1
|
Mmotsa TM, Magasana V, Nsibande DF, Buthelezi M, Dassaye R, Rodriguez VJ, Jones DL, Goga AE, Ngandu NK. Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner's HIV status, in six South African districts with a high antenatal HIV burden. BMC Public Health 2023; 23:1988. [PMID: 37828512 PMCID: PMC10571358 DOI: 10.1186/s12889-023-16921-z] [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: 11/08/2022] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Elimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women's decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner's HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden. METHODS A mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis. RESULTS Overall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman's disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure. CONCLUSION User-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.
Collapse
Affiliation(s)
- Tshiamo M Mmotsa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile F Nsibande
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mbongeleni Buthelezi
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Reshmi Dassaye
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology (Clinical/Community Division), University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ameena E Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Nobubelo K Ngandu
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| |
Collapse
|
2
|
Tibebu NS, Rade BK, Kebede AA, Kassie BA. Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state Referral Hospitals, Ethiopia. PLoS One 2023; 18:e0280045. [PMID: 36649277 PMCID: PMC9844863 DOI: 10.1371/journal.pone.0280045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners plays a significant role in the successful prevention and care of HIV infection. Pregnant women who did not reveal their HIV status to their sexual partners make the prevention and control efforts challenging. Therefore, this study was aimed to assess HIV status disclosure to sexual partners and associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state referral Hospitals, Ethiopia in 2021. METHODS An institution-based cross-sectional study was conducted from October 17th, 2020 to March 1st, 2021. A total of 423 pregnant women living with HIV were participated in this study. A systematic random sampling technique was used to select all eligible women. Data was collected using a semi-structured, pretested, and interviewer-administered questionnaire. EPI INFO version 7 and SPSS version 21 were used for data entry and analysis, respectively. Both univariable and multivariable logistic regression analyses were performed to find factors associated with women's disclosure status to a sexual partner. Statistical association was decided based on the adjusted odds ratio (AOR) with its 95% Confidence Interval (CI) and p-value of ≤ 0.05. RESULTS The prevalence of disclosure of their HIV status to their sexual partners was 73% (95% CI: 68.9%, 77.3%). Being an urban resident (AOR = 5.04, 95% CI: 2.14, 11.81), diagnosed HIV before pregnancy (AOR = 7.77, 95% CI: 3.09, 19.52), disclosing their HIV status to others (AOR = 7.01, 95% CI: 3.78, 13.25), planned pregnancy (AOR = 2.46, 95% CI: 1.32, 4.57), and having good knowledge on HIV/AIDS prevention (AOR = 2.19, 95% CI:1.22, 3.94) were found to be statistically significant with women's disclosure of their HIV status to their sexual partner. CONCLUSION In this study, nearly three-fourth of pregnant women disclosed their HIV status to their sexual partner. Thus, setting strategies in preventing unplanned pregnancy, HIV diagnosed before pregnancy, and increasing knowledge of HIV prevention will have significant role in escalating women's disclosure status.
Collapse
Affiliation(s)
- Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Bayew Kelkay Rade
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
3
|
Lukyamuzi Z, Nabisere RM, Nakalega R, Atuhaire P, Kataike H, Ssuna B, Baroudi M, Kiweewa FM, Musoke P, Butler LM. Community Health Workers Improve HIV Disclosure Among HIV-Affected Sexual Partners in Rural Uganda: A Quasi-Experimental Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100631. [PMID: 36316143 PMCID: PMC9622292 DOI: 10.9745/ghsp-d-21-00631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/23/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND We evaluated the efficacy of a community health worker (CHW)-led intervention in supporting disclosure among adults living with HIV in heterosexual relationships. METHODS We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure. RESULTS Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25-37) years, the majority were women (76.5%), and most (80%) did not know their partners' HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39). CONCLUSION CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.
