the successful completion of PMTCT was partially mediated through women's reduced internalized HIV stigma (β -0.03; 95%CI -0.06 to -0.00). CONCLUSION Greater MPI in PMTCT activities has direct and indirect effects on women's successful completion of all necessary steps across the PMTCT continuum. Reduced internalized HIV stigma is likely a key mechanism in the relationship.
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Affiliation(s)
- Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA
| | - Anna Helova
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa Abuogi
- Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rothrock SG, Cassidy DD, Barneck M, Schinkel M, Guetschow B, Myburgh C, Nguyen L, Earwood R, Nanayakkara PW, Nannan Panday RS, Briscoe JG. Outcome of Immediate Versus Early Antibiotics in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 76:427-441. [DOI: 10.1016/j.annemergmed.2020.04.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023]
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Hampanda KM, Mweemba O, Ahmed Y, Hatcher A, Turan JM, Darbes L, Abuogi LL. Support or control? Qualitative interviews with Zambian women on male partner involvement in HIV care during and after pregnancy. PLoS One 2020; 15:e0238097. [PMID: 32853263 PMCID: PMC7451516 DOI: 10.1371/journal.pone.0238097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Efforts to promote male partner involvement in the prevention of mother-to-child transmission (PMTCT) may inadvertently exploit gender power differentials to achieve programme targets. METHODS We explored women's relative power and perceptions of male partner involvement through interviews with postpartum Zambian women living with HIV (n = 32) using a critical discourse analysis. RESULTS Women living with HIV reported far-reaching gender power imbalances, including low participation in household decision-making, economic reliance on husbands, and oppressive gendered sexual norms, which hindered their autonomy and prevented optimal mental and physical health during and after their pregnancy. When the husband was HIV-negative, sero-discordance exacerbated women's low power in these heterosexual couples. Male involvement in HIV care was both helpful and hurtful, and often walked a fine line between support for the woman and controlling behaviours over her. Inequities in the sexual divisions of power and labour and gender norms, combined with HIV stigma created challenging circumstances for women navigating the PMTCT cascade. CONCLUSIONS Future programmes should consider the benefits and risks of male partner involvement within specific relationships and according to women's needs, rather than advocating for universal male involvement in PMTCT. This work highlights the persistent need for gender transformative approaches alongside PMTCT efforts.
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Affiliation(s)
- Karen M. Hampanda
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Center for Global Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Yusuf Ahmed
- Department of Obstetrics and Gynaecology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Abigail Hatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Lisa L. Abuogi
- Center for Global Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Dube A, Renju J, Wamoyi J, Hassan F, Seeley J, Chimukuche RS, Songo J, Kalua T, Crampin A, Moshabela M, Wringe A. Consequences of male partner engagement policies on HIV care-seeking in three African countries: Findings from the SHAPE UTT study. Glob Public Health 2020; 16:216-226. [PMID: 32780669 PMCID: PMC7612866 DOI: 10.1080/17441692.2020.1805788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or receiving HIV care in the context of antenatal care. Data were coded inductively and analysed thematically. Participants reported benefits of couple testing during antenatal care, including facilitated HIV status disclosure and mutual support for HIV care-seeking. However, unintended consequences included women attending without partners, being refused or delayed access to antenatal services. Some women were required to obtain letters from village leaders to justify the absence of their partners, again to delaying or disrupting care-seeking. When partners attended antenatal care, consultations were reportedly more likely to focus on HIV testing, and less on antenatal or neonatal care. Strategies to increase men's attendance at HIV clinics with their partners can promote mutual support within couples for HIV care engagement, but may risk undermining engagement in pregnancy and HIV care for some women if over-stringently applied. Efforts are needed to address the underlying pervasive stigma associated with HIV care, both alone and as a couple.
