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Domingues RMSM, Quintana MDSB, Coelho LE, Friedman RK, Jalil EM, Rabello ACVDA, Rocha V, Grinsztejn B. Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996-2016. HIV Res Clin Pract 2024; 25:2401268. [PMID: 39253752 DOI: 10.1080/25787489.2024.2401268] [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: 04/27/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Marcel de Souza Borges Quintana
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Lara Esteves Coelho
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ruth Khalili Friedman
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Emilia M Jalil
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Vania Rocha
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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2
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Rice WS, Ellison CK, Bruno B, Hussen SA, Chavez M, Nápoles TM, Walcott M, Batchelder AW, Turan B, Kempf MC, Wingood GM, Konkle-Parker DJ, Wilson TE, Johnson MO, Weiser SD, Logie CH, Turan JM, Piper K. Exploring the role of motherhood in healthcare engagement for women living with HIV in the USA. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 39041302 DOI: 10.1080/13691058.2024.2380765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
Mothers living with HIV are faced with managing their own complex healthcare and wellness needs while caring for their children. Understanding the lived experiences of mothers living with HIV, including grandmothers and mothers with older children - who are less explicitly represented in existing literature, may guide the development of interventions that best support them and their families. This study sought to explore the role of motherhood and related social/structural factors on engagement with HIV care, treatment-seeking behaviour, and overall HIV management among mothers living with HIV in the USA to inform such efforts. Semi-structured interviews were conducted between June and December 2015 with 52 mothers living with HIV, recruited from the Women's Interagency HIV Study (WIHS) sites in four US cities. Five broad themes were identified from the interviews: children as a motivation for optimal HIV management; children as providing logistical support for HIV care and treatment; the importance of social support for mothers; stressors tied to responsibilities of motherhood; and stigma about being a mother living with HIV. Findings underscore the importance of considering the demands of motherhood when developing more effective strategies to support mothers in managing HIV and promoting the overall health and well-being of their families.
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Affiliation(s)
- Whitney S Rice
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Celeste K Ellison
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Beverly Bruno
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Max Chavez
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
| | - Tessa M Nápoles
- Department of Social and Behavioral Sciences, University of CA, San Francisco, CA, USA
| | - Melonie Walcott
- Lindsley F. Kimball Research Institute, NY Blood Center, New York, NY, USA
| | - Abigail W Batchelder
- Department of Psychiatry, MA General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of AL at Birmingham, Birmingham, AL, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Deborah J Konkle-Parker
- Medicine and Population Health Sciences, University of MS Medical Center Schools of Nursing, Jackson, MS, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, SUNY Downstate Health Sciences University School of Public Health, New York, NY, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, School of Medicine, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, School of Medicine, San Francisco, CA, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health, Atlanta, GA, USA
| | - Kendra Piper
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
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3
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Kabunga A, Nabasirye CK, Kigingo E, Namata H, Shikanga EM, Udho S, Auma AG, Nabaziwa J, Tumwesigye R, Musinguzi M, Okalo P, Acup W. HIV-Related Stigma Among Pregnant Adolescents: A Qualitative Study of Patient Perspectives in Southwestern Uganda. HIV AIDS (Auckl) 2024; 16:217-227. [PMID: 38770109 PMCID: PMC11104363 DOI: 10.2147/hiv.s463506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024] Open
Abstract
Background The HIV epidemic disproportionately affects adolescents in Sub-Saharan Africa, with adolescent girls facing heightened vulnerability. Despite advancements in antiretroviral therapy, HIV-related stigma remains prevalent, particularly among pregnant adolescents. This qualitative study explores the perspectives of adolescents living with HIV in southwestern Uganda, seeking to understand the nature of HIV-related stigma in this context. Methods One-on-one narrative interviews were conducted with 28 pregnant adolescents living with HIV aged 14-19 receiving care at Mbarara Regional Referral Hospital. The qualitative approach allowed for in-depth exploration of participants' experiences. Thematic analysis was employed to identify recurring patterns in the narratives. Results Five overarching themes emerged from the analysis: Experiences of double stigma, social and cultural influences shaping stigma, healthcare system challenges, psychosocial impacts of stigma, and resilience and coping mechanisms. Double stigma, arising from societal prejudices related to both HIV status and teenage pregnancy, created a complex environment for participants. Despite these challenges, participants exhibited resilience through external support and internal strength. Conclusion This study reveals the pervasive double stigma experienced by pregnant adolescents living with HIV in southwestern Uganda, driven by societal biases against both HIV status and teenage pregnancy. Urgent targeted interventions are needed to address the intersectionality of stigma, cultural influences, healthcare issues, and psychosocial well-being for the betterment of this vulnerable population.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira City, Uganda
| | | | - Eustes Kigingo
- Department of Environmental Health and Disease Control, Lira University, Lira City, Uganda
| | - Halimah Namata
- Department of Mental Health, Makerere University, Kampala, Uganda
| | | | - Samson Udho
- Department of Midwifery, Lira University, Lira City, Uganda
| | | | - Jannat Nabaziwa
- Department of Community Health, Lira University, Lira City, Uganda
| | - Raymond Tumwesigye
- Department of Nursing, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Marvin Musinguzi
- Department of Community Health, Lira University, Lira City, Uganda
| | - Ponsiano Okalo
- Department of Psychiatry, Lira University, Lira City, Uganda
| | - Walter Acup
- Department of Community Health, Lira University, Lira City, Uganda
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Peel J, Brousse de Gersigny J, Teague R, Howard J, Bradshaw C, Chen M, Bissessor M. Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020. Sex Health 2024; 21:NULL. [PMID: 38164810 DOI: 10.1071/sh23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). METHODS We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. RESULTS A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. CONCLUSIONS Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.
