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Logie CH, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M, Narasimhan M, Fahme S, Turan B, Kagunda J, Konda K, Hasham A, Perez-Brumer A. Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings. Reprod Health 2024; 21:51. [PMID: 38609975 PMCID: PMC11010352 DOI: 10.1186/s12978-024-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada.
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada.
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Anoushka Lad
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Michelle Zhao
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Sasha Fahme
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bülent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Julia Kagunda
- Elim Trust, Nairobi, Kenya
- Daystar University, Nairobi, Kenya
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Hopkins J, Narasimhan M, Aujla M, Silva R, Mandil A. The importance of insufficient national data on sexual and reproductive health and rights in international databases. EClinicalMedicine 2024; 70:102554. [PMID: 38533341 PMCID: PMC10963186 DOI: 10.1016/j.eclinm.2024.102554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.
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Affiliation(s)
- Jonathan Hopkins
- 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, Avenue Appia 20, 1211, Geneva, Switzerland
| | - 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, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Mandip Aujla
- 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, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Ronaldo Silva
- 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, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Ahmed Mandil
- (Retired) Department of Science, Information & Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Narasimhan M, Say L, Allotey P. Three decades of progress and setbacks since the first international conference on population and development. Bull World Health Organ 2024; 102:226-226A. [PMID: 38562203 PMCID: PMC10976866 DOI: 10.2471/blt.24.291654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Pascale Allotey
- Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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Narasimhan M, Karna P, Ojo O, Perera D, Gilmore K. Self-care interventions and universal health coverage. Bull World Health Organ 2024; 102:140-142. [PMID: 38313150 PMCID: PMC10835638 DOI: 10.2471/blt.23.290927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Priya Karna
- World Health Organization Country Office, New Delhi, India
| | - Olumuyiwa Ojo
- World Health Organization Country Office, Abuja, Nigeria
| | | | - Kate Gilmore
- Department of International Development, London School of Economics, London, England
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Koebel J, Kazemi M, Kennedy VL, Medeiros P, Bertozzi B, Bevan L, Tharao W, Logie CH, Underhill A, Pick N, King E, Kestler M, Yudin MH, Rana J, Carvalhal A, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Narasimhan M, Gagnier B, Habanyama M, de Pokomandy A, Kaida A, Loutfy M. Dissemination of the Women-Centred HIV Care Model: A Multimodal Process and Evaluation. J Int Assoc Provid AIDS Care 2024; 23:23259582231226036. [PMID: 38389331 PMCID: PMC10894538 DOI: 10.1177/23259582231226036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Using data from a national cohort study and focus groups, the Women-Centred HIV Care (WCHC) Model was developed to inform care delivery for women living with HIV. METHODS Through an evidence-based, integrated knowledge translation approach, we developed 2 toolkits based on the WCHC Model for service providers and women living with HIV in English and French (Canada's national languages). To disseminate, we distributed printed advertising materials, hosted 3 national webinars and conducted 2 virtual capacity-building training series. RESULTS A total of 315 individuals attended the webinars, and the average WCHC knowledge increased by 29% (SD 4.3%). In total, 131 service providers engaged in 22 virtual capacity-building training sessions with 21 clinical cases discussed. Learners self-reported increased confidence in 15/15 abilities, including the ability to provide WCHC. As of December 2023, the toolkits were downloaded 7766 times. CONCLUSIONS We successfully developed WCHC toolkits and shared them with diverse clinical and community audiences through various dissemination methods.
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Affiliation(s)
- Jill Koebel
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - V Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Priscilla Medeiros
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Breklyn Bertozzi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | | | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Elizabeth King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, 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
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jesleen Rana
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Adriana Carvalhal
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Scarborough Health Network Research Institute, 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
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research/Human Reproduction Programme, World Health Organization, Geneva, Switzerland
| | - Brenda Gagnier
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Muluba Habanyama
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- The Ontario HIV Treatment Network, Toronto, Canada
| | - 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
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
- The CHIWOS Research Team is detailed in the Acknowledgments
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Ghebreyesus TA, Allotey P, Narasimhan M. Advancing the "sexual" in sexual and reproductive health and rights: a global health, gender equality and human rights imperative. Bull World Health Organ 2024; 102:77-78. [PMID: 38164333 PMCID: PMC10753275 DOI: 10.2471/blt.23.291227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
| | - Pascale Allotey
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Logie CH, Toccalino D, MacKenzie F, Hasham A, Narasimhan M, Donkers H, Lorimer N, Malama K. Associations between climate change-related factors and sexual health: A scoping review. Glob Public Health 2024; 19:2299718. [PMID: 38190290 DOI: 10.1080/17441692.2023.2299718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Holly Donkers
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Affiliation(s)
- Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 1211 Geneva, Switzerland.
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 1211 Geneva, Switzerland
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Narasimhan M, Duvall S, Tamrat T. Expanding people-centred primary health care with digital adaptation kits for self-care interventions. Lancet Digit Health 2023; 5:e643-e645. [PMID: 37726187 DOI: 10.1016/s2589-7500(23)00178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/28/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP, UN Population Fund, UNICEF, and World Bank Special Program of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
| | - Susan Duvall
- Department of Sexual and Reproductive Health and Research, UNDP, UN Population Fund, UNICEF, and World Bank Special Program of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - Tigest Tamrat
- Department of Sexual and Reproductive Health and Research, UNDP, UN Population Fund, UNICEF, and World Bank Special Program of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
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Gotsche CI, Steyn PS, Narasimhan M, Rodolph M, Baggaley R, Kiarie JN. Integrating pre-exposure prophylaxis of HIV infection into family planning services: a scoping review. BMJ Sex Reprod Health 2023; 49:210-218. [PMID: 36581443 PMCID: PMC10359582 DOI: 10.1136/bmjsrh-2021-201356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The aim of this review was to map evidence of integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning services. A comprehensive package, using a combination of PrEP and contraceptive delivery, could reduce the number of new HIV infections and/or unintended pregnancies for at-risk women and adolescent girls. METHODS A scoping literature search was conducted between August 2020 and October 2020. After developing the review question, electronic databases (MEDLINE, Embase, Cochrane Library, Global Health, Web of Science) were systematically reviewed. All types of articles published from 2012 to August 2020 in English were included. The intended outcome was to identify barriers and enablers of integrating services at the client-level and provider-level. RESULTS 38 articles met inclusion criteria, with 16 from low-and middle-income countries and 22 from high-income countries. Barriers at the client-level included a lack of risk perception associated with low uptake and continuation of PrEP and pill burden; and at the provider-level, barriers included a lack of studies on cost-effectiveness of integrating services and provider training and knowledge. Facilitators included the initiation of PrEP and contraception at the same time and by the same provider or HIV self-testing. CONCLUSION Mapping and synthesising current evidence, this review identified key barriers and facilitators for the integration of PrEP into family planning services for women and adolescent girls. In order to address these factors, more implementation research in a variety of settings is needed to meet women's sexual and reproductive health needs globally.
