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1.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 227-232, dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1145596

RESUMO

La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)


The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)


Assuntos
Humanos , Feminino , Pneumonia Viral/complicações , Infecções por Coronavirus/complicações , Contracepção Hormonal/métodos , Pneumonia Viral/patologia , Gravidez não Desejada , Infecções por Coronavirus/patologia , Anticoncepcionais/administração & dosagem , Anticoncepcionais/classificação , Anticoncepcionais/provisão & distribução , Direitos Sexuais e Reprodutivos , Coagulação Intravascular Disseminada/etiologia , Tromboembolia Venosa/etiologia , Pandemias , Betacoronavirus , Acesso aos Serviços de Saúde
2.
J Pregnancy ; 2020: 2856502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029400

RESUMO

Objectives: This study was aimed at assessing the magnitude of induced abortion and associated factors among students in Hawassa University, southern region, Ethiopia, 2019. Methods: An institutional-based cross-sectional study was conducted among a total of 422 students selected on the bases of a probability simple random sampling method. A pretested structured questionnaire was used to collect data. Analysis was made with SPSS 20. Descriptive summary and inferential statistics (binary logistic regression) were used with a 95% CI and P value of less than 5% as a level of significance. Findings were presented in tables, figure, and texts. Confidentiality of information was also secured. Results: The prevalence of induced abortion in the study setting was 68.7% (95% CI: 64.15%-73.2%). Participants who used emergency contraceptives had 12 times higher odds of undergoing abortion than those who did not use emergency contraceptives at AOR: 11.95, 95% CI: 5.615-25.326, P < 001. Conclusions: A higher prevalence of induced abortion was observed in the study setting. Contraceptive use was the predictor of induced abortion identified. Concerned bodies were recommended to work on the identified determinant of induced abortion in the study setting.


Assuntos
Aborto Induzido/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Emergências , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Prevalência , Inquéritos e Questionários , Adulto Jovem
3.
BMC Womens Health ; 20(1): 128, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32552670

RESUMO

BACKGROUND: In spite of the well-established associations between socioeconomic and demographic factors and the high rate of contraceptive discontinuation among sexually active married contraceptive users, little is known in Nigeria about the relationship between contraceptive discontinuation and sexually active married women who have experienced Intimate Partner Violence (IPV). METHODS: The 2013 Nigeria Demographic and Health Survey data on women's reproductive calendars and domestic violence were used to investigate the relationship between IPV and contraceptive discontinuation in a year period. A weighted sample size of 1341 women in a union in the domestic violence module, who have experienced IPV, and are using any contraceptive and are not sterilized in the 12 months periods was analyzed using frequency tables and chart, Pearson's chi-square test, and binary logistic regression model. RESULTS: The results showed that women who have experienced any type of IPV are 1.28 times more likely to have discontinued contraceptive use although they are still at risk of becoming pregnant (aOR = 1.28, CI: 1.15-1.91; p < 0.05) than those who have not experienced IPV. The tertiary level of education (aOR = 3.94, CI = 1.67-9.29; p < 0.05), unemployed status (aOR = 1.97, CI = 1.07-3.62; p < 0.05), and higher marital duration of 20 years and above (aOR = 4.89, CI = 2.26-10.57; p < 0.05) significantly influenced women who have experienced any types of IPV to discontinue contraceptives even though they are still at risk of becoming pregnant than those who have not experienced IPV. CONCLUSION: The study revealed that women who have experienced any form of IPV were significantly influenced by their education, occupation, the number of living children, and marital duration to discontinue contraception while still at risk of becoming pregnant. Thus, the study concludes that intervention programmes aimed at increasing contraceptive prevalence rate should be mindful of IPV which may affect women's use of contraceptives.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Adulto , Comportamento Contraceptivo/psicologia , Anticoncepcionais/administração & dosagem , Estudos Transversais , Feminino , Humanos , Violência por Parceiro Íntimo/psicologia , Casamento , Pessoa de Meia-Idade , Nigéria/epidemiologia , Gravidez , Gravidez não Planejada , Gravidez não Desejada , Fatores de Risco , Parceiros Sexuais/psicologia , Adulto Jovem
4.
Womens Health Issues ; 30(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507617

