Antenatal depression and its predictors among HIV positive women in Sub-Saharan Africa; a systematic review and meta-analysis.

Background: Antenatal depression in Human Immunodeficiency Virus (HIV) positive pregnant women can have significant adverse effects on both the mother and newborns, yet it is often overlooked in pregnancy care in Sub-Saharan Africa (SSA). Despite this, there is limited data on the combined prevalence of antenatal depression and its predictors among HIV-positive women in the region. Objective: To assess the pooled prevalence of antenatal depression and its associated factors among HIV-positive women in SSA. Methods: All primary cross-sectional studies published before 1st January/2024, were included. We conducted searches in relevant databases; PubMed, HINARI, Web of Science, PsycINFO, Psychiatry Online, ScienceDirect, and Google Scholar. The Joanna Briggs Institute checklist was used to critically appraise the selected studies. To assess heterogeneity among the studies, we utilized the I2 test. Publication bias was evaluated using a funnel plot and Egger's test. The forest plot was used to present the combined proportion of antenatal depression and odds ratio, along with a 95% confidence interval. Results: The pooled prevalence of antenatal depression among HIV-positive women in Sub-Saharan Africa was found to be 30.6% (95% CI, 19.8%-41.3%). Factors significantly associated with antenatal depression among HIV-positive women in SSA included being unmarried (AOR: 3.09, 95% CI: 1.57 - 6.07), having a previous history of depression (AOR: 2.97, 95% CI: 1.79 - 4.91), experiencing intimate partner violence (IPV) (AOR: 2.11, 95% CI: 1.44 - 3.09), and experiencing stigma (AOR: 1.36, 95% CI: 1.05 - 1.76). Conclusion: High prevalence of antenatal depression among HIV-positive women in SSA underscores the need for prioritizing identification and management. Interventions addressing factors like IPV and stigma, along with training for healthcare providers in recognizing symptoms and providing support, are recommended. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508236.

Knowledge, attitude, practices and associated factors of family planning among women living with hiv at the university of Gondar specialized hospital: a cross sectional study.

INTRODUCTION: HIV/AIDS poses a significant health challenge in sub-Saharan African countries, with a disproportionate impact on women of reproductive age. The disparities in knowledge, attitudes, and practices related to family planning among women living with HIV can be intricate and multi-faceted. This study aimed to assess the knowledge, attitude, practice, and associated factors regarding family planning among the women living with HIV at the University of Gondar specialized hospital, Gondar, Ethiopia. METHOD: A cross-sectional study was carried out at the University of Gondar Teaching Referral Hospital, focusing on HIV-positive women of reproductive age who visited the ART unit from July 8-28, 2022. Data collection involved the use of pre-tested, structured questionnaires administered through interviews. The gathered data were entered into the electronic Kobo Collect platform and subsequently exported for analysis using SPSS version 26. Descriptive summaries, including frequencies, means, and percentages, were presented through tables and figures. Logistic regression was employed to identify potential predictors, presenting adjusted odds ratios with a 95% confidence interval and a significance level set at a P-value of 0.05. RESULTS: A total of 328 study participants were included. About 93% of the study population had good knowledge about modern contraceptives, and about 94% of the study population had good knowledge about safer conception. Only 30.2% of the study population had knowledge of the dual contraceptive method. The attitude and practice of women towards family planning (FP) were 71.0% and 55.8%, respectively. The study revealed that the most commonly employed contraceptive method was injectable contraceptives, constituting 34.2% of usage. Having one and a greater number of children (AOR = 2.25, 95% CI: 1.10, 4.49), having discussions on fertility plans with healthcare providers (AOR = 2.20, 95% CI: 1.02, 4.761), and having good family planning practices (AOR = 2.15, 95% CI: 1.19, 3.87) were significantly associated with the attitude toward family planning. Married women (AOR = 1.88, 95% CI = 1.11, 3.1), able to read and write (AOR = 2.12, 95% CI:1.04,4.32), college and above educational level (AOR = 4.51, 95% CI:1.93,10.87), had discussion on fertility plan with healthcare providers (AOR = 5.09, 95% CI: 1.96, 13.24), knowledge about dual method (AOR = 1.95, CI: 1.08, 3.50), and knowledge about modern contraceptive methods (AOR = 7.24, 95% CI: 1.56, 33.58) were significantly associated with good practice of family planning. CONCLUSION: Women living with HIV exhibited notably high levels of knowledge regarding modern contraceptive methods and safer conception. The knowledge of the dual method was low. More than half of the study population had good practice in family planning. More than two-thirds of HIV-positive reproductive-age women had a good attitude about family planning. Having one or a greater number of children, having a discussion on a fertility plan with a healthcare provider, and having a good practice of family planning were significantly associated with a good attitude toward family planning. Married women, education status, discussions on fertility plans with healthcare providers, knowledge about dual methods, and knowledge about modern contraceptive methods were significantly associated with good family planning practices. The stakeholders should design interventions based on the aforementioned factors to improve the attitude and practice of family planning.

