3 research outputs found
Integration of Oral HIV Pre-Exposure Prophylaxis into Ambulatory Reproductive Care for Cisgender Women: A Scoping Review and Development of an Evidence-Based Implementation Strategy
No full textPublic Health Significance:
Pre-Exposure Prophylaxis (PrEP) is a daily antiretroviral medication to prevent HIV. 20% of new US HIV diagnoses are among women. Although PrEP has been available since 2012, less than 5% of PrEP users are women. Barriers to PrEP use include poor risk assessment by women’s health providers, lack of PrEP knowledge among women, and lack of PrEP familiarity among women’s health providers. Obstetrician-gynecologists (OB/GYNs) are uniquely positioned to assess women’s HIV acquisition risk and increase PrEP utilization.
Objectives:
To describe the development of a clinical protocol and provider education series for PrEP delivery in an ambulatory OB/GYN setting.
Methods:
An implementation strategy for PrEP delivery was designed based on an informal institutional asset assessment. An evidence-based PrEP protocol was developed with stakeholder engagement. Provider knowledge/familiarity with PrEP was identified as a key barrier to PrEP access and a multi-modal, interactive lecture series was developed in partnership with local community and national HIV/AIDS organizations.
Results:
A clinical protocol was distributed. Women’s health provider education sessions were held. Studies monitoring the proportion of PrEP prescriptions filled before and after implementation are ongoing. Demographic data, including reason for initiating and/or discontinuing PrEP will be described.
Discussion:
There is little data on implementation of PrEP delivery among OB/GYNs. OB/GYNs are uniquely positioned to increase access and utilization of PrEP among women at risk for HIV acquisition. This evidence-based implementation strategy may provide a model that can be adapted to other women’s health ambulatory settings and reduce disparities in PrEP use among women
Chemotherapy delay after primary debulking surgery for ovarian cancer
No full textTo determine the association of chemotherapy delay with overall survival (OS) and investigate predictors of delay among a population-representative American ovarian cancer cohort.
An observational retrospective cohort analysis of women with ovarian cancer who received National Comprehensive Cancer Network guideline-consistent care was performed with the 1998-2011 National Cancer Data Base. Chemotherapy delay was defined as initiation of multiagent chemotherapy >28days from primary debulking surgery. Associations of patient and disease characteristics with chemotherapy delay were tested with multivariate logistic regression. Survival analyses for women diagnosed from 2003 to 2006 approximated a 21-daycycle intravenous platinum-taxane chemotherapy cohort. Overall survival was estimated by Kaplan-Meier analyses and Cox proportional-hazards regressions, with sensitivity analyses using matched cohorts.
58.1% (26,149/45,001) of women experienced chemotherapy delay. Race, insurance status, cancer center type, and community median income were significantly associated with chemotherapy delay (P35days from surgery was associated with a 7% (95% confidence interval, 2-13%) increased hazard of death (P=0.01). Relative hazard of death was lowest between 25 and 29days after surgery but was not significantly different within the longer two-week interval from 21 to 35days.
A survival benefit may be achieved by consistently starting chemotherapy between 21 and 35days from primary debulking surgery. Women at higher risk for chemotherapy delay may be targeted for close follow-up
Abortion as Essential Health Care and the Critical Role Your Practice Can Play in Protecting Abortion Access
No full textFew obstetrician–gynecologists (ob-gyns) provide abortion care, resulting in abortion being separated from other reproductive health care. This segregation of services disrupts the ob-gyn patient–clinician relationship, generates needless costs, delays access to abortion care, and contributes to stigma. General ob-gyns have both the skills and the knowledge to incorporate abortion into their clinical practices. In this way, they can actively contribute to the protection of abortion access now with the loss of federal protection for abortion under Roe v Wade. For those who live where abortion remains legal, now is the time to start providing abortions and enhancing your abortion-referral process. For all, regardless of state legislation, ob-gyns must be leaders in advocacy by facilitating abortion care—across state lines, using telehealth, or with self-managed abortion—and avoiding any contribution to the criminalization of those who seek or obtain essential abortion care. Our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care to the fullest extent
