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1.
BMC Public Health ; 24(1): 1458, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822304

RESUMO

BACKGROUND/AIMS: The dapivirine vaginal ring is a self-administered, women-initiated, discreet, long-acting HIV-1 prevention option for women. It was found to be safe and effective in healthy HIV-negative women who adhered to product use instructions, and has been approved for use in women aged 18 and older in some African countries. A qualitative study was conducted to explore participants' and their male partners' discussions on accidental/purposeful vaginal ring removals during The Ring Study (IPM 027 clinical trial). METHODS: Data were collected via in-depth interviews and focus group discussions with female trial participants and their male partners, from seven research centres in South Africa and Uganda. Data were thematically analysed using NVivo. RESULTS: More participants reported purposeful ring removals than accidental expulsions. Various factors influenced purposeful ring removal - including individual (discomfort during use/sex and to clean it), partner (to show them, because of discomfort during sex, to test if partners could feel it, and concerns of harm), organisational (doctor's request), and socio-cultural (rumours about sickness and infertility). Some described their own ring use removal, others discussed why other participants removed their rings. CONCLUSIONS: Vaginal ring adherence is critical to improve and support product efficacy. Counselling on vaginal anatomy, vaginal ring insertion and importance of adherence is important to minimise vaginal ring removal. Couples counselling is also important to facilitate support and long-term vaginal ring adherence behaviour. Understanding factors influencing vaginal ring adherence is important for tailoring and targeting messages to support correct and consistent vaginal ring use as it is made available to the public.


Assuntos
Dispositivos Anticoncepcionais Femininos , Infecções por HIV , Pirimidinas , Pesquisa Qualitativa , Parceiros Sexuais , Humanos , Feminino , Masculino , Adulto , África do Sul , Pirimidinas/administração & dosagem , Uganda , Infecções por HIV/prevenção & controle , Parceiros Sexuais/psicologia , Adulto Jovem , Autorrelato , Grupos Focais , Remoção de Dispositivo , Pessoa de Meia-Idade , Entrevistas como Assunto , Adolescente , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico
2.
AIDS Behav ; 26(1): 1-12, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34097209

RESUMO

Men living with HIV (MLWH) often have reproductive goals that can increase HIV-transmission risks to their pregnancy partners. We developed a safer conception intervention for MLWH in South Africa employing cognitive behavioral skills to promote serostatus disclosure, ART uptake, and viral suppression. MLWH were recruited from an HIV clinic near Durban, South Africa, and encouraged to include partners in follow-up visits. Exit in-depth interviews were conducted with eleven men and one female partner. The emerging over-arching theme is that safer conception care mitigates internalized and community-level HIV-stigma among MLWH. Additional related sub-themes include: (1) safer conception care acceptability is high but structural barriers challenge participation; (2) communication skills trainings helped overcome barriers to disclose serostatus; (3) feasibility and perceived effectiveness of strategies informed safer conception method selection. Our findings suggest that offering safer conception care to MLWH is a novel stigma-reducing strategy for motivating HIV prevention and treatment and serostatus disclosure to partners.


Assuntos
Revelação , Infecções por HIV , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Masculino , Homens , Gravidez , Parceiros Sexuais , África do Sul
3.
BMC Health Serv Res ; 21(1): 509, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039312

RESUMO

BACKGROUND: There is a need for information and healthcare support for the fertility desires and contraceptive needs of people living with HIV (PLHIV) in order to provide safer conception support for sero-discordant couples wanting to safely conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in the eThekwini District, South Africa. METHODS: To evaluate the model's success, a cross-sectional survey was conducted before and after implementation of the model. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers' perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. RESULTS: Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and antiretroviral treatment (ART) access influenced PLHIVs' desires for children. Concerns for their own and their child's health negatively impacted on PLHIV's fertility desires. These concerns declined after integration of services. Similarly, providers' concerns about PLHIV having children decreased after the implementation of the model. CONCLUSIONS: Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.


Assuntos
Infecções por HIV , Saúde Reprodutiva , Criança , Estudos Transversais , Feminino , Fertilidade , Infecções por HIV/tratamento farmacológico , Pessoal de Saúde , Humanos , Masculino , Gravidez , África do Sul/epidemiologia
4.
Eur J Contracept Reprod Health Care ; 24(5): 390-398, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31517545

