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Khademi K, Kaveh MH. Social support as a coping resource for psychosocial conditions in postpartum period: a systematic review and logic framework. BMC Psychol 2024; 12:301. [PMID: 38807228 PMCID: PMC11131291 DOI: 10.1186/s40359-024-01814-6] [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: 08/16/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE This review seeks to examine the current state of postpartum social support and psychosocial conditions among women around the world, as well as explore the relationship between these factors. Additionally, it aims to propose a logical framework for enhancing postpartum social support and psychosocial conditions in this population. METHODS Following the development of a search strategy, two databases, PubMed and Science Direct, were searched for studies published between January 2019 and May 2023. The search was conducted throughout the entire month of May 2023. The risk of bias in the included cross-sectional studies was assessed using the Newcastle-Ottawa Quality Assessment Scale, which was adapted for this specific study design. To determine if the main objective of the cross-sectional studies was to investigate the relationship between social support and postpartum psychosocial conditions, a review was conducted based on the AMSTAR checklist, PRISMA checklist and PRISMA flow diagram. Data extraction was performed with the consensus of two authors, and a narrative synthesis approach was chosen for data synthesis, following the guidelines provided by the Centre for Reviews and Dissemination (CRD). RESULTS Eleven cross-sectional studies were included in the final analysis. Our findings revealed that all reviewed studies provided evidence of a positive association between social support and healthy psychosocial conditions in postpartum period. However, due to the absence of standardized measurement indicators to identify and compare the outcomes of various studies, there was a need to develop a conceptual framework that could enhance our understanding of the postpartum psychosocial condition including anxiety, depression, unfavorable quality of life and social support status up to 24 month after child birth. This framework aimed to incorporate childbirth and motherhood as "stressful events," while considering social support as a crucial "coping resource." Furthermore, it acknowledged empowerment, help-seeking behavior, and peer support as important "coping actions," alongside implementing client-centered interventions. Lastly, it recognized postpartum mental health and optimal quality of life as significant "effects" of these factors. CONCLUSIONS The proposed conceptual framework could define postpartum women's health as "the ability to adapt and self-manage."
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Affiliation(s)
- Khadijeh Khademi
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, 71536-75541, Iran.
| | - Mohammad Hossein Kaveh
- Research Center for Health Sciences, Department of Health Promotion, School of Health, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Schrubbe LA, Stöckl H, Hatcher AM, Calvert C. Sexual violence and antiretroviral adherence among women of reproductive age in African population-based surveys: the moderating role of the perinatal phase. J Int AIDS Soc 2023; 26:e26129. [PMID: 37306126 PMCID: PMC10258861 DOI: 10.1002/jia2.26129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Women face challenges in antiretroviral therapy (ART) adherence and achieving viral suppression despite progress in the expansion of HIV treatment. Evidence suggests that violence against women (VAW) is an important determinant of poor ART adherence in women living with HIV (WLH). In our study, we examine the association of sexual VAW and ART adherence among WLH and assess whether this association varies by whether women are pregnant/breastfeeding or not. METHODS A pooled analysis was conducted among WLH from Population-Based HIV Impact Assessment cross-sectional surveys (2015-2018) from nine sub-Saharan African countries. Logistic regression was used to examine the association between lifetime sexual violence and suboptimal ART adherence (≥1 missed day in the past 30 days) among reproductive age WLH on ART, and to assess whether there was any evidence for interaction by pregnancy/breastfeeding status, after adjusting for key confounders. RESULTS A total of 5038 WLH on ART were included. Among all included women, the prevalence of sexual violence was 15.2% (95% confidence interval [CI]: 13.3%-17.1%) and the prevalence of suboptimal ART adherence was 19.8% (95% CI: 18.1%-21.5%). Among only pregnant and breastfeeding women, the prevalence of sexual violence was 13.1% (95% CI: 9.5%-16.8%) and the prevalence of suboptimal ART adherence was 20.1% (95% CI: 15.7%-24.5%). Among all included women, there was evidence for an association between sexual violence and suboptimal ART adherence (adjusted odds ratio [aOR]: 1.69, 95% CI: 1.25-2.28). There was evidence that the association between sexual violence and ART adherence varied by pregnant/breastfeeding status (p = 0.004). Pregnant and breastfeeding women with a history of sexual violence had higher odds of suboptimal ART adherence (aOR: 4.11, 95% CI: 2.13-7.92) compared to pregnant and breastfeeding women without a history of sexual violence, while among non-pregnant and non-breastfeeding women, this association was attenuated (aOR: 1.39, 95% CI: 1.00-1.93). CONCLUSIONS Sexual violence is associated with women's suboptimal ART adherence in sub-Saharan Africa, with a greater effect among pregnant and breastfeeding WLH. To improve women's HIV outcomes and to achieve the elimination of vertical transmission of HIV, violence prevention efforts within maternity services and HIV care and treatment should be a policy priority.