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Affiliation(s)
- Joanne Peel
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia
| | | | - Richard Teague
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Jayne Howard
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
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5
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Domingues RMSM, Quintana MDSB, Coelho LE, Friedman RK, Rabello ACVDA, Rocha V, Grinsztejn B. Pregnancy incidence, outcomes and associated factors in a cohort of women living with HIV/AIDS in Rio de Janeiro, Brazil, 1996-2016. CAD SAUDE PUBLICA 2023; 39:e00232522. [PMID: 37466547 PMCID: PMC10494702 DOI: 10.1590/0102-311xen232522] [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: 12/05/2022] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Abstract
The aim of this research was to analyze pregnancy incidence and associated factors in a cohort of 753 women living with HIV/AIDS (WLWHA) in Rio de Janeiro, Brazil, from 1996 to 2016. Women aged 18-49 years who were not on menopause (surgical or natural) and did not have a tubal ligation were eligible for the study. Data were collected by medical professionals during initial and follow-up visits. Person-time pregnancy incidence rates were calculated throughout the follow-up period. Pregnancy incidence-associated factors were investigated by univariate and multiple analyzes, using an extension of the Cox survival model. Follow-up visits recorded 194 pregnancies, with an incidence rate of 4.01/100 person-years (95% CI: 3.47; 4.60). A higher pregnancy incidence was associated with CD4 nadir ≥ 350 cells/mm³, use of an antiretroviral regimen not containing Efavirenz, and prior teenage pregnancy. In turn, women with a viral load ≥ 50 copies/mL, age ≥ 35 years old, with two or more children and using a highly effective contraceptive method showed a lower incidence. Results showed a significant reduction in pregnancy incidence after 2006, a significant reduction in female sterilization from 1996 to 2016, and a high rate of cesarean sections. The association found between pregnancy incidence and the use of contraceptive methods and virological control markers suggests a good integration between HIV/AIDS and reproductive health services. The high rate of cesarean section delivery indicates the need to improve childbirth care.
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Affiliation(s)
| | | | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ruth Khalili Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Vania Rocha
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Ruiz-Algueró M, Izquierdo R, Suárez-García I, Moreno C, Alejos B, Rava M, Moreno S, Montero Alonso M, Gutiérrez F, Gutierrez Cuellar I, Curran A, Hernando V, Jarrín I. Unplanned pregnancies and social and partner support during pregnancy in Spanish women living with HIV. HIV Med 2023; 24:727-737. [PMID: 36810955 DOI: 10.1111/hiv.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To describe prevalence and factors associated with unplanned pregnancies, and social and partner support during pregnancy among women from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS We included all women recruited in CoRIS from 2004 to 2019, aged 18-50 years at recruitment who were pregnant during 2020. We designed a questionnaire, organized into the following domains: sociodemographic characteristics, tobacco and alcohol consumption, pregnancy and reproductive health, and social and partner support. The information was gathered via telephone interviews conducted from June to December 2021. We calculated prevalence of unplanned pregnancies as well as odds ratios (ORs) of association and 95% confidence intervals (CIs) according to sociodemographic, clinical and reproductive characteristics. RESULTS Among 53 women who were pregnant during 2020, 38 (71.7%) answered the questionnaire. Median age at pregnancy was 36 years [interquartile range (IQR) 31-39], 27 (71.1%) women were born outside of Spain, mainly in sub-Saharan Africa (39.5%) and 17 (44.7%) were employed. Thirty-four (89.5%) women had been through previous pregnancies and 32 (84.2%) had experienced previous abortions/miscarriages. Seventeen (44.7%) women had shared with their clinician their desire to get pregnant. Thirty-four (89.5%) pregnancies were natural and four used assisted reproductive techniques (in vitro fertilizations; one additionally used oocyte donation). Of 34 women with natural pregnancies, pregnancy was unplanned in 21 (61.8%) and 25 (73.5%) had information on how to become pregnant avoiding HIV transmission to the baby and partner. Women who did not seek advice from their physician about becoming pregnant had a significantly increased risk of unplanned pregnancy (OR = 71.25, 95% CI: 8.96-566.67). Overall, 14 (36.8%) women reported having low social support during pregnancy and 27 (71.0%) had good/very good support by their partner. CONCLUSIONS Most pregnancies were natural and unplanned and very few women had talked with their clinician about their desire to become pregnant. A high proportion of women reported low social support during pregnancy.
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Affiliation(s)
- Marta Ruiz-Algueró
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Rebeca Izquierdo
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Ines Suárez-García
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Moreno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Belen Alejos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Marta Rava
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Montero Alonso
- Infectious Diseases Unit, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Felix Gutiérrez
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Hospital General Universitario De Elche, Alicante, Spain
- University Miguel Hernandez, Alicante, Spain
| | | | - Adrián Curran
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victoria Hernando
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Inma Jarrín
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Cardenas MC, Farnan S, Hamel BL, Mejia Plazas MC, Sintim-Aboagye E, Littlefield DR, Behl S, Punia S, Enninga EAL, Johnson E, Temesgen Z, Theiler R, Gray CM, Chakraborty R. Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far. Viruses 2023; 15:v15040849. [PMID: 37112830 PMCID: PMC10142818 DOI: 10.3390/v15040849] [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: 12/26/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.
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Affiliation(s)
- Maria Camila Cardenas
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sheila Farnan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin L. Hamel
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Camila Mejia Plazas
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Pediatric Residency Program, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Elise Sintim-Aboagye
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Dawn R. Littlefield
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supriya Behl
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sohan Punia
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth Ann L Enninga
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Erica Johnson
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Zelalem Temesgen
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Regan Theiler
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Clive M. Gray
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7600, South Africa
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9531
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8
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Osmundo GDS, da Costa RA, Ruocco RMA, Francisco RPV. Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile. Clinics (Sao Paulo) 2023; 78:100174. [PMID: 36870111 PMCID: PMC9995930 DOI: 10.1016/j.clinsp.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVES To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women. METHOD This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation. RESULTS There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance. CONCLUSIONS PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.
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Affiliation(s)
- Gilmar de Souza Osmundo
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Rafaela Alkmin da Costa
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rosa Maria Aveiro Ruocco
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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9
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Wariyo A, Oljira L, Golicha W, Dirirsa G. Effect of predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar Towns, Eastern Ethiopia: a retrospective cohort study. BMC Womens Health 2022; 22:548. [PMID: 36572915 PMCID: PMC9793559 DOI: 10.1186/s12905-022-02135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. OBJECTIVE To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. METHODS Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan-Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. RESULTS The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. CONCLUSION The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes.
