RESUMO
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.
Assuntos
Autocuidado , Saúde da Mulher , Humanos , Feminino , Pobreza , Direitos da MulherAssuntos
Infecções por HIV , United States Government Agencies , Humanos , África/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Estados Unidos , United States Government Agencies/economia , United States Government Agencies/organização & administração , Cooperação InternacionalRESUMO
Understanding the sexual relationships of young women is critical for preventing HIV infections. This study aimed to describe the sexual behaviour of partners, comparing the accuracy of sexual health knowledge between partners. The study took place in 2017 in KwaZulu-Natal, South Africa. Purposive sampling was used to select 18-27-year-old sexually active women. Consenting female participants completed a structured and semi-structured interview, while consenting male sexual partners identified through the female participant completed a structured questionnaire on sexual health information. Using a reflexive inductive approach and thematic analysis, we identified key discrepancies in the assumptions partners make about each other's sexual health information. Twenty-three sexual dyads were identified and four key discrepancies were identified: Age: partners either over or underestimated the age of their partners, HIV status: where partners were unaware of, or incorrectly assumed their partner's status, Lack of awareness of partner's concurrent relationships and more general knowledge of the partner's sexual health behaviours. Discussions about sexual health are mediated by relationship length, type of partner, power and perceived fidelity. While it is possible to undertake dyadic level research, ethical tensions remain. Sex-positive and egalitarian sexual health interventions that target the individual, as well as the sexual relationship, are needed.
Assuntos
Infecções por HIV , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Medição de Risco , Comportamento Sexual , Parceiros Sexuais , África do Sul/epidemiologia , Adulto JovemRESUMO
Elvin Geng and co-authors discuss monitoring and achieving equity in provision of vaccines for COVID-19.
Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Saúde Global/tendências , Equidade em Saúde/tendências , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , HumanosRESUMO
Michael Reid and co-authors introduce a Collection on the global health in the post-COVID-19 era.
Assuntos
Pesquisa Biomédica , COVID-19 , Defesa Civil , Controle de Doenças Transmissíveis , Saúde Global , Cooperação Internacional , Pesquisa Biomédica/organização & administração , Pesquisa Biomédica/tendências , COVID-19/economia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Defesa Civil/organização & administração , Defesa Civil/tendências , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/tendências , Saúde Global/normas , Saúde Global/tendências , Humanos , SARS-CoV-2 , Organização Mundial da SaúdeRESUMO
Reimbursement of trial participants remains a frequently debated issue, with specific guidance lacking. Trials combining post-trial access and implementation science may necessitate new strategies and models. CAPRISA 008, a post-trial access study testing the feasibility of using family planning services to rollout a prelicensure HIV prevention intervention, tried to balance the real-life scenario of no reimbursement for attendance at public sector clinics with that of a trial including some visits that focused on research procedures and others that focused on standard of care procedures. A reduced reimbursement was offered for 'standard of care' visits, meant primarily to cover transport costs to and from the clinic only. This impacted negatively on accrual, retention and participant morale, primarily due to the protracted delay in regulatory approval, during which time, the costs of living, including travel costs had increased. Relevant guidelines were reviewed and institutional policy was updated to incorporate the South African National Health Research Ethics Committee guidelines on reimbursement (taking into account participant time, travel and inconvenience). The reimbursement amount for 'standard of care' visits was increased accordingly. The question remains whether a trial that combines post-trial access with implementation science, with clear benefits for the participants and the provision of above standard medical care, should have reimbursement rates that approach those of a proof-of-concept trial, for 'standard of care' visits.
Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Acessibilidade aos Serviços de Saúde/ética , Mecanismo de Reembolso , Sujeitos da Pesquisa , Ensaios Clínicos como Assunto , Estudos de Viabilidade , Humanos , Mecanismo de Reembolso/ética , Mecanismo de Reembolso/normas , Mecanismo de Reembolso/tendências , Projetos de Pesquisa , África do SulRESUMO
INTRODUCTION: The provision of voluntary medical male circumcision (VMMC) services was piloted in three public sector facilities in a high HIV disease burden, low circumcision rate province in South Africa to inform policy and operational guidance for scale-up of the service for HIV prevention. We report on adverse events (AEs) experienced by clients following the circumcision procedure. METHODS: Prospective recruitment of HIV-negative males aged 12 and older volunteering to be circumcised at three select public health facilities in KwaZulu-Natal between November 2010 and May 2011. Volunteers underwent standardized medical screening including a physical assessment prior to the surgical procedure being performed. AEs were monitored at three time intervals over a 21-day period post-operatively to determine safety outcomes in this pilot demonstration programme. RESULTS: A total of 602 volunteers participated in this study. The median age of the volunteers was 22 years (range 12-56). Most participants (75.6%) returned for the 48-hour post-operative visit; 51.0% for day seven visit and 26.1% for the 21st day visit. Participants aged 20-24 were most likely to return. The AE rate was 0.2% intra-operatively. The frequency of moderate AEs was 0.7, 0.3 and 0.6% at 2-, 7- and 21-day visits, respectively. The frequency of severe AEs was 0.4, 0.3 and 0.6% at 2-, 7- and 21-day visits, respectively. Swelling and wound infection were the most common AEs with mean appearance duration of seven days. Clients aged between 35 and 56 years presented with most AEs (3.0%). CONCLUSIONS: VMMC can be delivered safely at resource-limited settings. The intensive three-visit post-operative review practice may be unfeasible due to high attrition rates over time, particularly amongst older men.
Assuntos
Circuncisão Masculina/efeitos adversos , Infecções por HIV/prevenção & controle , Adolescente , Adulto , Criança , Atenção à Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prática de Saúde Pública , África do Sul , Adulto JovemRESUMO
BACKGROUND: Adolescents in South Africa (SA) have a huge unmet need for sexual and reproductive health (SRH) services. Integrating such services into schools may overcome many of the current barriers to access. OBJECTIVES: We describe an SRH service model developed for high-school students and its implementation in 14 high schools in rural SA. METHODS: Following consultation with community and other key stakeholders about the demand for and acceptability of adolescent-targeted SRH services, a three-tier school-based model was developed that included: (i) in-school group SRH information and awareness sessions; (ii) in-school individual SRH counselling and customised HIV counselling and testing (CCT); and (iii) referrals to in-school fixed, in-school mobile or public sector primary SRH clinics. RESULTS: From October 2011 to June 2012, 70 consultative meetings were held. There was overwhelming support for the pilot founded on concerns about the high HIV prevalence and teenage pregnancy rates among adolescents in the community. SRH information was provided to 8 867 high-school students, 4 171 (47.0%) of whom accessed on-site CCT services for HIV. The gender-specific prevalence of HIV in these students was 3.3% (64/1 962) and 1.1% (24/2 209) for females and males, respectively. Two hundred and thirty-nine students (5.7%) were referred for clinical services at in-school fixed, in-school mobile or public sector primary SRH clinics. CONCLUSIONS: The SRH service provision pilot was acceptable in the community and seems feasible for scale-up. Further work is required to understand inter-school variability in uptake, identify additional service needs of students, and characterise SRH demand dynamics.
Assuntos
Infecções por HIV , Gravidez na Adolescência , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Escolar/organização & administração , Estudantes , Adolescente , Comportamento do Adolescente , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Modelos Organizacionais , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Gravidez na Adolescência/estatística & dados numéricos , Saúde da População Rural , Aconselhamento Sexual/métodos , Aconselhamento Sexual/organização & administração , Educação Sexual/métodos , Educação Sexual/organização & administração , Comportamento Sexual , África do Sul/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adulto JovemAssuntos
Fármacos Anti-HIV/uso terapêutico , Epidemias/ética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/ética , Prevenção Primária/ética , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/uso terapêutico , Países em Desenvolvimento , Epidemias/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Humanos , Prevenção Primária/métodosRESUMO
The magnitude of the global human immunodeficiency virus (HIV) epidemic is determined by women from lower income countries, specifically sub-Saharan Africa. Microbicides offer women who are unable to negotiate safe sex practices a self-initiated HIV prevention method. Of note, is its potential to yield significant public health benefits even with relatively conservative efficacy, coverage and user adherence estimates, making microbicides an effective intervention to invest scarce healthcare resources. Existing healthcare delivery systems provide an excellent opportunity to identify women at highest risk for infection and to also provide an access point to initiate microbicide use. Innovative quality improvement approaches, which strengthen existing sexual reproductive health services and include HIV testing, and linkages to care and treatment services, provide an opportunity to lay the foundations for wide-scale provision of microbicides. The potential to enhance health outcomes in women and infants and potentially affect rates of new HIV infection may soon be realised.