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Affiliation(s)
- Leah A. Schrubbe
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Heidi Stöckl
- Institute for Medical Information ProcessingBiometry and Epidemiology, Faculty of Medicine, LMU MunichMunichGermany
- Pettenkofer School of Public HealthMunichGermany
| | - Abigail M. Hatcher
- Department of Health BehaviourUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Clara Calvert
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
- Centre for Global Health, Usher InstituteUniversity of EdinburghEdinburghUK
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Roudsari RL, Sharifi F, Goudarzi F. Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis. BMC Public Health 2023; 23:818. [PMID: 37143008 PMCID: PMC10158256 DOI: 10.1186/s12889-023-15692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Despite emphasizing the importance and benefits of men's active engagement in reproductive health programs, their engagement in reproductive health care is low. Researchers have identified different barriers to men's avoidance of participation in various aspects of reproductive health in different parts of the world. This study provided an in-depth review of the hindrances to men's non-participation in reproductive health. METHODS This meta-synthesis was conducted using keyword searches in databases including PubMed, Scopus, Web of Science, Cochrane, and ProQuest until January 2023. Qualitative English-language studies that investigated barriers to men's participation in reproductive health were included in the study. The critical appraisal skills program (CASP) checklist was used to assess the articles' quality. Data synthesis and thematic analysis were done using the standard method. RESULT This synthesis led to the emergence of four main themes such as failure to access all inclusive and integrated quality services, economic issues, couples' personal preferences and attitudes, and sociocultural considerations to seek reproductive healthcare services. CONCLUSION Healthcare system programs and policies, economic and sociocultural issues, and men's attitudes, knowledge, and preferences, influence men's participation in reproductive healthcare. Reproductive health initiatives should focus on eliminating challenges to men's supportive activities to increase practical men's involvement in reproductive healthcare.
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Affiliation(s)
- Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farangis Sharifi
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Goudarzi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
- Department of Midwifery, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
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Schrubbe LA, Stöckl H, Hatcher AM, Marston M, Kuchukhidze S, Calvert C. Prevalence and risk factors of unsuppressed viral load among pregnant and breastfeeding women in sub-Saharan Africa: analysis from population-based surveys. AIDS 2023; 37:659-669. [PMID: 36511117 DOI: 10.1097/qad.0000000000003459] [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] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the prevalence of viral suppression and risk factors for unsuppressed viral load among pregnant and breastfeeding women living with HIV (WLH). DESIGN Pooled analysis among pregnant and breastfeeding WLH from Population-Based HIV Impact Assessment (PHIA) cross-sectional surveys from 10 sub-Saharan African countries. METHODS Questionnaires included sociodemographic, relationship-related, and HIV-related items, while blood tests examined HIV serostatus and viral load (data collected 2015-2018). The weighted prevalence of viral suppression was calculated. Logistic regression was used to examine risk factors for unsuppressed viral load (≥1000 copies/ml). RESULTS Of 1685 pregnant or breastfeeding WLH with viral load results, 63.8% (95% confidence interval (CI): 60.8-66.7%) were virally suppressed at the study visit. Among all included women, adolescence (adjusted odds ratio (aOR): 4.85, 95% CI: 2.58-9.14, P < 0.001) and nondisclosure of HIV status to partner (aOR: 1.48, 95% CI: 1.02-2.14, P = 0.04) were associated with unsuppressed viral load. Among only partnered women, adolescence (aOR: 7.95, 95% CI: 3.32-19.06, P < 0.001), and lack of paid employment (aOR: 0.67, 95% CI: 0.47-0.94, P = 0.02) were associated with unsuppressed viral load. Examining only women on ART, nondisclosure of HIV status to partner (aOR: 1.85, 95% CI: 1.19-2.88, P = 0.006) was associated with unsuppressed viral load. CONCLUSION Viral suppression among pregnant and breastfeeding WLH in sub-Saharan Africa remains suboptimal. Relationship dynamics around nondisclosure of HIV-positive status to partners was an important risk factor for unsuppressed viral load. Improving HIV care via sensitive discussions around partner dynamics in pregnant and breastfeeding women could improve maternal HIV outcomes and prevention of mother-to-child transmission of HIV (PMTCT).