RESUMO

BACKGROUND: Research on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider-patient relationship. METHODS: We conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD. RESULTS: Although providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider. CONCLUSIONS: There were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient-provider relationship and autonomous contraceptive decision making.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Comportamento Contraceptivo/psicologia , Anticoncepção Pós-Coito/estatística & dados numéricos , Anticoncepção/psicologia , Anticoncepcionais Pós-Coito/provisão & distribução , Serviços de Planejamento Familiar/organização & administração , Relações Profissional-Paciente , Adolescente , Adulto , Serviços de Saúde Comunitária , Anticoncepção/métodos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Revelação , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Entrevistas como Assunto
5.
Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527659

RESUMO

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Gravidez na Adolescência/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais , Feminino , Direitos Humanos , Humanos , Gravidez
6.
Afr J Reprod Health ; 24(1): 133-142, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358945

RESUMO

Contraceptive use in Nigeria has remained low despite the efforts of government and non-governmental agencies to increase its uptake. Most studies on contraceptive use have focused on individual-level determinants and evidence is sparse on the influence of social or community context. This study examines the influences of contextual factors on modern contraceptive use in Nigeria. We used data from the 2013 Nigeria Demographic and Health Survey, and a sample of 12,186, currently married women aged 15-49 years. Multilevel logistic regression which provides a flexible modeling for hierarchical data was used to examine the effects of contextual factors on contraceptive use. Findings revealed considerable low usage of contraception across the regions of Nigeria. Living in high and moderate ethnically diverse communities and communities that have high proportion of educated women was significantly associated with increased usage. The findings provide useful information for policy makers to consider the social milieu in which women live for effective family planning interventions.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Meio Social , Adolescente , Adulto , Fatores Etários , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/etnologia , Escolaridade , Feminino , Humanos , Pessoa de Meia-Idade , Religião , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
7.
Cent Eur J Public Health ; 28(1): 3-12, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32228810

RESUMO

OBJECTIVE: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. METHODS: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. RESULTS: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. CONCLUSION: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.


Assuntos
Anticoncepcionais/administração & dosagem , Assunção de Riscos , Comportamento Sexual/psicologia , Adolescente , República Tcheca/epidemiologia , Feminino , Humanos , Gravidez , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
8.
BMC Womens Health ; 20(1): 67, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245462

RESUMO

BACKGROUND: Contraceptive utilization is a guarantee to avert unwanted pregnancies. In Ethiopia however, more than half of the rural women have shorter birth intervals. Consequently, 17 and 8% of the births have been either mistimed (wanted at later date) or unwanted, respectively. Therefore, this study investigated modern contraceptive utilization and its predictors among rural lactating women. METHODS: A community based-cross-sectional study was conducted from May 01 to June 29, 2019, in Dabat and Gondar zuria districts, northwest Ethiopia. Data from 603 lactating mother were collected through face to face interviews using a structured questionnaire. Bivariate and multivariate logistic regression analyses were fitted to identify the independent predictors of modern contraceptive utilization. RESULTS: The overall prevalence of modern contraceptive (MC) utilization rate was 45.8% [95% CI: 38.01, 53.59]. The contraceptive method mix was dominated by Depo-Provera (39.8%) followed by implants (4.8%). The odds of utilization of contraceptive were 5.58 times higher among mothers of children with fully immunized [AOR = 5.58, 95% CI: 3.45, 9.01] compared to mothers whose children were vaccinated partially or not at all. Mothers who received antenatal [AOR = 1.74, 95% CI: 1.13, 4.43] and postnatal care [AOR = 2.02, 95%CI: 1.24, 2.91) were 1.74 and 2.02 folds more likely to utilize modern contraceptives than mothers who did not receive such care, respectively. CONCLUSION: The prevalence of modern contraceptive utilization in this study area was lower than the planed national target. In the region, child immunization service is one of the promising platforms for reaching lactating mothers with modern contraceptive utilization. Our findings suggest that antenatal and postnatal care visits are the other key determinants of modern contraceptive utilization. Thus, in low-resource settings like ours, the health system approaches to improved antenatal and, postnatal care and child immunization services should be intensified with more effective advice on modern contraceptive utilization to reduce unwanted pregnancies.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Lactação/fisiologia , Mães/psicologia , Adulto , Comportamento Contraceptivo/etnologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Gravidez , Prevalência , Atenção Primária à Saúde , População Rural
9.
BMC Womens Health ; 20(1): 61, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216823