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Affiliation(s)
- Abdi Wariyo
- grid.449426.90000 0004 1783 7069School of Public Health, College of Health and Medical Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Lemessa Oljira
- grid.192267.90000 0001 0108 7468School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Wako Golicha
- grid.472427.00000 0004 4901 9087School of Public Health, Bule Hora University, Bule Hora, Ethiopia
| | - Gebisa Dirirsa
- grid.192267.90000 0001 0108 7468Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Zappulo E, Giaccone A, Schiano Moriello N, Gentile I. Pharmacological approaches to prevent vertical transmission of HIV and HBV. Expert Rev Clin Pharmacol 2022; 15:863-876. [PMID: 35876100 DOI: 10.1080/17512433.2022.2105202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mother-to-child transmission (MTCT) is mainly responsible for the global pediatric HIV and HBV epidemic. Vertical transmission can be prevented and reduced through a series of interventions at the primary healthcare level, including extensive screening of pregnant women, administration of antivirals or immune-based treatments, counselling on type of delivery and breastfeeding. AREAS COVERED In this narrative review, approved therapeutic options for the treatment of pregnant women living with HIV or HBV are discussed with special focus on efficacy and safety profiles of each agent or drug class examined. The search was performed using Medline (via PubMed), Web of Science, and Google Scholar to identify studies assessing vertical transmission of both HIV and HBV. EXPERT OPINION Elimination of MTCT of both infections is firmly endorsed by major global commitments and the integration of tailored preventive interventions into maternal and newborn health services is of strategical importance to achieve this critical target. However, further research centered on antiviral-based and immunization trials among pregnant women is urgently needed to mitigate the risk of maternal and neonatal adverse outcomes, effectively prevent transmission to the offspring and finally eliminate the pediatric HIV and HBV epidemic, one of the key global health challenges of our time.
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Affiliation(s)
- Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Agnese Giaccone
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
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11
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Cunga IVA, Bittencourt B, da Rosa CMA, Iser BPM, Parma GOC, Schuelter-Trevisol F. Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021877. [PMID: 35830006 PMCID: PMC9887967 DOI: 10.1590/s2237-96222022000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. METHODS This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. RESULTS There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. CONCLUSION The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.
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Affiliation(s)
- Ilda Vaica Armando Cunga
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em
Ciências da Saúde, Tubarão, SC, Brazil
| | - Bianca Bittencourt
- Governo do Estado de Santa Catarina, Diretoria de Vigilância
Epidemiológica, Florianópolis, SC, Brazil
| | | | | | | | - Fabiana Schuelter-Trevisol
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em
Ciências da Saúde, Tubarão, SC, Brazil
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12
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Khondoker CC, Kaida A, Marquez A, Campbell AR, Côté HCF, Albert AY, Pick N, Maan EJ, Russell EAB, Prior JC, Elwood C, Brophy J, Murray MCM. Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study. Reprod Health 2022; 19:3. [PMID: 34986848 PMCID: PMC8729076 DOI: 10.1186/s12978-021-01312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multiple contraindications to combined hormonal contraceptives (CHC) use exist. The impact of these factors on contraceptive choice, particularly among women living with HIV (WLWH), is not well understood. We measured and compared the prevalence of contraceptive use and contraindications among WLWH and women not living with HIV (controls). METHODS We examined cross-sectional survey and medical chart data from 83 WLWH and 62 controls, aged 16-49 and sexually active, from 2013-2017. We compared the age-adjusted prevalence and types of contraceptives used in the last month and the proportion of women with CHC contraindications, including drug interactions, medical comorbidities, and smoking at ≥ 35 years old. All WLWH received care at an interdisciplinary, women-centred HIV clinic. RESULTS Compared to controls, WLWH were older (median [IQR)] 39 [34-43] vs 31 [23-41] years; p = 0.003), had less post-secondary education (37% vs 73%; p < 0.001), and more often had household income < $15,000/year (49% vs 30%; p = 0.006). WLWH trended to higher contraceptive prevalence than controls (80% vs 63%; p = 0.06 adjusted for age). Overall hormonal contraceptive use was similar. However, despite controlling for age, WLWH used CHC less (4% vs 18%; p = 0.006) than controls, and had more frequently undergone tubal ligation (12% vs 2%; p = 0.03). WLWH also experienced more CHC contraindications (54% vs 13%; p = 0.0001), including smoking at ≥ 35 years old (30% vs 6%; p = 0.0003) or a CHC-related drug interaction (all antiretroviral related) (25% vs 0%; p = 0.0001). CONCLUSIONS WLWH attending our interdisciplinary clinic used hormonal contraception at similar rates as controls, though with different types. Differences may reflect different distributions of CHC contraindications. CHC contraindications present barriers to accessing the full range of contraceptive choices for WLWH. Guidelines and education for care providers and WLWH regarding contraceptive choices and drug interactions are needed, especially when care is provided without the benefit of an interdisciplinary women-centered healthcare team.
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Affiliation(s)
- Chadni C Khondoker
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anna Marquez
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Amber R Campbell
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Department of Experimental Medicine, UBC, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Pathology & Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Emilie A B Russell
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Chelsea Elwood
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, BC, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Melanie C M Murray
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
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13
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Huertas-Zurriaga A, Palmieri PA, Aguayo-Gonzalez MP, Dominguez-Cancino KA, Casanovas-Cuellar C, Linden KLV, Cesario SK, Edwards JE, Leyva-Moral JM. Reproductive decision-making of Black women living with HIV: A systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221090827. [PMID: 35404192 PMCID: PMC9006353 DOI: 10.1177/17455057221090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. OBJECTIVE The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. METHODS This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). RESULTS Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. CONCLUSION No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick A Palmieri
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Lima, Perú
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO, USA
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
| | - Mariela P Aguayo-Gonzalez
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Karen A Dominguez-Cancino
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Escuela de Enfermería, Universidad Científica del Sur, Lima, Perú
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - Cristina Casanovas-Cuellar
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kara L Vander Linden
- Department of Research, Saybrook University, Pasadena, CA, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, CA, USA
| | - Sandra K Cesario
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Joan E Edwards
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Juan M Leyva-Moral
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
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Kaida A, Cameron B, Conway T, Cotnam J, Danforth J, de Pokomandy A, Gagnier B, Godoy S, Gormley R, Greene S, Habanyama M, Kazemi M, Logie CH, Loutfy M, MacGillivray J, Masching R, Money D, Nicholson V, Osborne Z, Pick N, Sanchez M, Tharao W, Watt S, Narasimhan M. Key recommendations for developing a national action plan to advance the sexual and reproductive health and rights of women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455057221090829. [PMID: 35435062 PMCID: PMC9019372 DOI: 10.1177/17455057221090829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations: 1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women. 2. Centre Indigenous women’s priorities, voices, and perspectives. 3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences. 4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders. 5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action. Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Brittany Cameron
- PARN-Community Based HIV/STBBI Programs, Peterborough, ON, Canada
- International Community of Women Living with HV–North America (ICW-NA), Washington, DC, USA
| | - Tracey Conway
- Canadian Positive People Network (CPPN)/Réseau canadien de personnes séropositives (RCPS), Dunrobin, ON, Canada
| | - Jasmine Cotnam
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Brenda Gagnier
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sandra Godoy
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Muluba Habanyama
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jay MacGillivray
- Positive Pregnancy Program (P3), St. Michael’s Hospital, Toronto, ON, Canada
| | - Renee Masching
- Canadian Aboriginal AIDS Network (CAAN), Dartmouth, NS, Canada
| | - Deborah Money
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zoë Osborne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA women, a network by and for women living with HIV, Vancouver, BC, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Sarah Watt
- BC Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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15
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Cvetkovic A, King E, Skerritt L, Loutfy M, Tseng A, Murray M, van Schalkwyk J, Boucoiran I, Marcotte S, Hankins C, Savoie É, de Pokomandy A, Pick N, Tkachuk S, Rowe T, Smaill F, Walmsley S. A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:278-295. [PMID: 36338461 PMCID: PMC9629258 DOI: 10.3138/jammi-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
Background Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met. Methods In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. Results We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit. Conclusions It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues.