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Affiliation(s)
- Leah A Schrubbe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Abigail M Hatcher
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milly Marston
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Salome Kuchukhidze
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Triulzi I, Somerville C, Sangwani S, Palla I, Orlando S, Mamary HS, Ciccacci F, Marazzi MC, Turchetti G. Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis. Glob Health Action 2022; 15:2051223. [PMID: 35416763 PMCID: PMC9009925 DOI: 10.1080/16549716.2022.2051223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. OBJECTIVE This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. METHODS We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. RESULTS This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. CONCLUSIONS This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claire Somerville
- Gender Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Young CR, Gill E, Bwana M, Muyindike W, Hock RS, Pratt MC, Owembabazi M, Tukwasibwe D, Najjuma A, Kalyebara P, Natukunda S, Kaida A, Matthews LT. Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care. AIDS Behav 2022; 26:76-87. [PMID: 34152530 PMCID: PMC8688584 DOI: 10.1007/s10461-021-03343-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.
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Affiliation(s)
- Cynthia R Young
- Division of Infectious Diseases, University of Kentucky, Lexington, KY
| | - Elizabeth Gill
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mwebesa Bwana
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rebecca S. Hock
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Madeline C Pratt
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Moran Owembabazi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deogratius Tukwasibwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Paul Kalyebara
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Silvia Natukunda
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lynn T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL,Corresponding author:
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Mutale W, Freeborn K, Graybill LA, Lusaka MM, Mollan KR, Mweemba O, Kasaro M, Lungu R, Kumwenda A, Saidi F, Powers KA, Maman S, Rosenberg NE, Chi BH. Addition of HIV self-test kits to partner notification services to increase HIV testing of male partners of pregnant women in Zambia: two parallel randomised trials. LANCET GLOBAL HEALTH 2021; 9:e1719-e1729. [PMID: 34735862 PMCID: PMC8644317 DOI: 10.1016/s2214-109x(21)00393-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Testing men for HIV during their partner's pregnancy can guide couples-based HIV prevention and treatment, but testing rates remain low. We investigated a combination approach, using evidence-based strategies, to increase HIV testing in male partners of HIV-positive and HIV-negative pregnant women. METHODS We did two parallel, unmasked randomised trials, enrolling pregnant women who had an HIV-positive test result documented in their antenatal record (trial 1) and women who had an HIV-negative test result documented in their antenatal record (trial 2) from an antenatal setting in Lusaka, Zambia. Women in both trials were randomly assigned (1:1) to the intervention or control groups using permuted block randomisation. The control groups received partner notification services only, including an adapted version for women who were HIV-negative; the intervention groups additionally received targeted education on the use of oral HIV self-test kits for their partners, along with up to five oral HIV self-test kits. At the 30 day follow-up we collected information from pregnant women about their primary male partner's HIV testing in the previous 30 days at health-care facilities, at home, or at any other facility. Our primary outcome was reported male partner testing at a health facility within 30 days following randomisation using a complete-case approach. Women also reported male partner HIV testing of any kind (including self-testing at home) that occurred within 30 days. Randomisation groups were compared via probability difference with a corresponding Wald-based 95% CI. The trial is registered at ClinicalTrials.gov (NCT04124536) and all enrolment and follow-up has been completed. FINDINGS From Oct 28, 2019, to May 26, 2020, 116 women who were HIV-positive (trial 1) and 210 women who were HIV-negative (trial 2) were enrolled and randomly assigned to study groups. Retention at 30 days was 100 (86%) in trial 1 and 200 (95%) in trial 2. Women in the intervention group were less likely to report facility-based male partner HIV testing in trial 1 (3 [6%] of 47 vs 15 [28%] of 53, estimated probability difference -21·9% [95% CI -35·9 to -7·9%]) and trial 2 (3 [3%] of 102 vs 33 [34%] of 98, estimated probability difference -30·7% [95% CI -40·6 to -20·8]). However, reported male partner HIV testing of any kind was higher in the intervention group than in the control group in trial 1 (36 [77%] of 47 vs 19 [36%] of 53, estimated probability difference 40·7% [95% CI 23·0 to 58·4%]) and trial 2 (80 [78%] of 102 vs 54 [55%] of 98, estimated probability difference 23·3% [95% CI 10·7 to 36·0%]) due to increased use of HIV self-testing. Overall, 14 male partners tested HIV-positive. Across the two trials, three cases of intimate partner violence were reported (two in the control groups and one in the intervention groups). INTERPRETATION Our combination approach increased overall HIV testing in male partners of pregnant women but reduced the proportion of men who sought follow-up facility-based testing. This combination approach might reduce linkages to health care, including for HIV prevention, and should be considered in the design of comprehensive HIV programmes. FUNDING National Institutes of Health.
