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“I have to do it in secrecy”: Provider perspectives on HIV service delivery and quality of care for key populations in Zambia
No full textKey populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers
\u3ci\u3eEx vivo\u3c/i\u3e colonic tissue susceptibility to HIV-1 in cisgender men and women
No full textThe biology of HIV-1 acquisition through unprotected receptive anal intercourse is understudied. Considering that sex hormones are implicated in intestinal physiology, pathology, and HIV acquisition and pathogenesis, we explored links between sex hormones, ex vivo HIV-1BaL infection of colonic mucosa, and candidate biomarkers of susceptibility to HIV-1 (CD4+ T cell frequencies and immune mediators) in cisgender women and men. No consistent significant associations between sex hormone concentrations and ex vivo tissue infection with HIV- 1BaL were detected. In men, serum estradiol (E2) concentrations were positively associated with tissue proinflammatory mediators (IL17A, GM-CSF, IFNγ, TNFα, and MIG/CXCL9) and serum testosterone concentrations were negatively associated with frequencies of activated CD4+ T cells (CD4+CCR5+, CD4+HLADR+, and CD4+CD38+HLA-DR+). In women, the only significant interactions were positive associations between progesterone (P4)/E2 ratios and tissue ILRA concentrations and between P4/E2 ratios and frequencies of tissue CD4+α4β7high+ T cells. The study did not reveal relationships between biological sex or phase of the menstrual cycle and ex vivo tissue HIV-1BaL infection and tissue immune mediators. A comparison of CD4+ T cell frequencies between study groups revealed a higher frequency of tissue CD4+α4β7high+ T cells in women versus men. In contrast, higher frequencies of tissue CD4+CD103+ T cells were detected in men versus women in the follicular phase of the menstrual cycle. Overall, the study identified associations between systemic sex hormone concentrations, biological sex, and tissue candidate biomarkers of susceptibility to HIV-1. The significance of these results for tissue susceptibility to HIV-1 and early HIV-1 pathogenesis warrants further investigation
Risk factors for and outcomes of ring expulsions with a one year contraceptive vaginal system
No full textBackground: The FDA-approved, segesterone acetate/ethinyl estradiol, ring-shaped contraceptive vaginal system, known was Annovera (Sever Pharma Solutions/QPharma, Malmö, Sweden inserted and removed under a woman’s control for a 21 day in/7 day out regimen for up to 13 cycles of use. Objectives: We aimed to describe patterns of ring expulsion over time, identify potential predictors of expulsion and evaluate the impact of expulsions on method discontinuation and pregnancy risk. Study Design: Using data from 2064 participants in two multinational Phase 3 clinical trials of this contraceptive vaginal system we examined data from participants’ daily diaries for documentation of complete ring expulsion. We modeled the odds of reported expulsions over time, adjusting for background and demographic characteristics, using mixed-effects logistic regression models with random intercepts. We compared probability of continuation between those who did and did not report expulsions in the first cycle of use using survival analysis and hazards modeling. To determine if expulsions during the first cycle of use affected risk of pregnancy, we calculated Pearl Indices. Results: Most participants (75%) never experienced any expulsions during any cycle of use, with 91-97% not experiencing an expulsion during any one cycle. The incidence of expulsion was highest in Cycle 1 (9%). The odds of experiencing expulsions decreased by half in cycles 2-8 3 vs cycle 1 (0.48 95% CI 0.40-0.58) and in in cycles 9-13 expulsions were about a third that in cycle 1 (0.32 95% CI 0.26-0.41). Of those who did experience expulsions, most (62-84%) experienced ≤2 expulsions per cycle. Participants from study sites in Latin America vs U.S. had higher odds of not experiencing an expulsion (OR 1.95, 95% CI 1.45-2.63). Women with more education had higher odds of experiencing an expulsion. Notably, parity, age and BMI were not associated with expulsion. Participants who did experience any expulsions in Cycle 1 were more likely to discontinue early hazards ratio 1.28, 95% CI (1.14, 1.43) compared to participants who had an expulsion. The Pearl Index for participants who had expulsions during Cycle 1 was 3.99 (95% CI: 1.29-9.31), higher than among participants who reported no expulsions (PI 2.39, 95% CI: 1.61-3.41) but the overlapping confidence intervals indicate there is not sufficient evidence to demonstrate an association between expulsions and pregnancy risk. Conclusions: Expulsions were infrequent overall, decreased with subsequent cycles of use and were not associated with BMI or parity. Early discontinuation of product use was higher among participants who experienced an expulsion during Cycle 1. While it is unclear whether pregnancy risk is associated with expulsions, early recognition of expulsions among users may identify those at higher risk for discontinuation and may highlight, where enhanced anticipatory counselling and guidance may be advantageous
Replication of soft skills training in the Rohingya camp and host community in Cox’s Bazar, Bangladesh
Get PDFThe Population Council in collaboration with Research, Training and Management International (RTMI) and Underprivileged Children’s Education Program (UCEP) implemented a pilot project on soft skills training in Cox’s Bazar in 2022 and 2023. The purpose of this training was to improve the personal, social, and financial management skills of Rohingya youth, which would be useful on their return to Myanmar or during their interim period of stay in Bangladesh. This pilot initiative also included host community youth. The Council found the soft skills training relevant and necessary for the lives of Rohingya and host community youth and identified an increase in demand for the training. Although several United Nations agencies, nongovernmental organizations, and private organizations are actively working in the camps and host communities, the coverage of soft skills training programs is limited and uneven against increasing demand for the training among Rohingya and local youth. The need for increasing the coverage of soft skills training in the Rohingya camp has been accentuated in different reports. Based on the positive response from the pilot training program and increasing demand for the training, the Population Council designed and supported the scale-up of soft skills training intervention in the camp and host community.