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Affiliation(s)
- Anna Cvetkovic
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Julie van Schalkwyk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Édénia Savoie
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Timothy Rowe
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Walmsley
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Skerritt L, Kaida A, O'Brien N, Burchell AN, Bartlett G, Savoie É, Boucoiran I, Gormley R, Kestler M, Money D, Loutfy M, de Pokomandy A. Patterns of changing pregnancy intentions among women living with HIV in Canada. BMC WOMENS HEALTH 2021; 21:350. [PMID: 34615492 PMCID: PMC8496032 DOI: 10.1186/s12905-021-01492-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.
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Affiliation(s)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nadia O'Brien
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CRCHUM), Montreal, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Gillian Bartlett
- Department of Family and Community Medicine, University of Missouri, Columbia, USA
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada
| | - Isabelle Boucoiran
- Women and Children's Infectious Diseases Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Deborah Money
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada. .,Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada.
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17
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Zhang LJ, Shannon K, Tibashoboka D, Ogilvie G, Pick N, Kestler M, Logie C, Udall B, Braschel M, Deering KN. Prevalence and correlates of having sexual and reproductive health priorities met by HIV providers among women living with HIV in a Canadian setting. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 30:100666. [PMID: 34563858 DOI: 10.1016/j.srhc.2021.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To: (1) describe the prevalence of key reproductive health outcomes (e.g., pregnancy, unintended pregnancy; abortion); and (2) examine social-structural correlates, including HIV stigma, of having key sexual and reproductive health (SRH) priorities met by participants' primary HIV provider, among women living with HIV. METHODS Data were drawn from a longitudinal community-based open cohort (SHAWNA) of women living with HIV. The associations between social-structural factors and two outcomes representing having SRH priorities met by HIV providers ('being comfortable discussing sexual health [SH] and/or getting a Papanicolaou test' and 'being comfortable discussing reproductive health [RH] and/or pregnancy needs') were analyzed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios (AOR) and 95% confidence intervals [95% CIs] are reported. RESULTS Of 314 participants, 77.1% reported having SH priorities met while 64.7% reported having RH priorities met by their primary HIV provider at baseline. In multivariable analysis, having SH priorities met was inversely associated with: sexual minority identity (AOR: 0.59, 95% CI: 0.37-0.94), gender minority identity (AOR: 0.52, 95% CI: 0.29-0.95) and recent verbal or physical violence related to HIV status (AOR: 0.55, 95% CI: 0.31-0.97) and positively associated with recently accessing women-centred services (Oak Tree Clinic) (AOR: 4.25, 95% CI: 2.20-8.23). Having RH priorities met was inversely associated with: sexual minority identity (AOR: 0.56, 95% CI: 0.40-0.79), gender minority identity (AOR: 0.45, 95% CI: 0.25-0.81) and being born in Canada (AOR: 0.29, 95% CI: 0.15-0.56) and positively associated with recently accessing women-centred services (AOR: 1.81, 95% CI: 1.29-2.53) and a history of pregnancy (AOR: 2.25, 95% CI: 1.47-3.44). CONCLUSION Our findings suggest that there remain unmet priorities for safe SRH care and practice among women living with HIV, and in particular, for women living with HIV with sexual and/or gender minority identity and those who experience enacted HIV stigma. HIV providers should create safe, non-judgmental environments to facilitate discussions on SRH. These environments should be affirming of all sexual orientations and gender identities, culturally safe, culturally humble and use trauma-informed approaches.
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Affiliation(s)
- L J Zhang
- Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - K Shannon
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - D Tibashoboka
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - G Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada; BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, BC, Canada
| | - N Pick
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - M Kestler
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada
| | - C Logie
- Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, Canada
| | - B Udall
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - M Braschel
- Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada
| | - K N Deering
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, Canada; Centre for Gender and Sexual Health Equity, 1190 Hornby Street/ 647 Powell Street, Vancouver, Canada.
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18
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Phonphithak S, Hiransuthikul N, Sherer PP, Bureechai S. A qualitative study of the stigmatization and coping mechanisms among pregnant teenagers living with HIV in Thailand. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-02-2021-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
This aim of this study was to explore the experiences of stigmatization and coping mechanisms during pregnancy among pregnant women who are living with HIV in Thailand. The secondary objective was to determine factors contributing to stigma during motherhood among HIV-infected women as well as explore how they cope with the discrimination from society.
Design/methodology/approach
Qualitative data were collected using in-depth interviews to obtain different versions of stigmatized experience from 16 pregnant women living with HIV on stigmatization and coping mechanisms. There were 5 pregnant adolescents living with HIV and 11 adult pregnant women living with HIV. The content analysis was used to examine patterns of stigmatizations and attributed factors.
Findings
Personal stigma was found among pregnant women living with HIV regardless of age. HIV status disclosure was the crucial barrier of accessing to care for people experiencing stigmatizations. Personal stigma associated with higher HIV status was not disclosed. Interestingly, all teenage mothers who participated in this study disclosed their HIV-status to their family. People who have social support especially from family and significant others are found to be able to cope and get through the difficulties better than those who lack those social support.
Originality/value
This study yields outcomes similar to several other studies that have been conducted either in Thailand or other countries. This study found that family support was crucial in reducing HIV stigma. Furthermore, HIV-infected pregnant female adults were more afraid to disclose their HIV status to their husbands, other family members and their work colleagues.
