Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa.

OBJECTIVE: To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings. DESIGN: Nationally representative survey of clinicians. SETTING: HIV-prevalent settings in South Africa and Zimbabwe. POPULATION: Clinicians in South Africa and Zimbabwe. METHODS: Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. MAIN OUTCOME MEASURE: Multivariable logistic regression of contraceptive provision and clinician training needs. RESULTS: Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians' perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. CONCLUSIONS: Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.

Safety parameters for avoiding acute ocular damage from the reflected CO2 (10.6 microns) laser beam.

Reflections from instruments in the surgical field involving the CO2 laser beam present a serious ocular hazard. In addition to the use of plastic or glass protective eyewear, this hazard can be minimized by utilizing anodized instruments and recognizing the specific distances at which various reflections are no longer hazardous depending upon certain variables, including laser output wattage, emergent beam lengths, and surface characteristics of the reflecting instruments.

Embedded foreign bodies presenting as earlobe keloids.

We present a case report of a young woman who developed earlobe nodules subsequent to the piercing of her ears. Clinically the nodules appeared to be keloids. Surgical intervention demonstrated the nodules to consist of the embedded backings of her pierced earrings.