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Affiliation(s)
- Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Kellie Freeborn
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren A Graybill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Katie R Mollan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oliver Mweemba
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Rose Lungu
- UNC Global Projects - Zambia, Lusaka, Zambia
| | | | | | - Kimberly A Powers
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora E Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin H Chi
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ngangue P, Fleurantin M, Adekpedjou R, Philibert L, Gagnon MP. Involvement of Male Partners of Pregnant Women in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Haiti: A Mixed-Methods Study. Am J Mens Health 2021; 15:15579883211006003. [PMID: 33874810 PMCID: PMC8060766 DOI: 10.1177/15579883211006003] [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] [Indexed: 11/27/2022] Open
Abstract
This mixed-methods study aimed to determine the level of male involvement in the
prevention of mother-to-child transmission (PMTCT) services in Haiti and
identify barriers and associated factors. From May to June 2018, a questionnaire
was used to measure the level of male involvement. Semistructured interviews
with pregnant women were also conducted. Multivariate linear regression and
qualitative content analyses were performed to explore factors associated and
barriers to male partners’ involvement in PMTCT services. One hundred and two
pregnant women living with HIV completed the questionnaire. About 47% of male
partners had a high level of involvement. Specifically, 90% financially
supported their spouse, and 82% knew her appointment date at the antenatal
clinic (ANC). Only 25% of male partners accompanied their spouse to the ANC, and
19% routinely used a condom during sexual intercourse. Factors associated with
male involvement in PMTCT were being married and sharing HIV status with the
male partner. Male partners with a positive HIV status were more likely to be
involved in PMTCT. Qualitative findings revealed that barriers to male
involvement included the conflict between opening hours of the ANC and the male
partner’s schedule, waiting time at the ANC, and the perception of antenatal
care as being women’s business. Overall male partners’ involvement in PMTCT
services is moderate. Gender relations, sociocultural beliefs, and care
organization are likely to hinder this involvement. Developing and implementing
contextually and culturally accepted strategies for male partners of pregnant
women could contribute to strengthening their involvement in the PMTCT
program.
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Affiliation(s)
- Patrice Ngangue
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Leonel Philibert
- Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
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Momplaisir FM, Fortune K, Nkwihoreze H, Groves AK, Aaron E, Jemmott JB. Outcome expectancies toward adherence to antiretroviral therapy for pregnant and postpartum women with HIV. WOMEN'S HEALTH 2021; 17:17455065211061094. [PMID: 34812095 PMCID: PMC8640315 DOI: 10.1177/17455065211061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Adherence to antiretroviral therapy and retention in care significantly drop for women with HIV during the postpartum period. We have a limited understanding of how outcome expectancies influence maternal adherence and retention in care. Methods: Women with HIV from an urban academic clinic completed in-depth interviews in the third trimester and at 3 to 9 months postpartum to evaluate outcome expectancies, facilitators, and barriers to antiretroviral therapy adherence and retention in care. Interviews were audio-recorded and analyzed for content. A codebook was created using deductive (based on the theory of reasoned action approach) and inductive (based on emergent themes) codes. Results: We conducted 21 interviews with 12 women during pregnancy and 9 women during postpartum period. Participants had a mean age of 31 (standard deviation = 5.7) and most were African American (75%). Outcome expectancies centered mostly around pediatric health to prevent perinatal transmission of HIV and to be healthy to raise their children. Other outcome expectancies included preventing transmission of HIV to their partners. Social support from partners served as a strong facilitator as they helped routinize pill-taking behaviors, provided reminders, and decreased social isolation. Barriers to antiretroviral therapy adherence included depression, the disruption of scheduling routines, and the physical demands associated with the postpartum period. These barriers were accentuated for women with multiple children. Conclusion: Women’s commitment to pediatric health was the primary motive for antiretroviral therapy adherence. Partners also served an important role. These findings suggest that interventions linking pediatric and maternal health, and partner support can improve maternal HIV treatment in the postpartum period.
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Affiliation(s)
- Florence M Momplaisir
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hervette Nkwihoreze
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Erika Aaron
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - John B Jemmott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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