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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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Yam EA, Kahabuka C, Mbita G, Winani K, Apicella L, Casalini C, Mbuguni Z. Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services. PLoS One 2020; 15:e0235739. [PMID: 32692777 PMCID: PMC7373272 DOI: 10.1371/journal.pone.0235739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire. Conclusions Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
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Affiliation(s)
- Eileen A. Yam
- Population Council, Washington, DC, United States of America
- * E-mail:
| | | | | | - Koheleth Winani
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Zuhura Mbuguni
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Malama K, Kilembe W, Inambao M, Hoagland A, Sharkey T, Parker R, Wall KM, Tichacek A, Sarkar S, Vwalika B, Haddad L, Chomba E, Allen S. A couple-focused, integrated unplanned pregnancy and HIV prevention program in urban and rural Zambia. Am J Obstet Gynecol 2020; 222:S915.e1-S915.e10. [PMID: 31945337 PMCID: PMC8377731 DOI: 10.1016/j.ajog.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Zambia's total fertility rate (5 births per woman) and adult HIV prevalence (11.5%) are among the highest in the world, with heterosexual couples being the most affected group. Jointly counseling and testing couples for HIV has reduced up to 58% of new HIV infections in Zambian clinics. Married women using contraceptives in Zambia have a high (20%) unmet need for family planning and low (8.6%) uptake of cost-effective long-acting reversible contraceptives. We present an integrated counseling, testing, and family-planning program to prevent HIV and unplanned pregnancy in Zambia. OBJECTIVE The objective of this study was to integrate effective HIV prevention and family-planning services for Zambian couples. STUDY DESIGN A 3 year program (2013-2016) progressively integrated the promotion and provision of couples' voluntary HIV counseling and testing and long-acting reversible contraceptives. The program was based in 55 urban and 215 rural government clinics across 33 districts. In the first year, a couples' family-planning counseling training program was developed and combined with existing couples HIV counseling training materials. To avoid congestion during routine clinic hours, joint counseling services were initially provided on weekends, while nurses were trained in intrauterine device and hormonal implant insertion and removal during weekday family-planning services. Demand was created through mutual referral between weekend and weekday programs and by clinic staff, community health workers, and satisfied family-planning clients. When the bulk of integrated service training was completed, the program transitioned services to routine weekday clinic hours, ensuring access to same-day services. Performance indicators included number of staff trained, clients served, integrated service referrals, HIV infections averted, and unplanned pregnancies averted. RESULTS A stepwise approach trained high-performing service providers to be trainers and used high-volume clinics for practicum training of the next generation. In total, 1201 (391 urban, 810 rural) counselors were trained and served 120,535 urban and 87,676 rural couples. In urban clinics, 236 nurses inserted 65,619 long-acting reversible contraceptives, while in rural clinics, 243 nurses inserted 35,703 implants and intrauterine devices. The program prevented an estimated 12,869 urban and 8279 rural adult HIV infections, and 98,626 unintended urban pregnancies. In the final year, the proportion of clients receiving joint counseling services on weekdays rose from 11% to 89%, with many referred from within clinics including HIV testing and treatment services (32%), outpatient department (31%), family planning (16%), and infant vaccination (15%). The largest group of clients requesting long-acting reversible contraceptives (45%) did so after joint fertility goal-based counseling, confirming the high impact of this couple-focused demand creation approach. Remaining family-planning clients responded to referrals from clinic nurses (34%), satisfied implant/intrauterine device users (13%), or community health workers (8%). CONCLUSION Integrated HIV and unplanned pregnancy prevention can be implemented in low-resource public sector facilities. Combination services offered to couples mutually leverage HIV prevention and unplanned pregnancy prevention. The addition of long-acting reversible contraceptives is an important complement to the method mix available in government clinics. Demand creation in the clinic and in the community must be coordinated with a growing supply of well-trained providers.
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Affiliation(s)
- Kalonde Malama
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azurr, Marseille, France.
| | - William Kilembe
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Mubiana Inambao
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia; Department of Obstetrics and Gynaecology, Ndola Central Hospital, Ndola, Zambia
| | - Alexandra Hoagland
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University
| | - Tyronza Sharkey
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, the Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, the Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, the Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Supriya Sarkar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Lisa Haddad
- Department of Obstetrics and Gynaecology, School of Medicine, Emory University, Atlanta, GA
| | | | - Susan Allen
- Rwanda Zambia HIV Research Group, the Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA
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Yam EA, Sultana N, Hossain T, Zieman B, Roy S, Yasmin R, Sadiq N, Hossain SMI. Reproductive health and desire for children among young female sex workers in Bangladesh brothels. Health Care Women Int 2019; 40:981-994. [PMID: 31161893 DOI: 10.1080/07399332.2019.1623801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Globally, reproductive health research among female sex workers (FSWs) often focuses on pregnancy prevention, but many women who sell sex aspire to have children in the future. In Bangladesh, where early marriage and parenthood is the norm, we examine reproductive histories and childbearing desires of young women who sell sex in brothels. We interviewed 1061 FSWs aged 18 to 24 in eight brothels in three Bangladesh divisions. Interviewers elicited information on sociodemographic characteristics, contraceptive use, pregnancy history, and childbearing desire. Bivariate and multivariate analyses were conducted to examine correlates of wanting to have a child within 24 months.
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Affiliation(s)
- Eileen A Yam
- Population Council , Washington , District of Columbia , USA
| | | | | | - Brady Zieman
- Population Council , Washington , District of Columbia , USA
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Brown J, Zafer M. Overcoming barriers to providing HIV prevention for HIV serodiscordant couples desiring pregnancy. Fertil Steril 2018; 109:441-442. [PMID: 29566857 DOI: 10.1016/j.fertnstert.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Joelle Brown
- Department of Epidemiology and Biostatistics and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Maryam Zafer
- Icahn School of Medicine at Mt. Sinai, New York, New York
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Narasimhan M, Celum C, Askew I, Kiarie J, van der Poel S. Supporting people living with HIV in serodiscordant partnerships to attempt a desired pregnancy by integrating sexual and reproductive health and HIV interventions. J Int AIDS Soc 2017; 20:21829. [PMID: 28361499 PMCID: PMC5461117 DOI: 10.7448/ias.20.2.21829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Connie Celum
- International Clinical Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sheryl van der Poel
- Independent Researcher, Geneva, Switzerland
- Population Council, Washington, DC, USA
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