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19
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Summary of 2021 Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother 2021; 53:592-616. [PMID: 34405598 PMCID: PMC8511382 DOI: 10.3947/ic.2021.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Since the establishment of the Committee for Clinical Guidelines for the Diagnosis and Treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) by the Korean Society for AIDS in 2010, clinical guidelines have been prepared in 2011, 2013, 2015, and 2018. As new research findings on the epidemiology, diagnosis, and treatment of AIDS have been published in and outside of Korea along with the development and introduction of new antiretroviral medications, a need has arisen to revise the clinical guidelines by analyzing such new data. The clinical guidelines address the initial evaluation of patients diagnosed with HIV/AIDS, follow-up tests, appropriate timing of medication, appropriate antiretroviral medications, treatment strategies for patients who have concurrent infections with hepatitis B or C virus, recommendations for resistance testing, treatment for patients with HIV and tuberculosis coinfections, and treatment in pregnant women. Through these clinical guidelines, the Korean Society for AIDS and the Committee for Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS contributes to overcoming AIDS by delivering latest data and treatment strategies to healthcare professionals who treat AIDS in the clinic.
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20
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Skerritt L, de Pokomandy A, O'Brien N, Sourial N, Burchell AN, Bartlett G, Schuster T, Rouleau D, Proulx-Boucher K, Pick N, Money D, Gormley R, Carter A, Yudin MH, Loutfy M, Kaida A. Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort. Sex Reprod Health Matters 2021; 29:1932702. [PMID: 34165395 PMCID: PMC8231384 DOI: 10.1080/26410397.2021.1932702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2017), a community-based participatory study, restricting the analysis to participants aged 16-45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.
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Affiliation(s)
- Lashanda Skerritt
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia Sourial
- Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Ann N Burchell
- Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Bartlett
- Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tibor Schuster
- Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danielle Rouleau
- Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Karène Proulx-Boucher
- Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Neora Pick
- Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Money
- Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada
| | - Rebecca Gormley
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allison Carter
- Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark H Yudin
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:
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21
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Bula AK, Hatfield-Timajchy K, Chapola J, Chinula L, Hurst SA, Kourtis AP, Tang JH. Motivations to use hormonal contraceptive methods and condoms among HIV-positive and negative women randomized to a progestin contraceptive in Malawi: a qualitative study. BMC WOMENS HEALTH 2021; 21:114. [PMID: 33743659 PMCID: PMC7981805 DOI: 10.1186/s12905-021-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although many countries have been promoting hormonal contraceptives to prevent unintended pregnancy and condom use to prevent HIV transmission, little is known about how women targeted by these messages have interpreted and internalized them. We describe HIV-positive and negative women's understanding of the benefits of contraception and condoms and their motivations to use them. METHODS This is a qualitative sub-study from a clinical trial evaluating the effects of progestin contraception on HIV-positive and negative women aged 18-45 years randomly assigned to depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant. We purposively recruited 41 women to participate in in-depth interviews (IDIs) and focus group discussions (FGDs) after randomization into the main study. We conducted a total of 30 IDIs and 6 FGDs comprised of 4-7 women (N = 32). All women were counselled about potential risks for HIV acquisition/transmission with progestin-only contraception, drug-drug interactions between the implant and efavirenz-based ART, and the need to use condoms with their assigned contraceptive to help prevent pregnancy and HIV acquisition and transmission. RESULTS All women understood that HIV is transmitted through unprotected sex and that HIV transmission can be prevented through condom use but not DMPA injection or LNG implant use. Nearly all HIV-positive women knew or suspected that their partners were also HIV-positive and were most interested in using condoms to prevent infection with a drug-resistant HIV strain to keep their HIV viral load low. Almost all reported that their partners agreed to condom use, but few used them consistently. Most women believed that condoms were effective at preventing both HIV and pregnancy if used consistently. Nearly all women considered contraception and condom use as important in preventing unintended pregnancy and HIV because partner disclosure of HIV status is low. CONCLUSION Our results showed that both HIV-positive and negative women understood modes of HIV transmission and prevention and were aware that hormonal contraceptives are only effective for preventing pregnancy and not HIV. Although both HIV-negative and positive women were motivated to use condoms to prevent both HIV acquisition and infection with other HIV strains respectively, they all faced challenges from their partners in using condoms consistently.
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Affiliation(s)
- Agatha K Bula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.
| | | | - John Chapola
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - L Chinula
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.,Department of OB-GYN, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Stacey A Hurst
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Athena P Kourtis
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J H Tang
- Department of OB-GYN, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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22
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Chace Dwyer S, Jain A, Liambila W, Warren CE. The role of unintended pregnancy in internalized stigma among women living with HIV in Kenya. BMC WOMENS HEALTH 2021; 21:106. [PMID: 33731107 PMCID: PMC7968281 DOI: 10.1186/s12905-021-01224-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV. METHODS Baseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored. RESULTS About 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2-2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents' characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3-2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination. CONCLUSIONS Results suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.
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Affiliation(s)
- Sara Chace Dwyer
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA.
| | - Aparna Jain
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA
| | | | - Charlotte E Warren
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA
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23
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Jiang W, Osborn L, Drake AL, Unger JA, Matemo D, Kinuthia J, John-Stewart G, Ronen K. Recent Diagnosis, Lower Rates of HIV Disclosure, and High Technology Access in Pregnant Adolescent Girls and Young Women Living With HIV: A Descriptive Study. J Assoc Nurses AIDS Care 2021; 32:205-213. [PMID: 33136655 PMCID: PMC7985848 DOI: 10.1097/jnc.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wenwen Jiang
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lusi Osborn
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alison L. Drake
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Unger
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Matemo
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- Wenwen Jiang, MPH, is a Research Assistant, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Lusi Osborn, BS, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Alison L. Drake, PhD, MPH, is an Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Jennifer A. Unger, MD, MPH, is an Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA. Daniel Matemo, MPH, is a Research Scientist, Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Grace John-Stewart, MD, PhD, MPH, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA. Keshet Ronen, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
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Mirabal-Beltran R, Anderson J, Dariotis JK, Finocchario-Kessler S. A Checklist to Assess Childbearing Intentions and Promote Referral to Preconception Care or Contraception: A Multi-Site Study. Matern Child Health J 2021; 25:786-795. [PMID: 33389454 DOI: 10.1007/s10995-020-03051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. METHODS Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. RESULTS Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. DISCUSSION Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.
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Affiliation(s)
- Roxanne Mirabal-Beltran
- Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC, USA.