Prevalence and Epidemiological Characteristics of Anogenital Warts Among Recently Diagnosed HIV-Positive Women on Antiretroviral Therapy in Lagos, Nigeria.

Background Anogenital warts (AGWs) are a prevalent condition resulting from human papillomavirus (HPV) infection, which is the most frequently encountered sexually transmitted infection (STI) on a global scale. Women who are HIV-positive experience a disproportionately high burden of AGWs compared to other populations. It is imperative to comprehend the epidemiological factors linked to the disease within this particular at-risk population. Objectives The objective of the study was to ascertain the prevalence of AGWs and its demographic and socio-biological epidemiological features among recently diagnosed HIV-positive women (HPW) in Lagos, Nigeria. Materials and methods The research was a descriptive cross-sectional study conducted among a sample of 420 recently diagnosed HPW. The study was conducted at the HIV clinic of a tertiary health institution located in Lagos, Nigeria. The participants clinically diagnosed with AGWs were classified as the study group, while individuals without AGWs were classified as the comparison group. Interviewer-administered pretested questionnaires were utilized to gather pertinent demographic and socio-biological epidemiological data from the participants involved in the study. The data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, USA). Results The prevalence of AGWs among recently diagnosed HPW was found to be 8.5% (34/402). These warts were frequently observed on the vulvar labia (35.3%, 12/34), vaginal walls (14.7%, 5/34), and perianal region (14.7%, 5/34). It is worth noting that over a third of cases (35.3%, 12/34) involved multiple areas within the anogenital region. The diagnosis of AGWs was found to have significant associations with occupation (p=0.005), marital status (p<0.001), and educational status (p=0.028). The majority of HPW diagnosed with AGWs were unemployed (32.4%, 11/34), single (47.1%, 16/34), and did not have tertiary education (94.1%, 32/34). The utilization of oral contraceptive pills (OCPs), smoking, low CD4 count, and high viral load were the significant socio-biological factors associated with the diagnosis of AGWs (p<0.001, respectively). Conclusion The study found that the prevalence of AGW among HPW was 8.5% (34/402). Several epidemiological factors, including occupation, marital status, education, CD4 count, viral load, history of OCP use, and smoking, were found to be significantly associated with the diagnosis of AGW. There is a need to conduct more comprehensive studies to thoroughly assess the impact of these epidemiological factors.

Seroprevalence of Chlamydia trachomatis and associated risk factors among HIV positive women in North Central Nigeria.

Introduction: Chlamydia trachomatis infection is among the STDs that are known to increase the risk of HIV infection. The present study aims to determine the seroprevalence of C. trachomatis among HIV positive women in Ilorin and Offa, Kwara State, North Central Nigeria. Methods: Serum samples from 400 HIV positive women attending the HAART Clinic in Offa and the Ilorin General Hospital in Kwara State, Nigeria, were screened using Enzyme Linked Immunosorbent Assay (ELISA), utilizing the immunocomb Chlamydia IgG test kit (Calbiotech, El Cajon, CA, USA) to check for the existence of anti-C. trachomatis antibodies. Result: Anti-C. trachomatis antibodies were present in 92 (23.0%) of the 400 HIV positive women samples. There was a higher prevalence among the age group 36-40 years. Hence, age groupings were statistically and significantly associated (p=0.001) with the seroprevalence of C. trachomatis among HIV positive women. Married HIV positive women (60.9%) had the highest prevalence of C. trachomatis, with a statistically significant association (p=0.001). There was a statistically significant association between the number of sexual partner(s) (p=0.001) and the seroprevalence of C. trachomatis among HIV positive women. Conclusions: The high frequency confirms the necessity for comprehensive sexual education among young adults and routine testing for anti-C. trachomatis. It reflects the endemicity of the infection in Ilorin and Offa Kwara State, Nigeria.

Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross-sectional study.

Background and Aims: Cervical cancer is a global public health problem and the second most common cancer which leads to morbidity and mortality among women in developing countries like Ethiopia. In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018 alone. This study aimed to assess the prevalence and associated factors of precancerous cervical lesions among women on antiretroviral therapy (ART) at Dukem Health Center, Central Ethiopia. Methods: An institution-based cross-sectional study was carried out among randomly selected 257 women receiving ART at Dukem Health Center. Data were collected using a pretested structured questionnaire, medical record review, and visual inspection with acetic acid. Collected data were entered into Epi-info 7.4 and exported to SPSS version 26 for analysis. The prevalence of precancerous cervical lesions and the characteristics of study participants were identified. Utilizing both binary and multivariable logistic regression models, the existence and degree of association with precancerous cervical lesions were determined with a p value < 0.05 and a 95% confidence interval. Results: The prevalence of precancerous cervical lesions was 16% (95% CI: 11.7-20.6). Significant association was found between precancerous cervical lesions and a history of STIs (AOR = 4.30, 95% CI: 1.48-12.49), oral contraceptive use (AOR = 6.56, 95% CI: 2.10-20.50), having multiple lifetime sexual partners (AOR = 2.53: 95% CI: 1.05-6.10), and a recent CD4 count of less than 200 cells/mm3 (AOR: 11.33, 95% CI: 2.88-24.58). Conclusion: In the study area, the prevalence of precancerous cervical lesions was relatively high. Therefore, concerned bodies are recommended to increase awareness of the prevention of sexually transmitted diseases and limit sexual partners.

Fertility desires of antiretroviral therapy-attending HIV-positive women and its associated factors in Harari region, Ethiopia.

BACKGROUND: The desire to have children among mothers living with HIV remains a serious public health issue in nations with low coverage for antiretroviral therapy and the prevention of mother-to-child transmission, even if it is feasible to have an HIV-negative child. Therefore, this study aimed to assess fertility desire and associated factors among antiretroviral therapy-attending HIV-positive women at Hiwot Fana Specialized University Hospital, in Harari, Ethiopia. METHODS: A facility-based cross-sectional study design was employed among 639 anti retro-viral therapy attending HIV - positive women by systematic random sampling method selected from June 15 to November 30, 2020. A binary logistic regression model was fitted to identify the associated factors with fertility desire. Descriptive results were presented in percentages, whereas analytical results were reported in adjusted ORs (AORs) with a 95% CI. At p=0.05, statistical significance was declared. RESULTS: A total of 639 participants were included in the study; 69.5%(95% CI 65.7 to 72.9%) of the participants had fertility desire. Younger age (<35 years) (AOR=2.35, 95% CI 1.27 to 4.35), married women (AOR=3.02, 95% CI 1.32 to 12.25), childless women (AOR=2.86, 95% CI 1.17 to 4.82) and women whose duration of HIV diagnosis was ≤5 years (AOR=0.41, 95% CI 0.20 to 0.71) were significantly associated with fertility desire. CONCLUSION: The majority of the study participants have a desire to have children. In light of the high prevalence of fertility desire among antiretroviral therapy-attending HIV-positive women, it is recommended to counsel younger women on reproductive planning and encourage partner testing.

Awareness, Knowledge and Attitude Regarding Cervical Cancer among Women Living with HIV in the Souss-Massa Region, Southern Morocco: A Cross-Sectional Study.