RESUMO

BACKGROUND: Modern contraceptive methods enable couples to enjoy sexual intercourse without fear of the risk of pregnancy at any desired time. The evidence from different studies done in Ethiopia on modern contraceptive method utilization was highly varied and not conclusive. Therefore, the current study aims to study the magnitude of modern contraceptive utilization and associated factors among reproductive-age women in Ethiopia based on 2016 EDHS data. METHOD: A nationally representative 2016 EDHS data collected between January 18/ 2016 to June 27/2016 were used. Descriptive studies and logistic regression models were used to summarize descriptive data and measure statistical association respectively. Adjusted odds ratio and confidence interval were respectively used to measure association and its statistical significance. Finally, statistical significance was declared using a confidence interval. RESULT: In the current study, the overall modern contraceptive utilization among reproductive-age women in Ethiopia was 3203 (20.42%). The injectable contraceptive method was the most commonly used modern contraceptive method, 1886(58.88%) followed by implant/Norplant, 779 (24.32%). The results of multivariable logistic regression showed that age, residence, region, woman's occupation, number of living children, husband's education, age at first sexual intercourse, husband's desire for more children, wealth index and watching TV were independently associated to modern contraceptive utilization among reproductive-age women in Ethiopia. CONCLUSIONS: The magnitude of modern contraceptive utilization among reproductive-age women in Ethiopia in the current study is unexpectedly low. Age, residence, region, woman's occupation, number of living children, husband's education, age at first sexual intercourse, husband's desire for more children, wealth index and watching TV were independent predictors of modern contraceptive use among reproductive-age women in Ethiopia. Any intervention strategy that promotes modern contraceptive method utilization should consider these factors for its better success.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cônjuges/psicologia , Adolescente , Adulto , Criança , Anticoncepção/métodos , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Estudos Transversais , Demografia , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Cônjuges/etnologia , Adulto Jovem
10.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914967

RESUMO

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Assuntos
Coeficiente de Natalidade/tendências , Serviços de Saúde Comunitária , Anticoncepção/psicologia , Aconselhamento , Adolescente , Cidades , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Áreas de Pobreza , Gravidez , Avaliação de Programas e Projetos de Saúde , Características de Residência/estatística & dados numéricos , Espanha , Adulto Jovem
11.
Cancer Res ; 80(5): 1210-1218, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932455

RESUMO

Repeated exposure to the acute proinflammatory environment that follows ovulation at the ovarian surface and distal fallopian tube over a woman's reproductive years may increase ovarian cancer risk. To address this, analyses included individual-level data from 558,709 naturally menopausal women across 20 prospective cohorts, among whom 3,246 developed invasive epithelial ovarian cancer (2,045 serous, 319 endometrioid, 184 mucinous, 121 clear cell, 577 other/unknown). Cox models were used to estimate multivariable-adjusted HRs between lifetime ovulatory cycles (LOC) and its components and ovarian cancer risk overall and by histotype. Women in the 90th percentile of LOC (>514 cycles) were almost twice as likely to be diagnosed with ovarian cancer than women in the 10th percentile (<294) [HR (95% confidence interval): 1.92 (1.60-2.30)]. Risk increased 14% per 5-year increase in LOC (60 cycles) [(1.10-1.17)]; this association remained after adjustment for LOC components: number of pregnancies and oral contraceptive use [1.08 (1.04-1.12)]. The association varied by histotype, with increased risk of serous [1.13 (1.09-1.17)], endometrioid [1.20 (1.10-1.32)], and clear cell [1.37 (1.18-1.58)], but not mucinous [0.99 (0.88-1.10), P-heterogeneity = 0.01] tumors. Heterogeneity across histotypes was reduced [P-heterogeneity = 0.15] with adjustment for LOC components [1.08 serous, 1.11 endometrioid, 1.26 clear cell, 0.94 mucinous]. Although the 10-year absolute risk of ovarian cancer is small, it roughly doubles as the number of LOC rises from approximately 300 to 500. The consistency and linearity of effects strongly support the hypothesis that each ovulation leads to small increases in the risk of most ovarian cancers, a risk that cumulates through life, suggesting this as an important area for identifying intervention strategies. SIGNIFICANCE: Although ovarian cancer is rare, risk of most ovarian cancers doubles as the number of lifetime ovulatory cycles increases from approximately 300 to 500. Thus, identifying an important area for cancer prevention research.