This report describes the evolution of the soft skills training program, from the development stage to pilot testing and then to replication in the Rohingya camp and host community. It also narrates the lessons learned from the replication of the training intervention and outlines a plan for sustainability
Community-based approaches to promote uptake of Sulfadoxine-Pyrimethamine for intermittent preventive treatment of malaria in pregnancy: Midline findings from Kisumu and Migori Counties
Get PDFMen\u27s willingness to use and preferences for novel male contraceptive methods in Malawi
No full textEvidence is needed in low- and middle-income countries regarding men\u27s willingness to use new male contraceptive methods in development, preferences regarding method attributes, and what shapes willingness/preferences. We analyzed data from cross-sectional surveys with 611 men in Malawi, concerning willingness to use each of four types of new male methods. Mean age was 24.5 years; half (50 percent) were married/cohabiting. Over half (51 percent) of men expressed willingness to use at least one new male method, including a topical contraceptive gel (33 percent), injection (32 percent), pill (29 percent), and implant (14 percent). Many male product attributes were considered important (with 59–67 percent endorsement), including ease of use, comfort of use, side effects, partner approval, type of method, frequency of facility visits, and cost. A prevalent reported reason for willingness was to “share responsibility for family planning with my partner” (44 percent). In multivariate regression analyses, willingness was inversely associated with inequitable gender attitudes (p \u3c 0.001) and was not associated with married/cohabiting status, using condoms, or perceived risk for HIV. These findings add to growing evidence that a majority of men express willingness to use new male contraceptive methods like a topical gel, injectable, or pill. Reflection around gender roles is likely critical within future education about male contraceptive methods
Knowledge of abortion legality among health facility staff in Ghana
No full textBackground: Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana. Methods: Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics. Findings: Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman’s life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only. Conclusions: Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability
Dataset: Humanitarian Violence Against Children and Youth Survey (HVACS) in Uganda
No full textThe 2022 Violence Against Children and Youth Survey in Refugee Settings in Uganda was conducted by the Baobab Research Programme Consortium in collaboration with the Office of the Prime Minister, Department of Refugees in Uganda; the United Nations High Commissioner for Refugees (UNHCR) Regional Bureau for the East and Horn Africa and the Great Lakes Region; and UNHCR Uganda and its implementing partners. The overall aim of the research was to generate evidence on the extent, consequences and implications of violence against children (VAC) in refugee settings in Uganda in order to inform strategies to identify, prevent and respond to VAC in such settings. The specific objectives of the research were to: (i) determine the prevalence of physical, emotional and sexual violence against children in refugee settings in the country; (ii) identify the risk and protective factors for physical, emotional and sexual violence against children in refugee settings in the country; (iii) determine the health and social consequences associated with violence against children in refugee settings in the country; (iv) determine the level of knowledge and utilization of medical, psychosocial, legal, and protective services available for children who have experienced sexual, emotional and physical violence in refugee settings in the country; and (v) make recommendations to relevant government and non-governmental organizations on developing, improving and enhancing prevention and response strategies to address violence against children in refugee settings. The study was a cross-sectional representative household survey conducted in all 13 refugee settlements in Uganda. Data collection involved structured face-to-face interviews with 1,338 female and 927 male adolescents and youth aged 13-24 years living in the refugee settlements