BACKGROUND: Human immunodeficiency virus- positive women have an increased risk of precancerous lesions and invasive cervical cancer. This study aims to identify the level of awareness/knowledge and attitudes toward cervical cancer among women living with Human immunodeficiency virus in the region of Souss-Massa in southern Morocco.  Methods: This is a multicenter cross-sectional study conducted in the Souss-Massa region (southern Morocco) among women attending Human immunodeficiency virus treatment and care centers between March 2022 and September 2022. A questionnaire was used for data collection. The Chi-square test and logistic regression were deployed to identify factors associated with cervical cancer awareness among the target population. RESULTS: A total of 494 respondents to the questionnaire, 440 (89.1%) are aware of cervical cancer. Nevertheless, 405 (82.0%) and 369 (74.7%) were unaware of cervical cancer risk factors and symptoms, respectively. Only 125 (25.3%) knew the exact frequency of cervical cancer screening among Human immunodeficiency virus positive women, whereas 221 (44.7%) had ever been tested for cervical cancer. Factors associated with women's awareness of cervical cancer are as follows:  level of education (adjusted Odds Ratio = 3.78 with 95% CI, 1.23-11.65), time since diagnosis of Human immunodeficiency virus (adjusted Odds Ratio = 4.31 with 95% CI, 1.12- 16.52), knowledge of women with cervical cancer (adjusted Odds Ratio = 6.30 with 95% CI, 1.87-21.18) and heard the pap- smear/visual inspection with acetic acid (adjusted Odds Ratio = 4.92 with 95% CI, 2.35-10.33). CONCLUSION: The general knowledge of seropositive women regarding cervical cancer remains very low, which justifies the integration of cervical cancer prevention services with Human immunodeficiency virus care, and pinpoints the crucial role of patient education.

Adherence to option B+ PMTCT program and its predictors among HIV-positive women in Ethiopia. A systematic review and meta-analysis.

Background: Previously, few studies investigated level of adherence to option B+ lifelong antiretroviral therapy (ART) in Ethiopia. However, their findings were inconsistent. Therefore, this review aimed to determine the pooled magnitude of adherence to option B+ lifelong ART and its predictors among human immune virus (HIV)-positive women in Ethiopia. Methods: A comprehensive web-based search was conducted using PubMed, Cochrane Library, Science Direct, Google scholar, and African Journals Online databases to retrieve relevant articles. STATA 14 statistical software was used to carry out the meta-analysis. We used the random effects model to account for the large heterogeneity across included studies. Egger's regression test in conjunction with funnel plot and I 2 statistics were utilized to assess publication bias and heterogeneity among included studies respectively. Result: Twelve studies with a total of 2927 study participants were involved in this analysis. The pooled magnitude of adherence to option B+ lifelong ART was 80.72% (95% confidence interval [CI]: 77.05-84.39; I 2 = 85.4%). Disclosure of sero-status (OR 2.58 [95% CI: 1.55-4.3]), receiving counseling (OR 4.93 [95% CI: 3.21-7.57]), attending primary school and above (OR 2.45 [95% CI: 1.31-4.57]), partner support (OR 2.24 [95% CI: 1.11, 4.52]), good knowledge about prevention of mother-to-child transmission (PMTCT) (OR 4.22 [95% CI: 2.02-8.84]), taking less time to reach health facility (OR 1.64 [95% CI: 1.13-2.4]), and good relation with care provider (OR 3.24 [95% CI: 1.96-5.34]) were positively associated with adherence. Whereas, fear of stigma and discrimination (OR 0.12 [95% CI: 0.06-0.22]) and advanced disease stage (OR 0.59 [95% CI: 0.37-0.92]) were negatively associated. Conclusion: The level of adherence to option B+ lifelong ART was suboptimal. Strengthened comprehensive counseling and client education on PMTCT, HIV status disclosure, and male partner involvement are important to eliminate mother to child transmission and control the pandemic.

Determinants of long act reversible contraceptive utilization among HIV positive reproductive age women attending ART clinic in South West Ethiopia.