Assuntos
Neoplasias Ovarianas/epidemiologia , Ovário/imunologia , Ovulação/imunologia , Idoso , Anticoncepcionais/administração & dosagem , Tubas Uterinas/imunologia , Tubas Uterinas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/prevenção & controle , Ovário/patologia , Ovulação/efeitos dos fármacos , Modelos de Riscos Proporcionais , Estudos Prospectivos , História Reprodutiva , Medição de Risco , Fatores de Risco
12.
AIDS Behav ; 24(2): 637-647, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31254190

RESUMO

INTRODUCTION: Incorporating end-user input into the design of new vaginal microbicides for women is key to optimizing their uptake, consistent use, and, ultimately, success in combatting the heterosexual HIV epidemic. METHODS: The Quatro Study assessed four placebo forms of vaginally inserted HIV-microbicides among young microbicide-naïve African women: on-demand film, insert and gel, and monthly ring. Participants randomly used each product for 1 month and provided product satisfaction ratings (1-5 scale), and opinions on product attributes and potential alternative designs. Qualitative data were collected through focus group discussions at study exit. Multivariable associations between attribute opinions and overall product rating were examined using Poisson regression models with robust standard errors to assess the attributes most influential to satisfaction. RESULTS: Overall opinions of products and their individual attributes were generally positive; all products were rated either 4 or a 5 by ≥ 50% of participants. Attributes related to ease of use and interference with normal activities were the most salient predictors of satisfaction. Preferences for duration of use tended toward relatively shorter use periods for the ring (i.e., 1-3 months vs. 12 months) and for coitally independent dosing for the on-demand products. CONCLUSIONS: How well a product fit in with participants' lifestyles was important to their overall satisfaction. For on-demand products, greater flexibility around timing of use was desired, to avoid coital dependency of the dosing.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Anti-Infecciosos/administração & dosagem , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pré-Exposição/métodos , Doenças Sexualmente Transmissíveis/prevenção & controle , Cremes, Espumas e Géis Vaginais/uso terapêutico , Administração Intravaginal , Adulto , Coito , Estudos Cross-Over , Feminino , Grupos Focais , Infecções por HIV/tratamento farmacológico , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pesquisa Qualitativa , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 938, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31806010

RESUMO

BACKGROUND: Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. METHODS: This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. RESULT: The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. CONCLUSION: This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.


Assuntos
Anticoncepcionais/administração & dosagem , Assistência à Saúde/organização & administração , Difusão de Inovações , Pesquisa sobre Serviços de Saúde , Humanos , Injeções , Nigéria
14.
J Int AIDS Soc ; 22(12): e25427, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31855323

RESUMO

INTRODUCTION: Although pre-exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub-Saharan Africa, likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that providing long-acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy-to-reach target population. In this modelling study, we assessed the epidemiological impact and cost-effectiveness of providing long-acting PrEP to injectable contraceptive users in Limpopo, South Africa. METHODS: We developed a deterministic mathematical model calibrated to the HIV epidemic in Limpopo. Long-acting PrEP was provided to 50% of HIV negative injectable contraceptive users in 2018 and scaled-up over two years. We estimated the number of HIV infections that could be averted by 2030 and the drug price of long-acting PrEP for which this intervention would be cost-effective over a time horizon of 40 years, from a healthcare payer perspective. In the base-case scenario we assumed long-acting PrEP is 75% effective in preventing HIV infections and 85% of infected individuals are on antiretroviral drug therapy (ART) by 2030. In sensitivity analyses we adjusted PrEP effectiveness and ART coverage. Costs between $519 and $1119 per disability-adjusted life-year (DALY) averted were considered potentially cost-effective, and <$519 as cost-effective. RESULTS: Without long-acting injectable PrEP, 224,000 (interquartile range 176,000 to 271,000) new infections will occur by 2030; use of long-acting injectable PrEP could prevent 21,000 (17,000 to 26,000) or 9.8% (8.9% to 10.6%) new HIV infections by 2030 (including 6000 (4000 to 7000) in men). Long-acting PrEP would prevent 34,000 (29,000 to 39,000) or 12,000 (8000 to 15,000) at 75% and 95% ART coverage by 2030 respectively. To be considered potentially cost-effective the annual long-acting PrEP drug price should be <$16, and/or ART coverage remains at <85% in 2030. CONCLUSIONS: Providing long-acting PrEP to injectable contraceptive users in Limpopo is only potentially cost-effective when long-acting PrEP drug prices are low. If low prices are not feasible, providing long-acting PrEP only to women at high risk of HIV infection will become important.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Anticoncepcionais/administração & dosagem , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/economia , Profilaxia Pré-Exposição/métodos , Adulto , Fármacos Anti-HIV/economia , Análise Custo-Benefício , Epidemias , Feminino , Infecções por HIV/epidemiologia , Humanos , Injeções , África do Sul/epidemiologia
15.
S Afr Med J ; 109(10): 756-760, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635573