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Affiliation(s)
- Caroline I Gotsche
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Petrus S Steyn
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Michelle Rodolph
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneve, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneve, Switzerland
| | - James N Kiarie
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
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Yeh PT, Kennedy CE, Rhee DK, Zera C, Tunçalp Ö, Lucido B, Gomez Ponce de Leon R, Narasimhan M. Self-monitoring of blood glucose levels among pregnant individuals with gestational diabetes: a systematic review and meta-analysis. Front Glob Womens Health 2023; 4:1006041. [PMID: 37293246 PMCID: PMC10244567 DOI: 10.3389/fgwh.2023.1006041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/25/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction The World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and self-monitoring blood glucose (SMBG) to inform timely treatment decisions. To expand the evidence base of WHO's guideline on self-care interventions, we conducted a systematic review of SMBG among pregnant individuals with GD. Setting Following PRISMA guidelines, we searched PubMed, CINAHL, LILACS, and EMBASE for publications through November 2020 comparing SMBG with clinic-based monitoring during antenatal care (ANC) globally. Primary and secondary outcome measures We extracted data using standardized forms and summarized maternal and newborn findings using random effects meta-analysis in GRADE evidence tables. We also reviewed studies on values, preferences, and costs of SMBG. Results We identified 6 studies examining SMBG compared to routine ANC care, 5 studies on values and preferences, and 1 study on costs. Nearly all were conducted in Europe and North America. Moderate-certainty evidence from 3 randomized controlled trials (RCTs) showed that SMBG as part of a package of interventions for GD treatment was associated with lower rates of preeclampsia, lower mean birthweight, fewer infants born large for gestational age, fewer infants with macrosomia, and lower rates of shoulder dystocia. There was no difference between groups in self-efficacy, preterm birth, C-section, mental health, stillbirth, or respiratory distress. No studies measured placenta previa, long-term complications, device-related issues, or social harms. Most end-users supported SMBG, motivated by health benefits, convenience, ease of use, and increased confidence. Health workers acknowledged SMBG's convenience but were wary of technical problems. One study found SMBG by pregnant individuals with insulin-dependent diabetes was associated with decreased costs for hospital admission and length of stay. Conclusion SMBG during pregnancy is feasible and acceptable, and when combined in a package of GD interventions, is generally associated with improved maternal and neonatal health outcomes. However, research from resource-limited settings is needed. Systematic Review Registration PROSPERO CRD42021233862.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dong Keun Rhee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chloe Zera
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP, Geneva, Switzerland
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, Includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP, Geneva, Switzerland
| | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP, Geneva, Switzerland
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13
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Nguyen PY, Caddy C, Wilson AN, Blackburn K, Page MJ, Gülmezoglu AM, Narasimhan M, Bonet M, Tunçalp Ö, Vogel JP. Self-care interventions for preconception, antenatal, intrapartum and postpartum care: a scoping review. BMJ Open 2023; 13:e068713. [PMID: 37164476 PMCID: PMC10173967 DOI: 10.1136/bmjopen-2022-068713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To identify current and emerging self-care interventions to improve maternity healthcare. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase, EmCare, PsycINFO, Cochrane CENTRAL/CDSR, CINAHL Plus (last searched on 17 October 2021). ELIGIBILITY CRITERIA Evidence syntheses, interventional or observational studies describing any tool, resource or strategy to facilitate self-care in women preparing to get pregnant, currently pregnant, giving birth or post partum. DATA EXTRACTION/SYNTHESIS Screening and data collection were conducted independently by two reviewers. Self-care interventions were identified based on predefined criteria and inductively organised into 11 categories. Characteristics of study design, interventions, participants and outcomes were recorded. RESULTS We identified eligible 580 studies. Many included studies evaluated interventions in high-income countries (45%) and during antenatal care (76%). Self-care categories featuring highest numbers of studies were diet and nutrition (26% of all studies), physical activity (24%), psychosocial strategies (18%) and other lifestyle adjustments (17%). Few studies featured self-care interventions for sexual health and postpartum family planning (2%), self-management of medication (3%) and self-testing/sampling (3%). Several venues to introduce self-care were described: health facilities (44%), community venues (14%), digital platforms (18%), partner/peer support (7%) or over-the-counter products (13%). Involvement of health and community workers were described in 38% and 8% of studies, who supported self-care interventions by providing therapeutics for home use, training or counselling. The most common categories of outcomes evaluated were neonatal outcomes (eg, birth weight) (31%), maternal mental health (26%) and labour outcomes (eg, duration of labour) (22%). CONCLUSION Self-care interventions in maternal care are diverse in their applications, implementation characteristics and intended outcomes. Many self-care interventions were implemented with support from the health system at initial stages of use and uptake. Some promising self-care interventions require further primary research, though several are matured and up-to-date evidence syntheses are needed. Research on self-care in the preconception period is lacking.