BACKGROUND: Identifying the determinants of long-acting contraceptive utilization and managing the sexual and reproductive health of HIV-infected women is critical to reducing HIV transmission and maternal mortality. However, the determinants of long-acting contraceptive utilization have not been well understood in resource-limited settings like Ethiopia. The aim of this study was to identify determinants of long-acting reversible contraceptive utilization among HIV-positive women on ART in southwest Ethiopia. METHODS: A facility-based, unmatched case control study was conducted from July 24 to August 28, 2021, in south-west Ethiopia. The study participants were HIV positive women, with a sample size of 109 cases and controls. An interviewer administered a questionnaire, and a check list was used for data collection. A systemic random sampling technique was used to collect data from cases and controls. Bivariate and multivariable logistic regressions were employed to determine the determinants of LARC utilization among HIV-positive women. To demonstrate the strength of the determinant, the odds ratio was calculated with 95% confidence intervals, and a P-value less than 0.05 was used to declare statistical significance. RESULT: A total of 324 women (108 cases and 216 controls) of reproductive age who were HIV positive were interviewed, with a response rate of 99.0%. urban residence (AOR = 2.67, 95%CI: 1.23- 5.77), having formal education (AOR = 2.93, 95% CI:1.36, 6.34), being counseled by health care provider (AOR = 5.42,95% CI: 2.67-11.03), no future fertility intention (AOR = 2.87, 95% CI:1.44-5.70), having CD4 count less than 500 cell/mm3 (AOR = 4.18,95% CI:2.12-8.23), having information of HIV transmission from mother to child (AOR = 3.65,95% CI:1.49-8.95),not using condom during sexual intercourse (AOR = 4.86,95% CI:2.46-9.62),,having knowledge towards LARC (AOR = 2.38,95% CI:1.24-4.58) and attitude towards LARC (AOR = 6.41,95%CI:3.16-13.0) were independent determinants of LARC utilization among HIV positive women. CONCLUSION AND RECOMMENDATION: Women being counseled by a health care provider, having no future fertility intention, and having a CD4 count less than 500 cells/mm3 were found to be determinants of long-acting contraceptive method utilization among HIV-positive reproductive-age women. Also, our study supports the WHO Strategic Concepts for Improving the Links between Family Planning and HIV/AIDS Policy, Programs, and Services. It is recommended that Health care providers should use these factors as base line during family planning counseling and service delivery.

Factors affecting cervical cancer screening service uptake among clients visiting the ART clinic at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study.

BACKGROUND: Annually, around half a million new cases of cervical cancer and 250,000 deaths occur worldwide. It is the second-leading cancerous cause of death after breast cancer among women. Repeated infection and prolonged persistence with human papilloma virus is common among HIV-positive women due to their immune status. A one-visit screen and treat strategy for cervical cancer prevention was instituted in 2010 nationwide in 14 selected hospitals. So, assessing service uptake and associated factors among ART clients is mandatory. METHOD: From December 2015 to March 2016 G.C., a cross-sectional study was conducted. An interviewer-administered, semi-structured questionnaire was used to collect data. The data were entered, cleaned, and analyzed using IBM SPSS version 20 software. A statistically significant association of variables was determined based on an adjusted odds ratio with a 95 % confidence interval and a p value of 0.05. RESULT: Cervical cancer screening service uptake among the 647 interviewed participants was 59 %. Study participants accounting for 19 % (N = 123) were 18-29 age group, 56.6 % (N = 366) were 30-39 %, and 24.4 % (N = 158) were in 40-64 age group. Of 647 participants, 43.7 % (N = 283) were illiterate and educated less than secondary level of education, 36.0 % (N = 233) had a secondary level of education, and 20.2 % (N = 131) had an education above secondary. Being encouraged by others to get screened for cervical cancer (AOR = 1.88, 95 % CI: 1.25, 2.82), knowing another woman who got screened, and getting information from the media (AOR = 0.4, 95 % CI: 0.27, 0.60) were associated with the uptake of cervical cancer screening. CONCLUSION: The uptake of cervical cancer screening among ART clients attending the clinic was not satisfactory. Encouragement to get screened, knowing other screened women, and getting information from the media were important predictors of CCS service uptake. Exploring more information on the attitudes of clients to improve service uptake is mandatory.

Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar city, Northwest Ethiopia.