RESUMO

Background: Multipurpose prevention technologies are needed to provide protection against HIV and sexually transmitted infections. Gel-based vaginal microbicides inserted via an applicator are prone to leakage. A novel device for vaginal drug delivery was developed to contain gel-based formulations, aiming to improve gel retention and reduce leakage. The objectives of this study were to assess acceptability and performance of a nonwoven vaginal delivery device. Methods: A nonwoven vaginal delivery device was prepared, pre-saturated with a commercially available water-based lubricant, with a finger pocket for insertion and string for removal. Quantitative and qualitative methods were used to collect data from interviews with 40 women and 10 male partners recruited from a sexual and reproductive health clinic in Durban, KwaZulu-Natal, South Africa. Women wore one device in the clinic and one device overnight or with their partner during intercourse. The primary endpoint was acceptability including comfort, ease of insertion and removal, and opinions on device attributes. Results: Most women said the device was 'easy' to insert and remove. Six women reported leakage after insertion and 34 reported having sexual intercourse while wearing the device. One woman was lost-to-follow-up and five women only wore the device overnight because their partners did not agree to intercourse with the inserted device. The best-liked attribute was the device's lubrication (22 women, 7 men); the least-liked was the removal string (9 women, 8 men). Conclusions: Data are promising for further development of this nonwoven device for vaginal drug delivery. Plain English summary Multipurpose prevention technologies (MPTs) that protect against HIV and sexually transmitted infections (STIs) are urgently needed. A variety of vaginal gel-based products are actively being researched; however, these products can often have challenges with vaginal leakage and retention. This research investigates the acceptability and performance of a nonwoven device to deliver vaginal gel formulations. The gel used in this study was a currently available marketed personal lubricant. In South Africa, 40 women (and 10 male partners) were recruited and given the opportunity to comment on various device attributes after insertion, overnight wear and sexual intercourse with their male partners. Generally, participants found the device easy to use and acceptable, where many factors possibly contributed to the device's acceptability (i.e., similarity to tampons, saturation with lubricant, minimal leakage, ease of insertion, comfort during intercourse and the male partners' willingness to have vaginal intercourse with the device in place). Further studies of the vaginal delivery device for acceptability, safety and efficacy using a gel-based formulation with an active ingredient are warranted.


Assuntos
Sistemas de Liberação de Medicamentos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Parceiros Sexuais/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Cremes, Espumas e Géis Vaginais/administração & dosagem , Administração Intravaginal , Adulto , Coito/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Infecções Sexualmente Transmissíveis/psicologia , África do Sul , Resultado do Tratamento , Adulto Jovem
5.
Reprod Health ; 15(1): 189, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30442150

RESUMO

BACKGROUND: There are few rigorous studies evaluating the benefits of vertical versus integrated delivery of healthcare services, and limited published studies describing conceptual models of integration at service-delivery level in public healthcare facilities. This article seeks to fill this gap, by describing the development of a district-based model for integrating sexual and reproductive health (SRH) and HIV services in KwaZulu-Natal, South Africa. METHODS: Baseline data were collected from seven urban public healthcare facilities through client and provider interviews, and a facility inventory was completed to assess current service integration practices. Feedback sessions were held with health providers from participating facilities to share data collected and explore appropriate integration scenarios. A conceptual model of potential service integration was then designed, and subsequently implemented and evaluated in the research sites. RESULTS: Key principles of the model included a focus on health system strengthening and strong community input and involvement. The model was designed primarily to support the integration of family planning into HIV services, and included measures to improve client and commodity monitoring; capacity building through training and mentorship; and a 'health navigation' strategy to strengthen referrals within and between public healthcare facilities. Endline evaluation data were collected in the same facilities following implementation of the model. CONCLUSIONS: This manuscript demonstrates the utility of the conceptual model. It shows that service integration can be accomplished in a phased manner with support of community and healthcare providers. In addition, local context must be taken into account and the components of the model should be flexible to suit the needs of the health system.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/prevenção & controle , HIV/isolamento & purificação , Serviços de Saúde Reprodutiva , Saúde Sexual , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos
6.
Afr J AIDS Res ; 15(2): 99-108, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27399040

RESUMO

Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each individual's situation. Treatment as prevention and pre-exposure prophylaxis are two new evidence-based strategies to decrease HIV incidence, both of which require high HIV testing rates to be effective, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 90% of HIV-positive individuals knowing their status by 2030. However, HIV testing rates in many countries remain suboptimal. Just as no single HIV prevention method is ideal for all people in all situations, no single HIV testing modality is likely to be acceptable to everyone. By offering HIV testing choices, we may be able to increase testing rates. However, many low-resourced countries have been slow to take up new HIV testing options such as the self-administered at-home oral HIV test that is currently available in the United States. In this paper, we present findings from 20 in-depth interviews, conducted in 2010, documenting opinions about self-administered at-home oral HIV testing, a testing modality still largely unavailable in Africa. Participants were clients of three primary healthcare clinics in South Africa. Self-testing was seen as enabling confidentiality/privacy, saving time, and facilitating testing together with partners. However, concerns were raised about psychological distress when testing at home without a counsellor. Some suggested this concern could be minimised by having experienced clinic-based HIV testing and counselling before getting self-testing kits for home use. Thus, self-administered HIV testing could be an option added to the current testing modalities to address some important barriers to testing.


Assuntos
Sorodiagnóstico da AIDS/métodos , Comportamento de Escolha , Infecções por HIV/diagnóstico , Autoadministração/estatística & dados numéricos , Administração Oral , Adulto , Aconselhamento , Feminino , Infecções por HIV/prevenção & controle , Assistência Domiciliar , Humanos , Masculino , Profilaxia Pré-Exposição/métodos , Autoadministração/psicologia , África do Sul , Inquéritos e Questionários
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