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Affiliation(s)
- Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jenny Renju
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joyce Wamoyi
- Mwanza Intervention Trials Unit, Mwanza, United Republic of Tanzania
| | - Farida Hassan
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Janet Seeley
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Thokozani Kalua
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mosa Moshabela
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,University of Kwa-Zulu Natal, Durban, South Africa
| | - Alison Wringe
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Davis B, Rothrock AN, Swetland S, Andris H, Davis P, Rothrock SG. Viral and atypical respiratory co-infections in COVID-19: a systematic review and meta-analysis. J Am Coll Emerg Physicians Open 2020; 1:533-548. [PMID: 32838380 PMCID: PMC7323310 DOI: 10.1002/emp2.12128] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Respiratory co-infections have the potential to affect the diagnosis and treatment of COVID-19 patients. This meta-analysis was performed to analyze the prevalence of respiratory pathogens (viruses and atypical bacteria) in COVID-19 patients. Methods This review was consistent with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Searched databases included: PubMed, EMBASE, Web of Science, Google Scholar, and grey literature. Studies with a series of SARS-CoV-2-positive patients with additional respiratory pathogen testing were included. Independently, 2 authors extracted data and assessed quality of evidence across all studies using Cochrane's Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and within each study using the Newcastle Ottawa scale. Data extraction and quality assessment disagreements were settled by a third author. Pooled prevalence of co-infections was calculated using a random-effects model with univariate meta-regression performed to assess the effect of study subsets on heterogeneity. Publication bias was evaluated using funnel plot inspection, Begg's correlation, and Egger's test. Results Eighteen retrospective cohorts and 1 prospective study were included. Pooling of data (1880 subjects) showed an 11.6% (95% confidence interval [CI] = 6.9-17.4, I 2 = 0.92) pooled prevalence of respiratory co-pathogens. Studies with 100% co-pathogen testing (1210 subjects) found a pooled prevalence of 16.8% (95% CI = 8.1-27.9, I 2 = 0.95) and studies using serum antibody tests (488 subjects) found a pooled prevalence of 26.8% (95%, CI = 7.9-51.9, I 2 = 0.97). Meta-regression found no moderators affecting heterogeneity. Conclusion Co-infection with respiratory pathogens is a common and potentially important occurrence in patients with COVID-19. Knowledge of the prevalence and type of co-infections may have diagnostic and management implications.
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Affiliation(s)
- Bennett Davis
- University of QueenslandOchsner Clinical SchoolBrisbane, Australia and New OrleansNew OrleansLouisianaUSA
| | | | | | - Halle Andris
- Dr. P. Phillips HospitalOrlando HealthOrlandoFloridaUSA
| | - Phil Davis
- Dr. P. Phillips HospitalOrlando HealthOrlandoFloridaUSA
| | - Steven G. Rothrock
- Dr. P. Phillips HospitalOrlando HealthOrlandoFloridaUSA
- Florida State University College of MedicineTallahasseeFloridaUSA
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Comrie-Thomson L, Mavhu W, Makungu C, Nahar Q, Khan R, Davis J, Stillo E, Hamdani S, Luchters S, Vaughan C. Male involvement interventions and improved couples' emotional relationships in Tanzania and Zimbabwe: 'When we are walking together, I feel happy'. CULTURE, HEALTH & SEXUALITY 2020; 22:722-739. [PMID: 31429674 DOI: 10.1080/13691058.2019.1630564] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 06/07/2019] [Indexed: 06/10/2023]
Abstract
Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men's and women's experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples' emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men's behaviour change, to improve care-seeking and home care practices. Men's and women's subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships - both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions.
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Affiliation(s)
- Liz Comrie-Thomson
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Webster Mavhu
- Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe
- International Public Health Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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14
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Program implementation gaps and ethical issues in the prevention of HIV infection among infants, children, and adolescents in sub-Saharan Africa. Pediatr Res 2020; 87:406-413. [PMID: 31663519 DOI: 10.1038/s41390-019-0645-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/31/2019] [Accepted: 10/23/2019] [Indexed: 12/30/2022]
Abstract
Strategies for HIV prevention among infants, children, and adolescents have evolved significantly over the past 20 years. These include the global scale-up of simplified multidrug HIV regimens for pregnant women, leading to impressive reductions in new child HIV infections. However, significant gaps remain, especially in high HIV-burden sub-Saharan African countries. For example, many pregnant women living with HIV (WLHIV) are unable to access and sustain HIV testing and treatment partly due to low agency and harmful gender norms. Among pregnant WLHIV, adolescent girls face an additional layer of societal and health-system barriers in accessing care for themselves and their exposed infants. Legal and structural barriers limit access to HIV prevention-related sexual and reproductive health services among high-risk adolescents, including girls and young men who have sex with men. Key ethical issues underlying HIV prevention gaps for infants, children, and adolescents prevail. This narrative review explores these issues and highlights counter-measures for programming and policy, including gender empowerment, improving access to and appropriateness of critical health services, rights-based policy and legislation, closing research gaps, and considering the values and preferences of young people for HIV prevention and treatment services.
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15
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Aliyu MH, Sam-Agudu NA, Shenoi S, Goga AE, Ramraj T, Vermund SH, Audet CM. Increasing male engagement in the prevention of vertical transmission of HIV: what works in sub-Saharan Africa? BMJ 2019; 365:l1965. [PMID: 31171558 PMCID: PMC6598674 DOI: 10.1136/bmj.l1965] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Muktar Aliyu and colleagues discuss barriers, enablers, and research gaps in engaging male partners in prevention of vertical HIV transmission in sub-Saharan Africa
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Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, USA
| | - Nadia A Sam-Agudu
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
- Institute of Human Virology, Abuja, Nigeria
| | | | - Ameena E Goga
- South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, South Africa
| | - Trisha Ramraj
- South African Medical Research Council, Pretoria, South Africa
| | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, USA
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