INTRODUCTION: Intimate partner violence against women is a behavior within an intimate relationship that causes sexual, physical, or psychological harm to the women. It occurs among all socioeconomic, religious, and cultural groups in all settings, and affects the health of women, families, and the community at large. Determining the magnitude and determinants of intimate partner violence against HIV positive women could help to design preventive and control strategies. However, there is a dearth of information regarding the magnitude and determinants of intimate partner violence against HIV positive women in Ethiopia. Thus, this study aimed to assess the magnitude and associated factors of intimate partner violence against HIV positive women in Gondar city, Northwest Ethiopia. METHOD: A facility-based cross-sectional study was carried out from February to May 2021 in selected public health facilities of Gondar city among 626 HIV positive women. A systematic random sampling technique was used to select study participants. Data were analyzed using Statistical Package of Social Science (SPSS) version 20 software. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify determinants of intimate partner violence. Statistical significance was considered at a p value < 0.05. RESULTS: The overall prevalence of intimate partner violence against HIV positive women within the last 12 months was 64.2% (95% CI 60.4, 68.2). Physical violence was the most common type (54.8%), followed by sexual (51.1%) and emotional (48.9%) violence. Intimate partner violence among HIV positive women was associated with women's age 19-24 (AOR = 0.13, 95% CI 0.02, 0.79), monthly income of 500-2500 (AOR = 6.5, 95% CI 1.72, 25.0), urban residence (AOR = 0.35, 95% CI 0.13, 0.91), partner drink alcohol (AOR = 2.14, 95% CI 1.42, 4.06), and a husband with no multiple sexual partners (AOR = 0.75, 95% CI 0.34, 0.94). CONCLUSION: The result of this study revealed that intimate partner violence against HIV positive women was found to be high. Thus, protective measures that could increase the community's and women's awareness about the consequences of various forms of violence, and women empowerment are paramount. Priorities in programs of gender-based violence prevention should involve women from rural residences, older age, and males who consume alcohol.

Unintended pregnancies among HIV-positive women in sub-Saharan Africa: a scoping review protocol.

BACKGROUND: Unintended pregnancies pose a severe threat to the well-being of HIV-positive women and their unborn children. Factors contributing to the high incidence of unintended pregnancies include contraceptive failure, low uptake of contraceptives, and misuse of contraceptives. Despite various contraceptive options, an increased incidence of unintended pregnancies is rampant among HIV-positive women in the region of sub-Saharan Africa. This study seeks to present evidence of unintended pregnancies among women living with HIV in sub-Saharan Africa, including those using contraceptives. METHOD: This study entails a scoping review to survey and interrogate the literature to provide evidence for the incidence of unintended pregnancies among HIV-positive women in sub-Saharan Africa. A proposed framework by Arksey and O'Malley will guide this scoping review. Peer-reviewed articles which address the research questions will constitute the main search. Electronic databases such as EBSCOhost, Cochrane Library, World of Science, World Health Organization (WHO) library databases, Science Direct, Google Scholar PubMed, and gray literature search will be involved. Reference list from studies included will also be searched. The investigation of articles will be done employing keywords from the studies included. The inclusion and exclusion criteria will guide two separate reviewers with the screening of abstracts and full papers. To summarize the findings from this review, thematic content analysis will be done using NVivo version 11. DISCUSSION: We expect that this review will add to the current body of knowledge on the incidence of unintended pregnancies among HIV-positive women, identify gaps for further future research, and show evidence that may contribute to strengthening the health system's regulations, guidelines, and policies that may help prevent unintended pregnancies among HIV-positive women. SYSTEMATIC REVIEW REGISTRATION: 10.17605/OSF.IO/EY3R5.

Predictors and Factors Associated with Counseling Seeking Behavior Against Intimate Partner Violence Among HIV-Positive Women in Southwestern Uganda.

