Contraceptive method use among HIV-positive women in a US urban outpatient clinic: an exploratory cross-sectional study.

OBJECTIVE(S): Effective contraceptive method use is important for HIV-positive women to meet fertility goals, prevent unintended pregnancy and reduce risk of vertical HIV transmission. Our objective was to evaluate factors associated with HIV-positive women's contraceptive method use at last coitus defined as more effective [Tier 1 and 2 methods (T1/2)] versus less effective [Tier 3 or no method (T3/none)] by the US Medical Eligibility Criteria for contraception use. STUDY DESIGN: HIV-positive women, recruited from an HIV clinic in Atlanta, Georgia, between 2013 and 2014, completed a survey of demographic, clinical and reproductive health characteristics surrounding contraception. We examined the relationship between survey responses and contraceptive method use at last coitus using χ2 tests and multivariate logistic regression. RESULTS: Thirty-one percent of this HIV-positive and predominantly African-American (90%) cohort reported usage of T1/2 methods. T1/2 methods use was higher among younger women [adjusted odds ratio (aOR)=.90, p=.008] and those in noncommitted relationships (aOR =.32, p=.027). Only 21% reported dual method use at last intercourse. Fifty-three percent and 31% reported having heard of the intrauterine device and implant, respectively. Misconceptions about contraception were common. CONCLUSIONS: The use of T1/2 methods was more common in this cohort than in the general African-American population, but overall use and dual method use can still be improved, particularly among older women and those in noncommitted relationships. IMPLICATIONS: As this population had low awareness and usage of T1/2 methods and expressed many misconceptions, reoccurring contraceptive counseling may be helpful. Providers should address patient-level barriers, pregnancy intentions, and the importance of dual method and T1/2 method use.

Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia.

BACKGROUND: The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT). OBJECTIVE: To evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia. DESIGN: A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist. RESULTS: A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001). CONCLUSIONS: We found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.

Acute cytomegalovirus infection complicated by vascular thrombosis: a case report.

We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by extensive mesenteric arterial and venous thrombosis. To our knowledge, this is the first reported case of this syndrome in an immunocompetent individual who had no predisposing risk factors for thrombosis, and it demonstrates the propensity for cytomegalovirus to be involved in vascular disease.