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Affiliation(s)
- Phi-Yen Nguyen
- Methods in Evidence Synthesis Unit, Monash University, Melbourne, Victoria, Australia
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Cassandra Caddy
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Alyce N Wilson
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Kara Blackburn
- International Development, Burnet Institute, Melbourne, Victoria, Australia
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua P Vogel
- International Development, Burnet Institute, Melbourne, Victoria, Australia
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14
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Baynes C, Steyn P, Soi C, Dinis A, Tembe S, Mehrtash H, Narasimhan M, Kiarie J, Sherr K. Use of implementation science to advance family planning programs in low- and middle-income countries: A systematic review. Front Glob Womens Health 2022; 3:1038297. [PMID: 36561275 PMCID: PMC9763469 DOI: 10.3389/fgwh.2022.1038297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Objective As environmental and economic pressures converge with demands to achieve sustainability development goals, low- and middle-income countries (LMIC) increasingly require strategies to strengthen and scale-up evidence-based practices (EBP) related to family planning (FP). Implementation science (IS) can help these efforts. The purpose of this article is to elucidate patterns in the use of IS in FP research and identify ways to maximize the potential of IS to advance FP in LMIC. Design and methods We conducted a systematic review that describes how IS concepts and principles have been operationalized in LMIC FP research published from 2007-2021. We searched six databases for implementation studies of LMIC FP interventions. Our review synthesizes the characteristics of implementation strategies and research efforts used to enhance the performance of FP-related EBP in these settings, identifying gaps, strengths and lessons learned. Results Four-hundred and seventy-two studies were eligible for full-text review. Ninety-two percent of studies were carried out in one region only, whereas 8 percent were multi-country studies that took place across multiple regions. 37 percent of studies were conducted in East Africa, 21 percent in West and Central Africa, 19 percent in Southern Africa and South Asia, respectively, and fewer than 5 percent in other Asian countries, Latin America and Middle East and North Africa, respectively. Fifty-four percent were on strategies that promoted individuals' uptake of FP. Far fewer were on strategies to enhance the coverage, implementation, spread or sustainability of FP programs. Most studies used quantitative methods only and evaluated user-level outcomes over implementation outcomes. Thirty percent measured processes and outcomes of strategies, 15 percent measured changes in implementation outcomes, and 31 percent report on the effect of contextual factors. Eighteen percent reported that they were situated within decision-making processes to address locally identified implementation issues. Fourteen percent of studies described measures to involve stakeholders in the research process. Only 7 percent of studies reported that implementation was led by LMIC delivery systems or implementation partners. Conclusions IS has potential to further advance LMIC FP programs, although its impact will be limited unless its concepts and principles are incorporated more systematically. To support this, stakeholders must focus on strategies that address a wider range of implementation outcomes; adapt research designs and blend methods to evaluate outcomes and processes; and establish collaborative research efforts across implementation, policy, and research domains. Doing so will expand opportunities for learning and applying new knowledge in pragmatic research paradigms where research is embedded in usual implementation conditions and addresses critical issues such as scale up and sustainability of evidence-informed FP interventions.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020199353.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States,Correspondence: Colin Baynes
| | - Petrus Steyn
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Aneth Dinis
- Department of Global Health, University of Washington, Seattle, WA, United States,The National Directorate of Public Health, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Stelio Tembe
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Hedieh Mehrtash
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States,Department of Epidemiology, University of Washington, Seattle, WA, United States,Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
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15
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Borg SA, Narasimhan M, Wuliji T. Mobile learning to support health workers in pharmacies in expanding access to over-the-counter contraceptives: The World Health Organization Academy Learning Programme. Sex Reprod Health Matters 2022; 30:2089084. [PMID: 36799365 PMCID: PMC9946328 DOI: 10.1080/26410397.2022.2089084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Sarah Ann Borg
- Consultant, Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, World Health Organization, Geneva, Switzerland
| | - Tana Wuliji
- Technical Officer, Department of Health Workforce, World Health Organization, Geneva, Switzerland
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16
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Narasimhan M, Aujla M, Van Lerberghe W. Self-care interventions and practices as essential approaches to strengthening health-care delivery. Lancet Glob Health 2022; 11:e21-e22. [PMID: 36306809 PMCID: PMC9597558 DOI: 10.1016/s2214-109x(22)00451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, WHO, 1211 Geneva, Switzerland.
| | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, WHO, 1211 Geneva, Switzerland
| | - Wim Van Lerberghe
- Department of Health Systems Policies and Workforce, WHO, 1211 Geneva, Switzerland
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17
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Lewis EMA, Chapman G, Kaushik K, Determan J, Antony I, Meganathan K, Narasimhan M, Gontarz P, Zhang B, Kroll KL. Regulation of human cortical interneuron development by the chromatin remodeling protein CHD2. Sci Rep 2022; 12:15636. [PMID: 36115870 PMCID: PMC9482661 DOI: 10.1038/s41598-022-19654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Mutations in the chromodomain helicase DNA binding protein 2 (CHD2) gene are associated with neurodevelopmental disorders. However, mechanisms by which CHD2 regulates human brain development remain largely uncharacterized. Here, we used a human embryonic stem cell model of cortical interneuron (hcIN) development to elucidate its roles in this process. We identified genome-wide CHD2 binding profiles during hcIN differentiation, defining direct CHD2 targets related to neurogenesis in hcIN progenitors and to neuronal function in hcINs. CHD2 bound sites were frequently coenriched with histone H3 lysine 27 acetylation (H3K27ac) and associated with high gene expression, indicating roles for CHD2 in promoting gene expression during hcIN development. Binding sites for different classes of transcription factors were enriched at CHD2 bound regions during differentiation, suggesting transcription factors that may cooperatively regulate stage-specific gene expression with CHD2. We also demonstrated that CHD2 haploinsufficiency altered CHD2 and H3K27ac coenrichment on chromatin and expression of associated genes, decreasing acetylation and expression of cell cycle genes while increasing acetylation and expression of neuronal genes, to cause precocious differentiation. Together, these data describe CHD2 direct targets and mechanisms by which CHD2 prevents precocious hcIN differentiation, which are likely to be disrupted by pathogenic CHD2 mutation to cause neurodevelopmental disorders.
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Affiliation(s)
- E M A Lewis
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - G Chapman
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - K Kaushik
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - J Determan
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - I Antony
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - K Meganathan
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - M Narasimhan
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - P Gontarz
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - B Zhang
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - K L Kroll
- Department of Developmental Biology, Washington University School of Medicine, Saint Louis, MO, 63110, USA.
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18
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Ammerdorffer A, Laws M, Narasimhan M, Lucido B, Kijo A, Say L, Awiligwe A, Chinery L, Gülmezoglu AM. Reclassifying contraceptives as over-the-counter medicines to improve access. Bull World Health Organ 2022; 100:503-510. [PMID: 35923274 PMCID: PMC9306387 DOI: 10.2471/blt.21.287561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
Self-care interventions include over-the-counter contraceptives, which enable individuals to make informed, autonomous decisions about fertility management. As there is a substantial unmet need for contraception in many countries, increasing access by establishing sound, affordable and effective regulation of over-the-counter contraceptives could help reduce unintended pregnancies and improve maternal health. We performed a review of 30 globally diverse countries: (i) to assess national regulatory procedures for changing oral contraceptives, emergency contraceptives and injectable contraceptives from prescription-only to over-the-counter products; and (ii) to determine whether national lists of over-the-counter medicines included contraceptives. Of the 30 countries, 13 (43%) had formal regulatory procedures in place for changing prescription-only medicines to over-the-counter medicines, 11 (36%) had national lists of over-the-counter medicines, and four (13%) included contraceptives on those lists. Changing from prescription-only to over-the-counter medicines presents challenges for national medicines regulatory authorities and manufacturers, involving, for example, reporting side-effects, quality control and the often poorly-defined process of switching to over-the-counter products. To facilitate the over-the-counter availability of contraceptives, countries should consider adopting a formal regulatory procedure for reclassifying prescription-only contraceptives as over-the-counter contraceptives. Although the availability of over-the-counter contraceptives can increase users’ independence and anonymity and improve access, there may also be disadvantages, such as higher out-of-pocket costs and the need for accurate self-assessment. Basic remedial actions to improve, harmonize and standardize regulatory procedures for the reclassification of contraceptives are proposed with the aim of enabling national medicines regulatory authorities to manage the switch to over-the-counter contraceptives and to control their quality.