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jean Anderson
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacinda K Dariotis
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Human Development & Family Studies, The Family Resiliency Center, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
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25
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Loutfy M, Tharao W, Kazemi M, Logie CH, Underhill A, O’Brien N, Pick N, Kestler M, H.Yudin M, Rana J, MacGillivray J, Kennedy VL, Jaworsky D, Carvalhal A, Conway T, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Proulx-Boucher K, Carter A, Gormley R, Narasimhan M, Welbourn A, de Pokomandy A, Kaida A. Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework. J Int Assoc Provid AIDS Care 2021; 20:2325958221995612. [PMID: 33845677 PMCID: PMC8047935 DOI: 10.1177/2325958221995612] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).
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Affiliation(s)
- Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Carmen H. Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mark H.Yudin
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - V. Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Denise Jaworsky
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | | | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shaz Islam
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Ndung’u
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Kirby Institute, UNSW Sydney, Australia
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Alice Welbourn
- Salamander Trust, United Kingdom lead coordinator of the Global Values and Preferences Survey
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Akinyemi JO, Afolabi RF, Awolude OA. Semi-parametric model for timing of first childbirth after HIV diagnosis among women of childbearing age in Ibadan, Nigeria. PLoS One 2020; 15:e0240247. [PMID: 33027315 PMCID: PMC7540879 DOI: 10.1371/journal.pone.0240247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background HIV diagnosis is a watershed in women’s childbearing experience. It is usually accompanied by the fear of death and stigmatisation. Women diagnosed of HIV are often sceptical about pregnancy. Meanwhile, availability of antiretroviral treatments has impacted positively on childbearing experience among women living with HIV. We therefore investigated the timing of first childbirth after HIV diagnosis and its determinants among women in Ibadan, Nigeria. Methods We extracted and analysed data from a 2015 cross-sectional study on childbearing progression among 933 women living with HIV and receiving care at University College Hospital, Ibadan, Nigeria. Extended Cox proportional hazards regression, a semi-parametric event history model was used at 5% significance level. Results The women’s mean age was 38.1 (± SD = 6.1) years and the median time to first birth after HIV diagnosis (FBI_HIV) was 8 years. The likelihood of first birth after HIV diagnosis was lower among women who desired more children (HR = 0.63, CI: 0.51–0.78). Women whose partners had primary and secondary education respectively were about 2.3 times more likely to shorten FBI_HIV compared to those whose partners had no formal education. Knowledge of partner’s HIV-positive status (HR = 1.42, CI: 1.04,1.93) increased the likelihood of having a first birth after HIV diagnosis. Older age, longer duration on ART and a higher number of children at diagnosis were associated with a declined hazard of first birth after HIV diagnosis. Conclusions The median time to first childbirth after HIV diagnosis was long. Partner’s HIV-positive status and higher educational attainment were associated with early childbearing after HIV diagnosis.
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Affiliation(s)
- Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
- * E-mail:
| | - Olutosin Alaba Awolude
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ion A, Greene S, Sinding C, Grace D. Risk and preventing perinatal HIV transmission: uncovering the social organisation of prenatal care for women living with HIV in Ontario, Canada. HEALTH, RISK & SOCIETY 2020. [DOI: 10.1080/13698575.2020.1760217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Allyson Ion
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Christina Sinding
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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O'Brien N, Law S, Proulx-Boucher K, Ménard B, Skerritt L, Boucoiran I, Cox J, Andersson N, de Pokomandy A. Codesigning care improvements for women living with HIV: a patient-oriented deliberative dialogue workshop in Montréal, Quebec. CMAJ Open 2020; 8:E264-E272. [PMID: 32303519 PMCID: PMC7207038 DOI: 10.9778/cmajo.20190158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Care services have not been sufficiently adapted to meet the comprehensive care needs of women living with HIV. Our study objective was to engage patients and providers in codesigning care recommendations to improve care for this population in the province of Quebec. METHODS We conducted a 5-hour deliberative dialogue workshop in April 2019 in Montréal as the final phase of a mixed-methods study investigating comprehensive care for women living with HIV. The study drew on data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Recruitment was guided by a purposive maximum-variation sampling strategy to ensure an appropriate mix of participants and was facilitated by our existing CHIWOS networks. Participants included patients (women living with HIV) and HIV care providers (doctors, nurses, pharmacists). The workshop was facilitated professionally and included a synthesis of the evidence, small- and large-group deliberations, and voting on care improvements. RESULTS Eight patients and 8 HIV care providers participated. Drawing on identified care priorities, the participants identified 4 relatively rapid care improvements and 3 longer-term improvements. The rapid care improvements included delegating medical acts to members of multidisciplinary care teams; greater involvement of HIV community members within care settings and health care decision-making; creating a women's health information booklet; and increasing HIV education among all health care providers and raising awareness of women's care needs beyond HIV-specific care among HIV care providers. The longer-term care improvements included advocating for complete financial coverage of antiretroviral therapy within the government-sponsored Medicare program, facilitating access to allied care providers (e.g., physiotherapists and psychologists) and launching a population-wide campaign to increase awareness about the Undetectable = Untransmittable (U=U) initiative and other HIV advances. INTERPRETATION The deliberative dialogue workshop yielded evidence-based, stakeholder-driven recommendations to improve the comprehensive care of women living with HIV in Quebec.
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Affiliation(s)
- Nadia O'Brien
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Susan Law
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Karène Proulx-Boucher
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Brigitte Ménard
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Lashanda Skerritt
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Isabelle Boucoiran
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Joseph Cox
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Alexandra de Pokomandy
- Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
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İnkaya AÇ, Örgül G, Halis N, Alp Ş, Kara A, Özyüncü Ö, Yurdakok M, Ünal S, Beksaç MS. Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience. J Turk Ger Gynecol Assoc 2019; 21:180-186. [PMID: 31564083 PMCID: PMC7495123 DOI: 10.4274/jtgga.galenos.2019.2019.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey. Material and Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed. Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm3 (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery. Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.