Purpose: The study intended to establish the proportion of HIV-positive women experiencing IPV and the predictors of counseling-seeking behavior among women living with HIV in Isingiro district. Methods: The study was a cross-sectional quantitative study. We conducted the study in April 2021 among 296 HIV-positive women receiving ART services at Rwekubo and Nyamuyanja Health Centre fours. Data were collected using a researcher-administered questionnaire. Consecutively participants were recruited from the ART clinic. SPSS Version 23.0 was used to analyze data. We computed the prevalence of intimate partner violence among the study participants. Logistic regression was performed to identify the associated factors and predictors of counseling-seeking behavior. Results: Of the 296 participants interviewed, 66.2% of the HIV-positive women had experienced IPV. Only 40.2% of those who had experienced IPV had received counseling, 35.5% of the participants sought help for IPV from family and friends and 27% sought help from other service providers including the police. A majority (67.2%) of the participants had a primary level of education and over a third (45.9%) of the participants were from monogamous families. The factors associated with seeking care for IPV were education level (p = 0.002), type of family (p = 0.04), physical abuse within one last year (p < 0.001), emotional abuse (p < 0.001), awareness about IPV services (p < 0.001) and availability of counselors (p < 0.001). The predictors of care-seeking for IPV included awareness about IPV services (aOR: 295.6, 95% CI: 54.3-1608.9) and availability of counselors (aOR: 5.3, 95% CI: 1.5-19.2). Conclusion: The prevalence of IPV is 66.2%, and proportion of HIV-positive women who seek IPV counseling services is low. The predictors of counseling-seeking behavior were awareness about IPV services and availability of counselors. There is a need to improve awareness about IPV services and provide more counselors to offer help to the IPV victims.

Prenatal and Postnatal Intimate Partner Violence and Associated Factors Among HIV-Infected Women in Rural South Africa: A Longitudinal Study.

Intimate partner violence (IPV) has been highlighted as one of the challenges to the effectiveness of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs in rural areas in South Africa. This study aimed at assessing the prevalence of prenatal and postnatal physical as well as psychological IPV, and corresponding time-invariant and time-varying predictors, among HIV-positive women attending PMTCT services in rural South Africa. The Conflict Tactics Scale (CTS) was used to assess IPV at four time points prenatal and postnatal. This study highlighted high levels of physical and psychological IPV experienced by HIV-infected women during pregnancy and in the first year after childbirth. Time-invariant predictors and time-varying predictors of physical IPV and psychological IPV were individual, social, and behavioral factors. Multi-dimensional evidence-based interventions are needed to deal with the high levels of prenatal and postnatal physical as well as psychological IPV experienced by these women.

Maternal Health Outcomes and Male Partner Involvement Among HIV Infected Women in Rural South Africa.

INTRODUCTION: This study aimed to investigate the association between Male Partner Involvement (MPI) and maternal health outcomes among women attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. The association between Male Partner Participation in the main study (MPP) and maternal health outcomes among these women was also investigated. METHODS: The study utilized data collected from 535 HIV infected women in a randomized controlled trial between 2015 and 2016. Maternal health outcome data (delivery mode, pregnancy systolic and diastolic blood pressure, pregnancy body mass index, pregnancy CD4 count, and pregnancy viral load) were collected from the women's antenatal record forms accessed from the primary healthcare facilities. Bivariate and multivariable logistic regression models were used to estimate the association between socio-demographic characteristics of the women, MPI, and MPP with maternal health outcomes. RESULTS: The mean age of the women was 29.03 years (SD = 5.89). No significant associations were found between MPI and any of the maternal health outcomes contrary to what was hypothesized. Both the bivariate and multivariate analysis indicated a significant association between MPP and higher pregnancy viral load, contrary to the study hypothesis. Insignificant associations were found between MPP and both pregnancy CD4 count and pregnancy blood pressure. The only significant association between maternal health outcomes and socio-demographic characteristics, was between educational attainment and higher pregnancy CD4 count in both the bivariate and multivariate analysis. CONCLUSION FOR PRACTICE: The study showed no significant support for MPI in improving maternal health outcomes of women in PMTCT in rural South Africa. Future studies should include additional maternal health outcomes for investigation.

Unmet need for family planning and associated factors among women living with HIV in Gondar city, Northwest Ethiopia: cross-sectional study.