Collapse
Affiliation(s)
- Zubair Lukyamuzi
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ruth Mirembe Nabisere
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rita Nakalega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Patience Atuhaire
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hajira Kataike
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Clinical Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
4
|
Timely Initiation of Breastfeeding and Its Associated Factors at the Public Health Facilities of Dire Dawa City, Eastern Ethiopia, 2021. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2974396. [PMID: 36110122 PMCID: PMC9470322 DOI: 10.1155/2022/2974396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
Introduction Timely initiation of breastfeeding is defined as putting the newborn baby to the breast within one hour of birth. Despite the World Health Organization and national recommendations on timely initiation of breastfeeding, delayed initiation of breastfeeding is still a common problem. Objective The aim of this study was to assess the timely initiation of breastfeeding and its associated factors at the public health facilities of Dire Dawa city, Eastern Ethiopia, 2021. Methods A health facility-based cross-sectional study was employed from February 1, 2021, to March 2, 2021, at the public health facilities of Dire Dawa city among 302 mother-child pairs. The data were collected by systematic random sampling technique, entered into Epi data 4.2, and analyzed using Statistical Package of Social Science 25.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95%, and a P value of < 0.05 was considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables. Results In this study, timely initiation of breastfeeding was 70.9% (95% CI: 65.6-75.8%). In a multivariable analysis, maternal age group of 25-40 years (AOR = 2.21, 95% CI = 1.09 − 4.48), multiparty (AOR = 2.58, 95% CI = 1.24 − 5.40), counselling on timely initiation of breastfeeding during antenatal care visits (AOR = 2.38, 95% CI = 1.16 − 4.88), institutional delivery (AOR = 3.29, 95% CI = 1.27 − 8.52), vaginal delivery (AOR = 3.06, 95% CI = 1.20 − 7.81), counselling on breastfeeding immediately after delivery (AOR = 2.89, 95% CI = 1.29 − 6.45), not practicing pre lacteal feeding (AOR = 6.76, 95% CI = 2.35 − 19.44), and having good practice of colostrum feeding (AOR = 4.03, 95% CI = 1.95 − 8.36) were associated with timely initiation of breastfeeding. Conclusion and Recommendation. Mothers who had practiced timely initiation of breastfeeding were low compared to the national recommendation (92%). Age of the mother, multiparity, counseling on timely initiation of breastfeeding, institutional delivery, vaginal delivery, counseling after delivery, not practicing prelacteal feeding, and having a good practice of colostrum feeding were predictors of timely initiation of breastfeeding. It indicates a need to encourage mothers to have antenatal care visits and institutional delivery.
Collapse
|
5
|
Lelaka CM, Moyo I, Tshivhase L, Mavhandu-Mudzusi AH. Psychosocial support for HIV serodiscordant couples. Health Psychol Behav Med 2022; 10:537-556. [PMID: 35756334 PMCID: PMC9225695 DOI: 10.1080/21642850.2022.2084098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction South Africa has the largest HIV epidemic, with 8.2 million people living with the virus. It has a high HIV prevalence of 13.7% and 230,000 new infections in 2020. It is estimated that HIV serodiscordant couples contribute up to 60% of new HIV infections in sub-Saharan Africa. However, there have been no specific programmes/activities to deliberately cater for couples in HIV serodiscordant relationships. The purpose of this study was to examine the psychosocial support provided for HIV serodiscordant couples both in health care settings and in the community. Methods An interpretative phenomenological analysis (IPA) design was utilised for this study. In-depth interviews were conducted with thirteen HIV serodiscordant couples. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. A third person-an expert in qualitative research, acted as an independent co-coder and conducted the open coding of each transcript. Findings The findings indicated that HIV serodiscordant couples received psychosocial support from their partners, family, and health care workers. This support was emotional, or in the form of counselling, reminders on taking medication, financial and household chores. The support provided by health care providers proved to be deficient and did not address the diverse needs of this group. Conclusion Psychosocial support plays a critical role in enhancing the quality of life of HIV serodiscordant couples. Therefore, client centred, and tailor-made interventions should be made available to this special with diverse needs group.
Collapse
Affiliation(s)
| | - Idah Moyo
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Livhuwani Tshivhase
- Department of Nursing Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | |
Collapse
|
6
|
Aba Abraham S, Clow SE. HIV counselling and testing experiences of expectant mothers in the prevention of vertical transmission programme: implications for policy and service delivery. Ther Adv Infect Dis 2022; 9:20499361221078424. [PMID: 35198199 PMCID: PMC8859687 DOI: 10.1177/20499361221078424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study explored the HIV counselling and testing (HCT) experiences of women who were diagnosed positive in the current pregnancy in a district hospital within the Sekondi-Takoradi Metropolis in Ghana following the implementation of the ‘opt out’ testing policy. Methods: Adopting a qualitative explorative descriptive design, 12 mothers were sampled purposively and in-depth interviews were conducted. Thematic analysis using Colaizzi’s approach was applied to unearth the experiences of the participants. Results: Three key themes emerged: The Pre-test Counselling Experience; The Test; and After Talk: Post-test Counselling. Provider-initiated testing was offered to all the participants at antenatal booking. Most counsellors were silent about the ‘opt-out’ option of testing while pretest counselling focused on preventing vertical transmission and not on the health of the woman. Attitudes towards pretest counselling was mainly indifference or anxiety which affected the women’s initial acceptance of a positive result. All the women took a confirmatory test after the initial positive results which aided them in accepting their diagnosis. Of the women who tested, all received post-test counselling that focused on enrolling on antiretroviral therapy (ART). Conclusion: Attitudes towards pretest counselling impacts the mothers’ reaction to a positive test result. HIV counselling that does not solicit voluntary testing may be effective in increasing testing but may affect uptake of treatment. It is recommended that midwives providing HCT be trained periodically to enhance service delivery while focus on women-centred care and improving women’s agency in the prevention of vertical transmission services should be the paramount.
Collapse
Affiliation(s)
- Susanna Aba Abraham
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Sheila E. Clow
- Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|