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Affiliation(s)
- Ahmet Çağkan İnkaya
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Örgül
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nurhayat Halis
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şehnaz Alp
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özgür Özyüncü
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Yurdakok
- Department of Child Health and Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M. Sinan Beksaç
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abdi F, Alimoradi Z, Alidost F. Pregnancy outcomes and effects of antiretroviral drugs in HIV-positive pregnant women: a systematic review. Future Virol 2019. [DOI: 10.2217/fvl-2018-0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Despite the clear morbidity, mortality and vertical transmission rates in women infected with HIV, there is still controversy surrounding the relationship between maternal infection and adverse neonatal outcomes. Antiretroviral therapy during pregnancy is considered the main and most effective method for reducing the vertical transmission of infection. However, there is no consensus over potential associations between antiretroviral therapy and adverse pregnancy outcomes. This systematic review focuses on the effects of antiretroviral drugs on pregnancy outcomes in HIV-positive women. Methods: After searching MEDLINE, the Cochrane Database of Systematic Reviews, the ISI Web of Sciences and EMBASE, 570 potentially eligible papers were identified. Only 32 papers were selected based on the inclusion criteria. Results: The most prevalent adverse pregnancy outcomes were low birth weight, preterm birth and stillbirth. Conclusion: Considering the higher prevalence of adverse pregnancy outcomes in HIV-infected women, HIV screening methods should be administered in all pregnant women. Appropriate treatment modalities should also be selected to minimize adverse pregnancy outcomes.
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Affiliation(s)
- Fatemeh Abdi
- Student Research Committee, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zainab Alimoradi
- Department of Midwifery, Nursing & Midwifery Faculty, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farzane Alidost
- Department of Reproductive Health, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fortin-Hughes M, Proulx-Boucher K, Rodrigue C, Otis J, Kaida A, Boucoiran I, Greene S, Kennedy L, Webster K, Conway T, Ménard B, Loutfy M, de Pokomandy A. Previous experiences of pregnancy and early motherhood among women living with HIV: a latent class analysis. AIDS Care 2019; 31:1427-1434. [PMID: 30822106 DOI: 10.1080/09540121.2019.1587374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Previous maternity experiences may influence subsequent reproductive intentions and motherhood experiences. We used latent class analysis to identify patterns of early motherhood experience reported for the most recent live birth of 905 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Four indicators were used: difficulties getting pregnant, feelings when finding out pregnancy, feelings during pregnancy, and feelings during the first year postpartum. Most (70.8%) pregnancies analyzed occurred before HIV diagnosis. A four-class maternity experience model was selected: "overall positive experience" (40%); "positive experience with postpartum challenges" (23%); "overall mixed experience" (14%); and "overall negative experience" (23%). Women represented in the "overall negative experience" class were more likely to be younger at delivery, to not know the HIV status of their pregnancy partner, and to report previous pregnancy termination. Women represented in the "positive experience with postpartum challenges" class were more likely to report previous miscarriage, stillbirth or ectopic pregnancy. We found no associations between timing of HIV diagnosis (before, during or after pregnancy) and experience patterns. Recognition of the different patterns of experiences can help providers offer a more adapted approach to reproductive counseling of women with HIV.
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Affiliation(s)
- Marilyn Fortin-Hughes
- Department of Sexology, Université du Québec à Montréal , Montreal , Quebec , Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre , Montreal , Quebec , Canada
| | - Carl Rodrigue
- Department of Sexology, Université du Québec à Montréal , Montreal , Quebec , Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec à Montréal , Montreal , Quebec , Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University , Burnaby , Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Hôpital Sainte-Justine and Université de Montréal , Montreal , Quebec , Canada
| | - Saara Greene
- School of Social Work, McMaster University , Hamilton , Canada
| | - Logan Kennedy
- Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University , Burnaby , Canada
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada
| | - Brigitte Ménard
- Chronic Viral Illness Service, McGill University Health Centre , Montreal , Quebec , Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada.,Department of Medicine, University of Toronto , Toronto , Ontario , Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre , Montreal , Quebec , Canada.,Department of Family Medicine, McGill University , Montreal , Quebec , Canada
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- Department of Sexology, Université du Québec à Montréal , Montreal , Quebec , Canada
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33
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Van Ommen CE, Albert AYK, Piske M, Money DM, Cote HCF, Lima VD, Maan EJ, Alimenti A, van Schalkwyk J, Pick N, Murray MCM. Exploring the live birth rates of women living with HIV in British Columbia, Canada. PLoS One 2019; 14:e0211434. [PMID: 30726263 PMCID: PMC6364910 DOI: 10.1371/journal.pone.0211434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the birth rates of women living with HIV (WLWH) compared to the general population in British Columbia (BC), Canada. METHODS We retrospectively reviewed clinical and population level surveillance data from 1997 to 2015. Live birth rates from 1997 to 2015 among WLWH aged 15-49 years were compared with those of all BC women. Next, the number of live births among WLWH with a live birth between 1997-2012 and HIV-negative controls matched 1:3 by geocode were compared. RESULTS WLWH had a lower birth rate compared to all BC women [31.4 (95%CI, 28.6-34.3) vs. 40.0 (39.3-40.1)/1000 person years]. Stratified by age, WLWH aged 15-24 years had a higher birth rate while WLWH aged 25-49 years had a lower birth rate than BC women (p<0.01). Between 1997 and 2015, birth rates for both populations decreased among women aged 15-24 years, and increased among women aged 25-49 years, most strikingly among WLWH 35-49 years (p<0.01). When comparing WLWH with a live birth to HIV-negative geocode matched controls, WLWH aged 15-24 years (p = 0.03) and aged 25-34 years (p<0.01) had more live births than controls while WLWH aged 35-49 years did not (p = 0.06). CONCLUSIONS On a population level, WLWH have lower birth rates than the general population. However, this is not observed among WLWH who have ever given birth compared with matched controls, suggesting that sociodemographic factors may play an important role. WLWH are increasingly giving birth in their later reproductive years. Taken together, our data supports the integration of reproductive health and HIV care.