RESUMO

BACKGROUND: Evidence-informed priority setting is vital to improved investment in public health interventions. This is particularly important as South Africa (SA) makes the shift to universal health coverage and institution of National Health Insurance. OBJECTIVES: To measure the financial impact of increasing the demand for modern contraceptive methods in the SA public health sector. We estimated the total cost of providing contraceptives, and specifically the budgetary impact of premature removals of long-acting reversible contraceptives. METHODS: We created a deterministic model in Microsoft Excel to estimate the costs of contraception provision over a 5-year time horizon (2018 - 2023) from a healthcare provider perspective. Only direct costs of service provision were considered, including drugs, supplies and personnel time. Costs were not discounted owing to the short time horizon. Scenario analyses were conducted to test uncertainty. RESULTS: The base-case cost of current contraceptive use in 2018 was estimated to be ZAR1.64 billion (ZAR29 per capita). Injectable contraceptives accounted for ~47% of total costs. To meet the total demand for family planning, SA would have to spend ~30% more than the estimate for current contraceptive use. In the year 2023, the 'current use' of modern contraceptives would increase to ZAR2.2 billion, and fulfilling the total demand for family planning would require ZAR2.9 billion. The base-case cost of implantable contraceptives was estimated at ZAR54 million. Assuming a normal removal rate, the use of implants is projected to increase by 20% during the 5-year period between 2019 and 2023, with an estimated 46% increase in costs. The cost of early removal of Implanon NXT is estimated at ZAR75 million, with total contraception costs estimated at ZAR102 million in 2019, compared with ZAR56 million when a normal removal rate is applied. CONCLUSIONS: The costs of scaling up modern contraceptives in SA are substantial. Early and premature removals of implantable contraceptives are costly to the nation and must be minimised. The government should consider conducting appropriate health technology assessments to inform the introduction of new public health interventions as SA makes the shift to universal health coverage by means of National Health Insurance.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Programas Nacionais de Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Anticoncepção/economia , Anticoncepção/tendências , Comportamento Contraceptivo/tendências , Anticoncepcionais/economia , Implantes de Medicamento/administração & dosagem , Implantes de Medicamento/economia , Serviços de Planejamento Familiar , Humanos , Contracepção Reversível de Longo Prazo/economia , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/tendências , Modelos Teóricos , Setor Público/economia , Setor Público/tendências , África do Sul
17.
Adv Ther ; 36(12): 3381-3389, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602573

RESUMO

INTRODUCTION: AG200-15, an investigational transdermal contraceptive delivery system or patch, is designed to be a low-dose, non-daily, combined hormonal contraceptive option for women. In this phase 1 study, the in vivo adhesion of the AG200-15 patch was compared to Xulane®, the only contraceptive patch available in the USA. METHODS: This phase 1, randomized, open-label, single-dose, two-treatment, two-period crossover adhesion study compared the 7-day adhesion of the AG200-15 and Xulane contraceptive patches. Eighty-three women, ages 18 to 35 years old, with body mass index (BMI) ≥ 19 kg/m2 and < 35 kg/m2, and weight ≥ 48 kg and < 90 kg were enrolled. Trained study site personnel used a five-point scale to assess patch adhesion daily. A score of 0 reflected at least 90% adhesion; while a score of 4 represented complete detachment of the patch. The primary objective was to compare the adhesion properties of the two patches; AG200-15 would be considered statistically non-inferior to Xulane if the upper 95% confidence limit (CL) of the mean difference in adhesion scores was below + 0.15. RESULTS: The overall mean (standard deviation) scores for AG200-15 (N = 78) and Xulane (N = 77) were 0.14 (0.28) and 0.39 (0.40), respectively (lower scores on the adhesion scale indicate better adhesion). The study demonstrated a difference in mean adhesion scores of - 0.24, meeting the prespecified non-inferiority criterion by demonstrating a one-sided upper CL of - 0.16. Thus, the in vivo adhesion of AG200-15 was shown to be non-inferior to that of Xulane. Most subjects experienced no skin irritation at the application site for either patch and no serious adverse event was reported in the study. CONCLUSION: The in vivo adhesion of AG200-15 is non-inferior to that of Xulane on the basis of the prespecified criterion of the upper bound of the one-sided 95% CL for the mean adhesion score difference being below + 0.15. Both patches were generally well tolerated. FUNDING: Agile Therapeutics, Inc.