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Affiliation(s)
- Anne Ammerdorffer
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Mark Laws
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Agnes Kijo
- Regulatory Convergence and Networks Team, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Arinze Awiligwe
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Lester Chinery
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - A Metin Gülmezoglu
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
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19
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Malama K, Logie CH, Narasimhan M, Ouedraogo L, Asmani C, Elamin H, van de Merwe LLA, Hopkins J, Bukusi EA. Short Communication: Awareness of HIV Self-Care Interventions Across Global Regions: Results from a Values and Preferences Survey. AIDS Res Hum Retroviruses 2022; 38:645-648. [PMID: 35579954 PMCID: PMC9419936 DOI: 10.1089/aid.2021.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The high burden of HIV in sub-Saharan Africa places significant demands on health care services. Interventions such as HIV self-testing, and pre- and post-exposure prophylaxis (PrEP and PEP) could empower individuals to determine their HIV status and prevent HIV acquisition. In 2018, the World Health Organization disseminated an online, anonymous, global values and preferences survey to adults 18 years of age and older. The survey aimed to inform guidance on awareness, use, and preferences around self-care interventions for sexual and reproductive health. We conducted a cross-sectional analysis using Pearson's chi-squared test to compare awareness of HIV self-testing, PrEP and PEP across five global regions. Our analysis included 814 participants from 110 countries. We noted that respondents from Africa reported higher awareness of HIV interventions than participants from Europe, Latin America and the Caribbean, North America, and Asia. Our finding highlights an opportunity to expand self-care interventions for HIV prevention and management in Africa.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Address correspondence to: Kalonde Malama, MPH, PhD, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto M5S 1V4, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, 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, Geneva, Switzerland, World Health Organization, Geneva, Switzerland
| | - Léopold Ouedraogo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chilanga Asmani
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Hafya Elamin
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | - L. Leigh-Ann van de Merwe
- Social Health Empowerment, Feminist Collective of Transgender Women of Africa, East London, South Africa
| | | | - Elizabeth Anne Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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20
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Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, Tunçalp Ö, Gomez Ponce de Leon R, Narasimhan M. Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review. BMC Pregnancy Childbirth 2022; 22:454. [PMID: 35641913 PMCID: PMC9152837 DOI: 10.1186/s12884-022-04751-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes. METHODS We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP. RESULTS We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs. CONCLUSION Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021233839 .
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dong Keun Rhee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chloe A Zera
- Department of Obstetrics and Gynecology, Harvard Medical Faculty Physicians, Boston, MA, USA
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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21
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Abstract
Jon Hopkins and Manjulaa Narasimhan examine the barriers to self-care for people experiencing homelessness and how to overcome them
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Affiliation(s)
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, 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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22
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Atkins K, Kennedy CE, Yeh PT, Narasimhan M. Over-the-counter provision of emergency contraceptive pills: a systematic review. BMJ Open 2022; 12:e054122. [PMID: 35288384 PMCID: PMC8921871 DOI: 10.1136/bmjopen-2021-054122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions. DESIGN Systematic review (PROSPERO# CRD42021231625). ELIGIBILITY CRITERIA We included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs. DATA SOURCES We searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020. RISK OF BIAS For trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool. DATA EXTRACTION AND SYNTHESIS We summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data. RESULTS We included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs. CONCLUSION OTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.
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Affiliation(s)
- Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kennedy CE, Yeh PT, Gholbzouri K, Narasimhan M. Self-testing for pregnancy: a systematic review and meta-analysis. BMJ Open 2022; 12:e054120. [PMID: 35228285 PMCID: PMC8886405 DOI: 10.1136/bmjopen-2021-054120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and reproductive health and rights. We conducted a systematic review of pregnancy self-testing effectiveness, values and preferences and cost. DESIGN Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. DATA SOURCES PubMed, CINAHL, LILACS and EMBASE and four trial registries were searched through 2 November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included trials and observational studies that compared urine self-testing for pregnancy to health worker-led pregnancy testing on effectiveness outcomes; quantitative and qualitative studies describing values and preferences of end users and health workers and costs of pregnancy self-testing. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively. RESULTS For effectiveness, four randomised trials following 5493 individuals after medical abortion showed no difference or improvements in loss to follow-up with home pregnancy self-testing compared with return clinic visits. One additional trial of community health workers offering home pregnancy tests showed a significant increase in pregnancy knowledge and antenatal counselling among 506 clients. Eighteen diverse values and preferences studies found support for pregnancy self-testing because of quick results, convenience, confidentiality/privacy, cost and accuracy. Most individuals receiving pregnancy self-tests for postabortion home management preferred this option. No studies reported cost data. CONCLUSION Pregnancy self-testing is acceptable and valued by end users. Effectiveness data come mostly from articles on postabortion care, and cost data are lacking. Greater availability of pregnancy self-tests, including in postabortion care and CHW programs, may lead to improved health outcomes. PROSPERO REGISTRATION NUMBER CRD42021231656.
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Affiliation(s)
- Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karima Gholbzouri
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Abstract
INTRODUCTION Novel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users. METHODS We conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies. RESULTS No studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six 'case studies' presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would 'definitely recommend' the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA. CONCLUSION Provision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals. PROSPERO REGISTRATION NUMBER CRD42021231650.
