Assessing the quality of HIV/AIDS services at military health facilities in Zambia.

After rapidly scaling up HIV/AIDS-related health services, the Zambian Defence Force (ZDF) has become concerned with assuring their quality. This evaluation assesses provider performance at eight ZDF facilities based on direct observations of 191 antenatal care (ANC) consultations and 175 follow-up consultations for antiretroviral therapy (ART). In addition, 43 ZDF health providers were interviewed about the work environment and service quality. On-the-job performance varied widely: providers completed as few as 0% and as many as 100% of tasks associated with each performance standard. Overall scores averaged 66% (range: 47-93%) for ANC consultations and 60% (range: 37-100%) for ART consultations. Perceptions of the work environment were generally positive, but 57% of providers lack confidence in their clinical skills and 42% think staffing is insufficient. These findings, which point to the unique opportunities and challenges in the military setting, will be used to guide a quality improvement initiative.

Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men.

BACKGROUND: There is a need for female-controlled methods of HIV prevention. Vaginal microbicides, substances inserted into the vagina to prevent women acquiring HIV and sexually transmitted infections (STIs) from men, could be useful in this regard. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9). OBJECTIVES: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of HIV infection by women from men. SEARCH STRATEGY: Extensive searches of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders. SELECTION CRITERIA: Randomised controlled trials meeting pre-determined quality criteria with HIV infection as the outcome. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by the another. Any discrepancies were adjudicated by a third reviewer. MAIN RESULTS: Five trials were included in the review and four contributed to a meta-analysis. Overall, the risk of HIV infection was not statistically significantly different among women receiving N-9 (relative risk [RR] 1.12, 95% CI 0.88-1.42; p=0.4). The risk of genital lesions was statistically significantly greater among women receiving N-9 (RR 1.18, 95%CI 1.02-1.36; p=0.02). REVIEWER'S CONCLUSIONS: There is no evidence that nonoxynol-9 protects against vaginal acquisition of HIV infection by women from men. There is evidence that it may do harm by increasing the frequency of genital lesions.

Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men.

BACKGROUND: The incidence and prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) is high in much of the developing and parts of the developed worlds. STIs and RTIs are associated with the vaginal transmission of HIV. Additional strategies to improve STI control are needed, and vaginal microbicides are a possible strategy. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9). OBJECTIVES: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of sexual transmitted infections (exclusive of HIV) by women from men. SEARCH STRATEGY: Systematic search of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders. SELECTION CRITERIA: Randomised controlled trials meeting pre-determined quality criteria with STI as the outcome. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by another. MAIN RESULTS: Ten of 12 identified randomised controlled trials were included and findings among them were broadly consistent. In meta-analysis, the risks of gonorrhoea (relative risk [RR] 0.91, 95%CI 0.67-1.24), cervical infection (RR 1.01, 0.84-1.22), trichomoniasis (RR 0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04), chlamydia (RR 0.88, 0.77-1.01) and candidiasis (RR 0.97, 0.84-1.12) were not statistically significantly different in women receiving N-9 compared with placebo. Genital lesions were more common in the N-9 users (RR 1.17, 95%CI 1.02-1.35). REVIEWER'S CONCLUSIONS: There is good evidence that nonoxynol-9 does not protect against sexually transmitted infections, and there is some evidence that it may be harmful by increasing the rate of genital ulceration. As such, this product cannot be recommended for STI prevention.