Assuntos
Anticoncepcionais/uso terapêutico , Etinilestradiol/uso terapêutico , Levanogestrel/uso terapêutico , Norgestrel/análogos & derivados , Administração Cutânea , Adolescente , Adulto , Índice de Massa Corporal , Anticoncepcionais/administração & dosagem , Anticoncepcionais/efeitos adversos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Estudos de Equivalência como Asunto , Etinilestradiol/administração & dosagem , Etinilestradiol/efeitos adversos , Feminino , Humanos , Levanogestrel/administração & dosagem , Levanogestrel/efeitos adversos , Norgestrel/administração & dosagem , Norgestrel/efeitos adversos , Norgestrel/uso terapêutico , Oximas/administração & dosagem , Oximas/efeitos adversos , Oximas/uso terapêutico , Adulto Jovem
18.
Reprod Health ; 16(1): 152, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655615

RESUMO

BACKGROUND: Public health literature is replete with evidence on individual and interpersonal indicators of modern contraceptive use. There is, however, limited knowledge regarding healthcare system indicators of modern contraceptive use. This study assessed how the healthcare system influences use of modern contraceptive among women in Ghana, Kenya, and two large population states in Nigeria. METHODS: This study used data from Phase 1 of the Performance Monitoring and Accountability 2020. The analytical sample was limited to women with a need for contraception, defined as women of reproductive age (15 to 49 years) who wish to delay or limit childbirth. Therefore, this analysis consisted of 1066, 1285, and 1955 women from Nigeria, Ghana, and Kenya respectively. Indicators of healthcare assessed include user-fees, visit by health worker, type of health facility, multiple perinatal services, adolescent reproductive healthcare, density of healthcare workers, and regularity of contraceptive services. All analyses were conducted with SAS (9.4), with statistical significance set at p < 5%. RESULTS: The prevalence of modern contraceptive was 22.7, 33.2, and 68.9% in Nigeria, Ghana, and Kenya respectively. The odds of modern contraceptive use were higher among Nigerian women who lived within areas that provide adolescent reproductive healthcare (OR = 2.05; 95% C.I. = 1.05-3.99) and Kenyan women residing in locales with polyclinic or hospitals (OR = 1.91; 1.27-2.88). Also, the odds of contraceptive use were higher among Kenyan women who lived in areas with user-fee for contraceptive services (OR = 1.40; 1.07-1.85), but lower among Ghanaian women residing in such areas (OR = 0.46; 0.23-0.92). Lastly, the odds of modern contraceptive use were higher among women visited by a health-worker visit among women in Ghana (OR = 1.63; 1.11-2.42) and Nigeria (OR = 2.97; 1.56-5.67) than those without a visit. CONCLUSION: This study found an association between country-specific indicators of healthcare and modern contraceptive use. Evidence from this study can inform policy makers, health workers, and healthcare organizations on specific healthcare factors to target in meeting the need for contraception in Ghana, Kenya, and Nigeria.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Assistência à Saúde/normas , Serviços de Planejamento Familiar/normas , Conhecimentos, Atitudes e Prática em Saúde , Indicadores de Qualidade em Assistência à Saúde/normas , Adolescente , Adulto , Feminino , Gana , Humanos , Quênia , Nigéria , Gravidez , Responsabilidade Social , Fatores Socioeconômicos , Adulto Jovem
19.
Ups J Med Sci ; 124(3): 203-212, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31495254

RESUMO

Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.