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Affiliation(s)
- Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Ferguson
- Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Rachel Baggaley
- Department of HIV, Viral Hepatitis, and STIs, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Logie CH, Berry I, Ferguson L, Malama K, Donkers H, Narasimhan M. Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey. Sex Reprod Health Matters 2022; 29:2009104. [PMID: 35100942 PMCID: PMC8812803 DOI: 10.1080/26410397.2021.2009104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Self-care interventions hold the potential to improve sexual and reproductive health (SRH) and well-being. Yet key knowledge gaps remain regarding how knowledge and uptake vary across different types of self-care interventions. There is also limited understanding of health workers’ confidence in promoting SRH self-care interventions, and how this may differ based on personal uptake experiences. To address these knowledge gaps, we conducted a web-based cross-sectional survey among health workers and laypersons from July to November 2018. We investigated the following information about SRH self-care interventions: knowledge and uptake; decisions for use; and associations between health workers’ uptake and providing prescriptions, referrals, and/or information for these interventions. Participants (n = 837) included laypersons (n = 477) and health workers (n = 360) from 112 countries, with most representation from the WHO European Region (29.2%), followed by the Americas (28.4%) and African (23.2%) Regions. We found great heterogeneity in knowledge and uptake by type of SRH self-care intervention. Some interventions, such as oral contraception, were widely known in comparison with interventions such as STI self-sampling. Across interventions, participants perceived benefits of privacy, convenience, and accessibility. While pharmacies and doctors were preferred access points, this varied by type of self-care intervention. Health workers with knowledge of the self-care intervention, and who had themselves used the self-care intervention, were significantly more likely to feel confident in, and to have provided information or referrals to, the same intervention. This finding signals that health workers can be better engaged in learning about self-care SRH interventions and thereby become resources for expanding access.
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Affiliation(s)
- Carmen H Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence: .,Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Isha Berry
- Doctoral Candidate, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laura Ferguson
- Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Kalonde Malama
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Holly Donkers
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, 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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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. Womens Health (Lond Engl) 2022; 18:17455057221090829. [PMID: 35435062 PMCID: PMC9019372 DOI: 10.1177/17455057221090829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Ferguson L, Narasimhan M. Centring rights-based access to self-care interventions. Sex Reprod Health Matters 2022; 29:2138053. [PMID: 36368037 PMCID: PMC9662043 DOI: 10.1080/26410397.2022.2138053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Ferguson L, Narasimhan M, Gutierrez J, Jardell W, Gruskin S. Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health. Sex Reprod Health Matters 2022; 29:2105284. [PMID: 35975874 PMCID: PMC9387312 DOI: 10.1080/26410397.2022.2105284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Self-care interventions for health are becoming increasingly available, and among the preferred options, including during the COVID-19 pandemic. This research assessed the extent of attention to laws and policies, human rights and gender in the implementation of self-care interventions for sexual and reproductive health (SRH), to identify where additional efforts to ensure an enabling environment for their use and uptake will be useful. A literature review of relevant studies published between 2010 and 2020 was conducted using PubMed, Scopus and Web of Science. Relevant data were systematically abstracted from 61 articles. In March–April 2021, semi-structured interviews were conducted with 10 key informants, selected for their experience implementing self-care interventions for SRH, and thematically analysed. Laws and policies, rights and gender are not being systematically addressed in the implementation of self-care interventions for SRH. Within countries, there is varied attention to the enabling environment including the acceptability of interventions, privacy, informed consent and gender concerns as they impact both access and use of specific self-care interventions, while other legal considerations appear to have been under-prioritised. Operational guidance is needed to develop and implement supportive laws and policies, as well as to ensure the incorporation of rights and gender concerns in implementing self-care interventions for SRH.
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Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| | - Jose Gutierrez
- Student, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- Project Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Professor of Population and Public Health Sciences and Law, Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Narasimhan M, Logie CH, Gauntley A, Gomez Ponce de Leon R, Gholbzouri K, Siegfried N, Abela H, Ouedraogo L. Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage. Sex Reprod Health Matters 2021; 28:1778610. [PMID: 32530386 PMCID: PMC7887951 DOI: 10.1080/26410397.2020.1778610] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
WHO's normative guidance on self-care interventions for sexual and reproductive health and rights (SRHR) promotes comprehensive, integrated and people-centred approaches to health service delivery. Implementation of self-care interventions within the context of human rights, gender equality, and a life course approach, offers an underused opportunity to improve universal health coverage (UHC) for all. Results from an online global values and preferences survey provided lay persons' and healthcare providers' perspectives on access, acceptability, and implementation considerations. This analysis examines 326 qualitative responses to open-ended questions from healthcare providers (n = 242) and lay persons (n = 70) from 77 countries. Participants were mostly women (66.9%) and were from the Africa (34.5%), America (32.5%), South-East Asia (5.6%), European (19.8%), Eastern Mediterranean (4.8%), and Western Pacific regions (2.8%). Participants perceived multiple benefits of self-care interventions for SRHR, including: reduced exposure to stigma, discrimination and access barriers, increased confidentiality, empowerment, self-confidence, and informed decision-making. Concerns include insufficient knowledge, affordability, and possible side-effects. Implementation considerations highlighted the innovative approaches to linkages with health services. Introduction of self-care interventions is a paradigm shift in health care delivery bridging people and communities through primary health care to reach UHC. Self-care interventions can be leveraged by countries as gateways for reaching more people with quality, accessible and equitable services that is critical for achieving UHC. The survey results underscored the urgent need to reduce stigma and discrimination, increase access to and improve knowledge of self-care interventions for SRHR for laypersons and healthcare providers to advance SRHR.