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Affiliation(s)
- Clara E. Van Ommen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y. K. Albert
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Micah Piske
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah M. Money
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Hélène C. F. Cote
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evelyn J. Maan
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious and Immunologic Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julianne van Schalkwyk
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Neora Pick
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C. M. Murray
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Gelagay AA, Koye DN, Yeshita HY. Factors affecting long acting and permanent contraceptive methods utilization among HIV positive married women attending care at ART clinics in Northwest Ethiopia. ACTA ACUST UNITED AC 2018; 76:47. [PMID: 30026946 PMCID: PMC6047118 DOI: 10.1186/s13690-018-0294-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 11/19/2017] [Indexed: 12/22/2022]
Abstract
Background Globally, unintended pregnancy has been very high accounting for 27% of maternal deaths. Different studies noted that nearly half of HIV positive women who gave unintended birth were using contraceptive methods prior to their unintended pregnancy. This implies that contraceptive failure contributes to unintended pregnancy. Long-term and permanent contraceptive methods are safe and effective contraceptive options. In women who are using long acting and permanent methods, the unintended pregnancy rate is very low and it is almost the same both in typical and perfect users. However, there is limited information on factors that affect long acting and permanent contraceptive methods utilization among Human Immuno-deficiency Virus (HIV) positive women in Ethiopia. Therefore, the purpose of this study was to assess long acting and permanent contraceptive utilization and its associated factors. Methods An institution-based cross-sectional study was conducted among 505 married women attending care at Anti Retroviral Therapy (ART) clinics in Bahir Dar from March 16, 2014 to April 15, 2014. The data were collected using a structured and interviewer administered questionnaire. Both bivariate and multivariate logistic regressions were used to identify associated factors. Results A total of 505 married women participated in the study with a response rate of 99.6%. The utilization of long acting and permanent contraceptive methods (LAPMs) was 27.5% [95% CI, 23.8-31.5]. The multivariate analyses showed that women who were getting pre- anti retroviral therapy (Pre-ART) services [Adjusted Odds Ratio = 2.65, 95% confidence interval: 1.44, 4.86], had spousal discussion on family planning sometimes [Adjusted Odds Ratio = 6.03, 95% CI:2.42-15.01] and frequently [Adjusted Odds Ratio = 6.61, 95% confidence interval: 2.49-17.47], had previous experience on long acting contraceptive methods [Adjusted Odds Ratio = 9.06, 95% confidence interval: 5.38-15.26], no exposure to myths about LAPMs [Adjusted Odds Ratio = 2.07, 95% confidence interval: 1.24-3.45], had birth intention after 2 years [Adjusted Odds Ratio = 6.95, 95% confidence interval: 3.35-14.42], and no such intention [Adjusted Odds Ratio = 7.60, 95% confidence interval: 3.77-15.34] were factors significantly associated with utilization of long acting and permanent contraceptive methods. Conclusion The utilization of long acting and permanent contraceptive methods was relatively high. Discussion with partners on family planning, previous experiences of LAPMs, not hearing myths about LAPMs, women not started ART, and no birth intention were positively associated with LAPMs utilization. It is therefore recommended that health service providers need to make couples counseling on FP, undergo behavioral change communication (BCC) to avoid misconceptions/myths regarding LAPMs. Further research is also recommended to address the gaps mentioned in the limitation section and to explore the reason/s for not using LAPMs (qualitative study).
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Affiliation(s)
- Abebaw Addis Gelagay
- 1Department of Reproductive Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Digsu Negese Koye
- 2Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hedija Yenus Yeshita
- 1Department of Reproductive Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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35
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HIV treatment in pregnancy. Lancet HIV 2018; 5:e457-e467. [PMID: 29958853 DOI: 10.1016/s2352-3018(18)30059-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 01/15/2023]
Abstract
Almost 25 years since antiretroviral therapy (ART) was first shown to prevent mother-to-child transmission of HIV, 76% of pregnant women living with HIV (over 1 million women) receive ART annually. This number is the result of successes in universal ART scale-up in low-income and middle-income countries. Despite unprecedented ART-related benefits to maternal and child health, challenges remain related to ART adherence, retention in care, and unequal access to ART. Implementation research is ongoing to understand and to address obstacles that lead to loss to follow-up. The biological mechanisms that underlie observed associations between antenatal ART and adverse outcomes in pregnancy and birth are not completely understood, with further research needed as well as strengthening of the systems to assess safety of antiretroviral drugs for the mother and HIV-exposed child. In the treat-all era, as duration of treatment and options for ART expand, pregnant women will remain a priority population for treatment optimisation to promote their health and that of their ART-exposed children.
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Kaida A, Patterson S, Carter A, Loutfy M, Ding E, Sereda P, Webster K, Pick N, Kestler M, de Pokomandy A. Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:223-236. [PMID: 29193584 DOI: 10.1363/psrh.12046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Preventing unintended pregnancy and HIV transmission is important for women with HIV, but little is known about their contraceptive use, particularly under current antiretroviral therapy (ART) recommendations for treatment and prevention. METHODS The prevalence of contraceptive use and of dual protection was examined among 453 sexually active women with HIV aged 16-49 and enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study in 2013-2015; multivariable logistic regression was used to identify correlates of use. Two definitions of dual protection were assessed: the World Health Organization (WHO) definition (consistent condom use alongside another effective method) and an expanded definition (consistent condom use or a suppressed HIV viral load alongside an effective method). RESULTS Overall, 73% of women used effective contraceptives, primarily male condoms (45%) or tubal ligation (19%). Eighteen percent practiced WHO-defined dual protection, and 40% practiced dual protection according to the expanded definition. Characteristics positively associated with contraceptive use were younger age, having been pregnant, being heterosexual, being unaware of ART's HIV prevention benefits and having had partners of unknown HIV status (odds ratios, 1.1-6.7). Younger age and perceived inability to become pregnant were positively associated with both definitions of dual protection (1.04-3.3); additionally, WHO-defined dual protection was associated with perceiving HIV care to be women-centered and having had partners of unknown HIV status (2.0-4.1), and dual protection under the expanded definition was related to having been pregnant (2.7). CONCLUSIONS Future research should explore how sustained ART and broader contraceptive options can support women's sexual and reproductive health care needs.
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Affiliation(s)
- Angela Kaida
- Associate professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sophie Patterson
- Ph.D. candidate, Faculty of Health Sciences, Simon Fraser University
- Research assistant, British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - Allison Carter
- Ph.D. candidate, Faculty of Health Sciences, Simon Fraser University
- Research assistant, British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - Mona Loutfy
- Associate professor and physician scientist, Women's College Research Institute, Women's College Hospital
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Torontoa, Toronto
| | - Erin Ding
- Statistician, British Columbia Centre for Excellence in HIV/AIDS
| | - Paul Sereda
- Data analyst, British Columbia Centre for Excellence in HIV/AIDS
| | - Kath Webster
- Peer research associate and community representative, National Management Team of the CHIWOS study, Vancouver
| | - Neora Pick
- Medical director, Oak Tree Clinic, British Columbia Women's Health Centre
- Associate professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver
| | - Mary Kestler
- Clinical assistant professor, Oak Tree Clinic and Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver
| | - Alexandra de Pokomandy
- Assistant professor and physician scientist, Chronic Viral Illness Service, McGill University Health Centre, and Department of Family Medicine, McGill University, Montreal
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