Assuntos
Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Aconselhamento/métodos , Serviços de Planejamento Familiar/educação , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva/educação , Adulto , Conscientização , Aconselhamento/estatística & dados numéricos , Feminino , Fertilidade/fisiologia , Humanos , Cuidado Pré-Concepcional/métodos , Gravidez , Gravidez não Desejada , Medição de Risco , Inquéritos e Questionários , Suécia , Adulto Jovem
20.
Lancet HIV ; 6(9): e601-e612, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31498109

RESUMO

BACKGROUND: Drug-drug interactions between orally administered antiretroviral therapy (ART) and hormones released from an intravaginal ring are not known. We hypothesised that ART containing either efavirenz or ritonavir-boosted atazanavir would alter plasma concentrations of vaginally administered etonogestrel and ethinylestradiol but that ART concentrations would be unchanged during use of an intravaginal ring. METHODS: We did a parallel, three-group, pharmacokinetic evaluation at HIV clinics in Asia (two sites), South America (five), sub-Saharan Africa (three), and the USA (11) between Dec 30, 2014, and Sept 12, 2016. We enrolled women with HIV who were either ART-naive (control group; n=25), receiving efavirenz-based ART (n=25), or receiving atazanavir-ritonavir-based ART (n=24). Women receiving ART were required to be on the same regimen for at least 30 days, with 400 copies or less per mL of plasma HIV-1 RNA; women not receiving ART had CD4 counts of 350 cells per µL or less. We excluded participants who had a bilateral oophorectomy or conditions that were contraindicated in the intravaginal ring product labelling. An intravaginal ring releasing etonogestrel and ethinylestradiol was inserted at entry (day 0). Single plasma samples for hormone concentrations were collected on days 7, 14, and 21 after intravaginal ring insertion. The primary outcome was the plasma concentration of etonogestrel and ethinylestradiol on day 21. Etonogestrel and ethinylestradiol concentrations were compared between each ART group and the control group by geometric mean ratio (GMR) with 90% CIs and Wilcoxon rank-sum test. As secondary outcomes, efavirenz or ritonavir-boosted atazanavir concentrations were assessed by 8-h intensive pharmacokinetic sampling at entry before intravaginal ring insertion and before intravaginal ring removal on day 21. Antiretroviral areas under the concentration-time curve (AUC0-8 h) were compared before and after intravaginal ring insertion by GMR (90% CI) and Wilcoxon signed-rank test. This study is registered with ClinicalTrials.gov, number NCT01903031. FINDINGS: Between Dec 30, 2014, and Sept 12, 2016, we enrolled 84 participants in the study; ten participants were excluded from the primary hormone analysis. 74 participants met the primary endpoint: 25 in the control group, 25 in the efavirenz group, and 24 in the atazanavir group. On day 21 of intravaginal ring use, participants receiving efavirenz had 79% lower etonogestrel (GMR 0·21, 90% CI 0·16-0·28; p<0·0001) and 59% lower ethinylestradiol (0·41, 0·32-0·52; p<0·0001) concentrations compared with the control group. By contrast, participants receiving ritonavir-boosted atazanavir had 71% higher etonogestrel (1·71, 1·37-2·14; p<0·0001), yet 38% lower ethinylestradiol (0·62, 0·49-0·79; p=0·0037) compared with the control group. The AUC0-8 h of efavirenz or atazanavir did not differ between the groups. INTERPRETATION: Hormone exposure was significantly lower when an intravaginal ring contraceptive was combined with efavirenz-based ART. Further studies designed to examine pharmacodynamic endpoints, such as ovulation, when intravaginal ring hormones are combined with efavirenz are warranted. FUNDING: National Institutes of Health, through the AIDS Clinical Trials Group and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Sulfato de Atazanavir/uso terapêutico , Benzoxazinas/uso terapêutico , Anticoncepcionais/farmacocinética , Desogestrel/farmacocinética , Infecções por HIV/tratamento farmacológico , Linestrenol/farmacocinética , Ritonavir/uso terapêutico , Adulto , Alquinos , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/sangue , Sulfato de Atazanavir/administração & dosagem , Sulfato de Atazanavir/sangue , Benzoxazinas/administração & dosagem , Benzoxazinas/sangue , Anticoncepcionais/administração & dosagem , Dispositivos Anticoncepcionais Femininos , Ciclopropanos , Desogestrel/administração & dosagem , Interações Medicamentosas , Feminino , Infecções por HIV/sangue , HIV-1/efeitos dos fármacos , HIV-1/metabolismo , Humanos , Linestrenol/administração & dosagem , Pessoa de Meia-Idade , Progesterona/sangue , Ritonavir/administração & dosagem , Ritonavir/sangue , Carga Viral/efeitos dos fármacos , Adulto Jovem
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