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Affiliation(s)
- Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Carmen H Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Alice Gauntley
- Research Assistant, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | | | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Heather Abela
- Research Assistant, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Leopold Ouedraogo
- Regional Advisor, Reproductive and Women's Health (RWH), AFRO, Brazzaville, Congo
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King SE, Yeh PT, Rhee DK, Tuncalp Ö, Rogers LM, Narasimhan M. Self-management of iron and folic acid supplementation during pre-pregnancy, pregnancy and postnatal periods: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-005531. [PMID: 33990359 PMCID: PMC8127969 DOI: 10.1136/bmjgh-2021-005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction While the use of folic acid pre-pregnancy and iron and folic acid (IFA) during pregnancy and postnatal have been demonstrated to be effective and are recommended interventions by WHO, ensuring individuals adhere to the supplementation regimen can be a challenge. Self-care interventions that support an individual’s ability to promote their own health with or without the support of health workers could help promote the uptake and adherence to supplementation. This systematic review assessed the evidence around self-management of IFA or folic acid supplementation accessed over-the-counter during pre-pregnancy, pregnancy and postnatal periods. Methods Peer-reviewed studies were included if they compared self-management of IFA or folic acid supplementation with health worker-initiated supplement use on maternal and/or fetal and newborn health outcomes, end-users’ or health workers’ values and preferences, or cost and/or cost-effectiveness. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through November 2020, hand-searched clinical trial registries, reviewed databases and contacted experts in the field. Abstract screening and full-text review were conducted independently by two reviewers. Results Overall, 2344 results were identified, and 28 studies were identified for full-text review. All studies were excluded, as they were not primary research, lacked the outcomes of interest, lacked specificity in supplement type, and/or lacked a comparison group. Conclusion No evidence was identified that distinguishes self-management of folic acid supplements pre-pregnancy and of IFA supplements during pregnancy and postnatal, highlighting a gap in our current understanding of self-care related to dietary supplementation in pregnancy. The findings of this review identify an area for further research to support the current movement towards self-care interventions as an added choice to help individuals more fully attain their reproductive health and rights. Systematic review registration number PROSPERO CRD42020205548
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Affiliation(s)
- Shannon E King
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dong Keun Rhee
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Özge Tuncalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, Geneva, Switzerland
| | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, Geneva, Switzerland
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31
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Nishimura H, Yeh PT, Oguntade H, Kennedy CE, Narasimhan M. HPV self-sampling for cervical cancer screening: a systematic review of values and preferences. BMJ Glob Health 2021; 6:e003743. [PMID: 34011537 PMCID: PMC8137189 DOI: 10.1136/bmjgh-2020-003743] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The WHO recommends human papillomavirus (HPV) cervical self-sampling as an additional screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer for women aged ≥30 years. This systematic review assesses end user's values and preferences related to HPV self-sampling. METHODS We searched four electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Embase) using search terms for HPV and self-sampling to identify articles meeting inclusion criteria. A standardised data extraction form was used to capture study setting, population, sample size and results related to values and preferences. RESULTS Of 1858 records retrieved, 72 studies among 52 114 participants published between 2002 and 2018 were included in this review. Almost all studies were cross-sectional surveys. Study populations included end users who were mainly adolescent girls and adult women. Ages ranged from 14 to 80 years. Most studies (57%) were conducted in high-income countries. Women generally found HPV self-sampling highly acceptable regardless of age, income or country of residence. Lack of self-confidence with collecting a reliable sample was the most commonly cited reason for preferring clinician-collected samples. Most women preferred home-based self-sampling to self-sampling at a clinic. The cervical swab was the most common and most accepted HPV DNA sampling device. CONCLUSIONS HPV self-sampling is generally a highly accepted method of cervical cancer screening for end users globally. End user preferences for self-sampling device, method and setting can inform the development of new and expanded interventions to increase HPV screening.
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Affiliation(s)
- Holly Nishimura
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Habibat Oguntade
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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Narasimhan M, Logie CH, Moody K, Hopkins J, Montoya O, Hardon A. The role of self-care interventions on men's health-seeking behaviours to advance their sexual and reproductive health and rights. Health Res Policy Syst 2021; 19:23. [PMID: 33596921 PMCID: PMC7888093 DOI: 10.1186/s12961-020-00655-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Self-care interventions are influencing people's access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men's health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. MAIN TEXT A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men's lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men's health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. CONCLUSION Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men's engagement with health services and with their own self care practices.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | | | | | - Oswaldo Montoya
- MenEngage Alliance Global Secretariat, 1875 Connecticut Avenue. Floor 10, Washington, D.C., 20009, United States of America
| | - Anita Hardon
- Institute for Advanced Studies and Anthropology Department, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
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Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
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Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Kennedy CE, Yeh PT, Li J, Gonsalves L, Narasimhan M. Lubricants for the promotion of sexual health and well-being: a systematic review. Sex Reprod Health Matters 2021; 29:2044198. [PMID: 35315312 PMCID: PMC8942543 DOI: 10.1080/26410397.2022.2044198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AbstractPromoting sexual health is a World Health Organization (WHO) priority. Lubricants are widely available and used to improve sexual pleasure and reduce pain during intercourse. To inform WHO's self-care interventions guideline, we conducted a systematic review of the peer-reviewed literature to answer the question: does use of lubricants during or prior to sex result in improved sexual health and well-being. We searched PubMed, CINAHL, LILACS and EMBASE on 8 July 2020 for effectiveness, values and preferences, and cost data related to commercially available vaginal and anal lubricants. Data were systematically extracted and qualitatively synthesised. Effectiveness evidence was summarised in GRADE evidence profiles. Seven studies met the effectiveness review criteria. Two randomised trials found lubricant use led to improved female sexual well-being and had no impact on incidence of human papillomavirus (moderate certainty evidence). One observational study with gay and bisexual men showed lubricants were associated with increased reports of pain during receptive intercourse and no difference in pain during insertive intercourse, but a reduced degree of pain in both types of intercourse (low/very low certainty evidence). One observational study with female breast cancer survivors found better outcomes of vaginal dryness and dyspareunia with lubricant use (very low certainty evidence). Twenty-one values and preferences studies from diverse populations globally found that most individuals supported lubricant use for reasons of comfort/reduced pain and sexual pleasure. No cost studies were identified. Although evidence is limited, lubricants appear to offer an acceptable approach to improving sexual health and well-being.
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Affiliation(s)
- Caitlin E Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Correspondence:
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jingjia Li
- Research Assistant, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lianne Gonsalves
- Technical Officer, Department of Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP), Geneva, Switzerland
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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: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Logie C, Okumu M, Abela H, Wilson D, Narasimhan M. Sexual and reproductive health mobile apps: results from a cross-sectional values and preferences survey to inform World Health Organization normative guidance on self-care interventions. Glob Health Action 2020; 13:1796346. [PMID: 32778000 PMCID: PMC7480537 DOI: 10.1080/16549716.2020.1796346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mobile application (app) platforms have the potential to advance sexual and reproductive health (SRH). Yet there is a dearth of knowledge regarding global perspectives from healthcare providers on how SRH mobile apps are being leveraged in their healthcare practice. In 2019 the World Health Organization (WHO) developed a consolidated guideline on self-care interventions for SRH. To inform this guideline, we conducted a global values and preferences survey. This study aimed to (a) understand the awareness, access, and uptake of SRH mobile apps; (b) examine how many healthcare provider (HCP) participants provided linkages, referrals and information to clients regarding SRH mobile apps; and (c) among HCP, assess how many felt confident and informed regarding SRH mobile apps. We hosted a cross-sectional web-based survey on the WHO Department of Reproductive Health and Research website and shared the survey with SRHR listservs. There were 825 survey participants, 360 whom identified as healthcare providers (HCP). Approximately one-third of HCP participants had provided a referral/information to their clients about sexual or reproductive health apps. While 40.8% of HCP felt confident and informed about sexual health apps, half (47.4%) reported needing more information, and 15.6% expressed interest in receiving training to use in practice. While 42.6% of HCPs felt confident and informed about reproductive health apps, 45.7% needed more information, and 15.1% were interested in further training. There was also an open-ended question for HCP to share their thoughts about self-care SRH interventions. Specifically regarding SRH apps, HCP responses revealed the importance of considering: (a) security and confidentiality; (b) potential benefits of SRH apps for underserved groups (i.e. youth, rural communities); (c) community engagement; (d) health benefits; and (e) and online training for HCP on SRH mobile apps. Findings signal interest and opportunities for training and engaging HCP in using mobile apps to advance SRH.