INTRODUCTION: all women, including those living with HIV, have the right to choose the timing, spacing, and number of their births and need access to family planning services. This study aimed at assessing the prevalence and factors associated with an unmet need for family planning among women receiving Antiretroviral Therapy (ART) services. METHODS: a facility-based cross-sectional study was conducted from March to April 2018 in Gondar city, Ethiopia. A systematic random sampling technique was used to recruit 441 reproductive-age women on ART. The data were collected using a pretested structured questionnaire. The bivariate and backward multivariable logistic regression model was fitted to identify factors associated with the unmet need for family planning. RESULTS: the prevalence of the unmet need for family planning among women living with HIV was 24.5%. Increase in women´s age (AOR: 0.90, 95% CI (0.85, 0.95)), having more than three children (AOR: 0.13, 95% CI (0.04, 0.38)), intention to have more children (AOR: 0.09, 95% CI (0.03, 0.23)), not disclosing sero-status to partner (AOR: 0.40, 95% CI (0.20, 0.82)) and having no experience of contraception use (AOR: 0.43, 95% CI (0.21, 0.90)) were protective factors against unmet need for family planning. Rural residence (AOR: 2.17, 95% CI (1.05, 4.46)) was associated with increased odds of unmet need for family planning. CONCLUSION: one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.

Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa.

BACKGROUND: Mothers living with HIV are at risk for mental health problems, which may have a negative impact on the management of their HIV condition and care of their children. Although South Africa has a high prevalence of HIV, there is a dearth of studies on sociodemographic predictors of postnatal depression (PND) among HIV-positive women in South Africa, even in KwaZulu Natal, a province with the highest prevalence of HIV in the country. OBJECTIVE: The objective of the study was to determine sociodemographic factors associated with the prevalence of postnatal depression symptoms among a sample of HIV-positive women attending health services from primary healthcare facilities in Umhlathuze District, KwaZulu Natal. METHODS: A quantitative cross-sectional survey was used to collect data from 386 HIV-positive women who had infants aged between 1 and 12 weeks. The Edinburgh Postnatal Depression Scale (EPNDS), to which sociodemographic questions were added, was used to collect data. RESULTS: The prevalence of PND symptoms among this sample of 386 HIV-positive women was 42.5%. The age of the mothers ranged from 16 to 42 years, with a mean of 29 years. The majority of the mothers were single or never married (85.5%; n = 330), living in a rural setting (81.9%; n = 316%), with a household income of less than R 2000 (estimated 125 USD) per month (64.9%; n = 120). The government child support grant was the main source of income for most of the mothers (53%; n = 183). PND symptoms were significantly associated with the participant's partner having other sexual partners (p-value < 0.001), adverse life events (p-value = 0.001), low monthly income (p-value = 0.015), and being financially dependent on others (p-value = 0.023). CONCLUSION: The prevalence of PND symptoms among the sample is high, with a number of social and demographic factors found to be significantly associated with PND. This requires the consideration of sociodemographic information in the overall management of both HIV and postnatal depression. Addressing the impact of these factors can positively influence the health outcomes of both the mother and the baby.

Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial.

BACKGROUND: Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. METHODS: We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. RESULTS: Participant characteristics included median age of 39 years and median CD4 count 489 cells/µL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87-1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. CONCLUSIONS: This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV. CLINICAL TRIALS REGISTRATION: NCT01928225.

Level of quality of option B+PMTCT service provision in public health facilities in Mekelle zone, northern Ethiopia: cross-sectional study.

BACKGROUND: Substantial improvements have been observed in coverage and access to maternal health services in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study aimed to assess the level of quality of Option B+ PMTCT in Northern Ethiopia. METHODS: A facility based survey was conducted from February to April 2016 in Northern Ethiopia. Twelve health facilities were enrolled in the study. Mixed method approach was used in line with Donabedian (Input- Process-Output) service quality assessment model. Data of 168 HIV positive mothers & their infant were abstracted from registers, and follow up charts. During the Option B+ service consultation, a total of 60 sessions were involved for direct observation. Of which, 30 clients and 12 service providers were subjected for exit and in-depth interview respectively. Facilities were categorized rendering good service quality based on predetermined quality judgment criteria. Reasons of good and bad service quality were thematically fitted with each quality component based on emerging themes (TM1-TM3), and categories (CA1-CA6). RESULTS: Of the total 12 study health facilities, 2(16.7%) were achieved the desired level of service quality based on the three quality components. The input quality was better and judged as good in 33.3% health facilities. However; process and output service quality were realized in one - fourth of them. CONCLUSION: Insignificant numbers of facilities fulfilled the aspired level of service quality. Quality of care was found influenced by multiple inputs, processes, and output related barriers and facilitators. Comprehensive Program monitoring is needed based on three quality components to improve the overall service quality.