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Affiliation(s)
- Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, ON, Canada
| | - Moses Okumu
- School of Social Work, University of North Carolina , Chapel Hill, NC, USA
| | - Heather Abela
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, ON, Canada
| | - David Wilson
- Health, Nutrition, and Population Global Practice, World Bank , Washington, DC, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization , Geneva, Switzerland
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Mayhew SH, Warren CE, Ndwiga C, Narasimhan M, Wilcher R, Mutemwa R, Abuya T, Colombini M. Health systems software factors and their effect on the integration of sexual and reproductive health and HIV services. Lancet HIV 2020; 7:e711-e720. [PMID: 33010243 DOI: 10.1016/s2352-3018(20)30201-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Rose Wilcher
- Knowledge Management and Structural Interventions, HIV Unit, FHI 360, Durham, NC, USA
| | - Richard Mutemwa
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | | | - Manuela Colombini
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Gülmezoglu AM, Ammerdorffer A, Narasimhan M, Wilson AN, Vogel JP, Say L, Tunçalp Ö. Correction to: Self-care and remote care during pregnancy: a new paradigm? Health Res Policy Syst 2020; 18:119. [PMID: 33046104 PMCID: PMC7552382 DOI: 10.1186/s12961-020-00641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Manjulaa Narasimhan
- UNDP/UNFPA/UNICEF/WHO/ World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/ World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/ World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Gülmezoglu AM, Ammerdorffer A, Narasimhan M, Wilson AN, Vogel JP, Say L, Tunçalp Ö. Self-care and remote care during pregnancy: a new paradigm? Health Res Policy Syst 2020; 18:107. [PMID: 32948188 PMCID: PMC7499941 DOI: 10.1186/s12961-020-00627-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
Self-care interventions and remote care offer innovative and equitable ways to strengthen access to sexual and reproductive health services. Self-isolation during COVID-19 provided the opportunity for obstetric facilities and healthcare providers to integrate and increase the usage of interventions for self-care and remote care for pregnant women and to improve the quality of care overall.
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Affiliation(s)
| | | | - Manjulaa Narasimhan
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Siegfried N, Narasimhan M, Logie CH, Thomas R, Ferguson L, Moody K, Remme M. Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights. BMJ Glob Health 2020; 5:e002128. [PMID: 32337081 PMCID: PMC7170423 DOI: 10.1136/bmjgh-2019-002128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/28/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction In January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised. Methods We expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases. Results We identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations. Conclusion A framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.
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Affiliation(s)
- Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Rebekah Thomas
- Guideline Review Committee Secretariat (Science Division), World Health Organization, Geneva, Switzerland
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kevin Moody
- Independent Consultant, Amsterdam, The Netherlands
| | - Michelle Remme
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
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Logie CH, Okumu M, Mwima S, Hakiza R, Irungi KP, Kyambadde P, Kironde E, Narasimhan M. Social ecological factors associated with experiencing violence among urban refugee and displaced adolescent girls and young women in informal settlements in Kampala, Uganda: a cross-sectional study. Confl Health 2019; 13:60. [PMID: 31867053 PMCID: PMC6918605 DOI: 10.1186/s13031-019-0242-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Research on violence targeting urban forcibly displaced adolescent girls and young women (AGYW) is limited, particularly regarding polyvictimization (exposure to multiple forms of violence). Yet there is a global trend of refugee urbanization, and urban AGYW are at the nexus of violence disparities among adolescents, forcibly displaced persons, and slum dwellers. This study explored factors associated with young adulthood violence (> 16 years) (YAV) and intimate partner violence (IPV) among forcibly displaced AGYW in Kampala, Uganda. METHODS We conducted a cross-sectional survey with forcibly displaced AGYW aged 16-24 from five informal settlement (slum) communities across Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) using peer network sampling. We assessed YAV (experienced at age 16 or above) (sexual, physical, emotional violence) and recent (past 12-month) IPV (physical, sexual, control violence). We conducted descriptive statistics, followed by multinomial logistic regression analyses to explore social ecological factors (e.g., intrapersonal: depression; interpersonal: sexual relationship power, community: food insecurity) associated with experiencing YAV and YAV polyvictimization, and IPV and IPV polyvictimization. RESULTS Over half of participants (n = 333; mean age = 19.31; SD = 2.56, range = 16-24) reported YAV (n = 179; 53.7%) and 9.3% (n = 41) reported YAV polyvictimization. Most participants that were in an intimate relationship in the last 12 months (n = 200; 85.8%) reported IPV, among these, 45.5% reported one form of IPV and 54.5% reported IPV polyvictimization. In adjusted analyses, experiencing any YAV was significantly associated with: adolescent sexual and reproductive health (SRH) stigma; sexual relationship power; mobile app usage; depressive symptoms; childhood abuse; and childhood polyvictimization. In adjusted analyses YAV polyvictimization was associated with: depressive symptoms; childhood polyvictimization; sexual relationship power; and food insecurity. Recent IPV polyvictimization in adjusted analyses was associated with owning/using a mobile phone and depressive symptoms. Participants with higher sexual relationship power had lower odds of recent IPV polyvictimization. CONCLUSION Findings suggest that YAV and IPV polyvictimization require urgent attention among forcibly displaced AGYW in Kampala. Multi-level strategies are required to address intrapersonal e.g. (depression), interpersonal (e.g. childhood abuse, sexual relationship power) and community (e.g. adolescent SRH stigma, food insecurity) factors associated with experiencing violence. Future research can tailor approaches to advance health, agency and human rights among urban forcibly displaced AGYW.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON M5G 1N8 Canada
| | - Moses Okumu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- School of Social Work, University of North Carolina-Chapel Hill, 325 Pittsboro ST CB#3550, Chapel Hill, NC 27599 USA
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
| | - Simon Mwima
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | - Robert Hakiza
- Most At Risk Population Initiative, Kampala, Uganda
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | | | - Peter Kyambadde
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH-1211, 27 Geneva, Switzerland
- World Health Organization, Department of Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme (HRP), Geneva, Switzerland
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42
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Abstract
BACKGROUND Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. METHODS We conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017. RESULTS Of 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes. CONCLUSIONS Global progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Yeh PT, Kennedy CE, de Vuyst H, Narasimhan M. Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001351. [PMID: 31179035 PMCID: PMC6529022 DOI: 10.1136/bmjgh-2018-001351] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Human papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment. Methods The included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR). Results 33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events. Conclusion A growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment. Systematic review registration number PROSPERO CRD42018114871.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hugo de Vuyst
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France.,Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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Yeh PT, Kennedy CE, Van der Poel S, Matsaseng T, Bernard L, Narasimhan M. Should home-based ovulation predictor kits be offered as an additional approach for fertility management for women and couples desiring pregnancy? A systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001403. [PMID: 31139458 PMCID: PMC6509595 DOI: 10.1136/bmjgh-2019-001403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction To inform the WHO Guideline on self-care interventions, we conducted a systematic review of the impact of ovulation predictor kits (OPKs) on time-to-pregnancy, pregnancy, live birth, stress/anxiety, social harms/adverse events and values/preferences. Methods Included studies had to compare women desiring pregnancy who managed their fertility with and without OPKs, measure an outcome of interest and be published in a peer-reviewed journal. We searched for studies on PubMed, CINAHL, LILACS and EMBASE through November 2018. We assessed risk of bias assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for observational studies, and conducted meta-analysis using random effects models to generate pooled estimates of relative risk (RR). Results Four studies (three RCTs and one observational study) including 1487 participants, all in high-income countries, were included. Quality of evidence was low. Two RCTs found no difference in time-to-pregnancy. All studies reported pregnancy rate, with mixed results: one RCT from the 1990s among couples with unexplained or male-factor infertility found no difference in clinical pregnancy rate (RR: 1.09, 95% CI 0.51 to 2.32); two more recent RCTs found higher self-reported pregnancy rates among OPK users (pooled RR: 1.40, 95% CI 1.08 to 1.80). A small observational study found higher rates of pregnancy with lab testing versus OPKs among women using donor insemination services. One RCT found no increase in stress/anxiety after two menstrual cycles using OPKs, besides a decline in positive affect. No studies measured live birth or social harms/adverse events. Six studies presented end-users’ values/preferences, with almost all women reporting feeling satisfied, comfortable and confident using OPKs. Conclusion A small evidence base, from high-income countries and with high risk of bias, suggests that home-based use of OPKs may improve fertility management when attempting to become pregnant with no meaningful increase in stress/anxiety and with high user acceptability. Systematic review registration number PROSPERO registration number CRD42019119402.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Thabo Matsaseng
- Reproductive Medicine Unit, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Genève, Switzerland
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45
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Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001349. [PMID: 31139454 PMCID: PMC6509609 DOI: 10.1136/bmjgh-2018-001349] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Self-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services. Methods Peer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR). Results Eleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour. Discussion While greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake. Prospero registration number PROSPERO CRD42018114866.
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Affiliation(s)
- Yasmin Ogale
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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46
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Kennedy CE, Yeh PT, Gaffield ML, Brady M, Narasimhan M. Self-administration of injectable contraception: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001350. [PMID: 31179026 PMCID: PMC6528768 DOI: 10.1136/bmjgh-2018-001350] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) may facilitate self-administration and expand contraceptive access. To inform WHO guidelines on self-care interventions, we conducted a systematic review and meta-analysis comparing self-administration versus provider administration of injectable contraception on outcomes of pregnancy, side effects/adverse events, contraceptive uptake, contraceptive continuation, self-efficacy/empowerment and social harms. Methods We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, LILACS and EMBASE in September 2018 for peer-reviewed studies comparing women who received injectable contraception with the option of self-administration with women who received provider-administered injectable contraception on at least one outcome of interest. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR). Results Six studies with 3851 total participants met the inclusion criteria: three RCTs and three controlled cohort studies. All studies examined self-injection of DMPA-SC; comparison groups were either provider-administered DMPA-SC or provider-administered intramuscular DMPA. All studies followed women through 12 months of contraceptive coverage and measured (dis)continuation of injectable contraception. Meta-analysis found higher rates of continuation with self-administration compared with provider administration in three RCTs (RR: 1.27, 95% CI 1.16 to 1.39) and three controlled cohort studies (RR: 1.18, 95% CI 1.10 to 1.26). Four studies reported pregnancies; all showed no difference across study arms. Four studies reported side effects/adverse events; while two controlled cohort studies showed increased injection site reactions with self-administration, no other side effects increased with self-administration. One study found no difference in social harms. No studies reported measuring uptake or self-efficacy/empowerment. Conclusion A growing evidence base suggests that self-administration of DMPA-SC can equal or improve contraceptive continuation rates compared with provider administration. This benefit comes without notable increases in pregnancy or safety concerns. Self-injection of DMPA-SC is a promising approach to increasing contraceptive use.
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Affiliation(s)
- Caitlin E Kennedy
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Lyn Gaffield
- Human Reproduction Programme (HRP), Organisation mondiale de la Sante, Geneve, Switzerland
| | | | - Manjulaa Narasimhan
- Human Reproduction Programme (HRP), World Health Organization, Geneva, Switzerland
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47
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Abstract
Empowering and supporting people to manage their own health benefits everyone
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Affiliation(s)
| | | | - Ian Askew
- World Health Organization, Geneva, Switzerland
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48
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Abstract
A safe and sustainable waste management system for self care products requires education and multisectoral approaches say Ash Pachauri and colleagues
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Affiliation(s)
- Ash Pachauri
- Center for Human Progress, Ashburn, Virginia 20148, USA
| | - Prerna Shah
- Protect our Planet (POP) Movement, G-1, Jangpura Extension, New Delhi, India
| | - Bethanie C Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Norma P M Sevilla
- Interdisciplinary Center for Research and Studies on Environment and Development, National Polytechnic Institute, Mexico City, Mexico
| | - Manjulaa Narasimhan
- World Health Organization, including UNDP/UNFPA/Unicef/WHO/World Bank Special Programme (HRP), Geneva, Switzerland
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49
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Abstract
Ethnographic studies examining how women manage their sexual and reproductive health can inform strategies to address unmet needs, say Anita Hardon and colleagues
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Affiliation(s)
- Anita Hardon
- Centre for Social Science and Global Health, University of Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Efenita Taqueban
- Department of Anthropology, University of the Philippines, Diliman, Quezon City, Philippines
| | - Manjulaa Narasimhan
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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50
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Remme M, Narasimhan M, Wilson D, Ali M, Vijayasingham L, Ghani F, Allotey P. Self care interventions for sexual and reproductive health and rights: costs, benefits, and financing. BMJ 2019; 365:l1228. [PMID: 30936210 PMCID: PMC6441864 DOI: 10.1136/bmj.l1228] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Remme
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | | | - Moazzam Ali
- Department of Reproductive Health and Research, and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Lavanya Vijayasingham
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Fatima Ghani
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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