scholarly journals Integration of HIV and sexual and reproductive health in the era of anti-retroviral-based prevention: findings from assessments in Kenya, Malawi and Zimbabwe

2021 ◽  
Vol 5 ◽  
pp. 145
Author(s):  
Fannie Kachale ◽  
Imelda Mahaka ◽  
Fatima Mhuriro ◽  
Mary Mugambi ◽  
Joseph Murungu ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Program Implementation ◽  
Sexual And Reproductive Health ◽  
Scale Up ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Structural Factors ◽  
Hiv Epidemic ◽  
Key Informant

Background: Though substantial progress has been made to curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. With the scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon, countries have a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV/SRH services. Methods: This article is a comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi and Zimbabwe to highlight cross-country trends and context-specific realities around HIV/SRH integration. The analyses in Kenya and Zimbabwe were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager project and include 20 health facility assessments, 73 key informant interviews and six community dialogues. In Malawi, the analysis was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 key informant interviews and a review of national policies and program implementation in Blantyre. Findings were validated through a review of literature and policies in each country. Results: The policy environment in all three countries is conducive to HIV/SRH integration, though operationalization continues to present challenges, with most policies preceding and not accounting for oral PrEP rollout. National coordination mechanisms, youth-friendly health services and prevention of mother-to-child transmission programs are promising practices, while siloed and resource-constrained health systems, limited provider capacity, lack of support for demand generation and structural factors exacerbate barriers to achieving integration. Conclusions: As new HIV prevention products are introduced, demand for integrated HIV/SRH services is likely to grow. Investing in HIV/SRH integration can help to ensure sustainable, government-led responses to the HIV epidemic, streamline service delivery and improve the health outcomes and lives of AGYW.

scholarly journals Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 578 ◽  
Author(s):  
Sarah Masyuko ◽  
Irene Mukui ◽  
Olivia Njathi ◽  
Maureen Kimani ◽  
Patricia Oluoch ◽  
...  
Keyword(s):  
Public Sector ◽  
Hiv Prevention ◽  
Scale Up ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Health Providers ◽  
Middle Income ◽  
The Government ◽  
Exposure Prophylaxis

Background While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. Methods: This paper details Kenya’s experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP.Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.

scholarly journals Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lesley Rose Ninsiima ◽  
Isabel Kazanga Chiumia ◽  
Rawlance Ndejjo
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Sexual And Reproductive Health ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Inclusion Criteria ◽  
Reproductive Health Services ◽  
Factors Influencing ◽  
Sub Saharan ◽  
Youth Friendly

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

scholarly journals A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rohan D. Jeremiah ◽  
Dhruvi R. Patel ◽  
Ellen Chirwa ◽  
Esnath Kapito ◽  
Xiaohan Mei ◽  
...  
Keyword(s):  
Health Promotion ◽  
Hiv Prevention ◽  
Reproductive Health ◽  
Antenatal Care ◽  
Hiv Testing ◽  
Late Pregnancy ◽  
Sub Saharan Africa ◽  
Partner Communication ◽  
Logistic Regression Models ◽  
Hiv Test

Abstract Background HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. Methods A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. Results Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. Conclusions HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

scholarly journals Ejercicio de derechos a la salud sexual y reproductiva entre mujeres de 20-29 años en Panamá y factores asociados.[Sexual and reproductive health rights exercise among women aged 20-29 in Panama and associated factors.]

2021 ◽  
Vol 40 (03) ◽  
Author(s):  
Fermina Chamorro Mojica ◽  
Faride Rodriguez ◽  
Selvis Stocel ◽  
Ruth De León
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Reproductive Health ◽  
Associated Factors ◽  
Sexual And Reproductive Health ◽  
Prevención Del Vih ◽  
Conjugal Violence ◽  
Modern Contraceptives ◽  
Professional Care ◽  
Health Rights

<p>Introducción: Los derechos a la salud sexual y reproductiva (DSSR) son básicos, y la capacidad de las mujeres para ejercerlos influye en lograr objetivos de desarrollo. Objetivos: Estimar indicadores de DSSR en mujeres de 20-29 años identificando factores asociados. Métodos: Con datos de la Encuesta Nacional de Salud Sexual y Reproductiva 2014-2015 se analizaron 1206 casadas/unidas (982 con demanda de planificación familiar, 1082 con hijos, y 978 usuarias de anticonceptivos), midiéndose la violencia conyugal en el último año, conocimiento sobre prevención del VIH, demanda satisfecha con anticonceptivos modernos, atención profesional al parto y autonomía. Se utilizó la regresión logística multivariada para probar asociaciones. Resultados: Padeció violencia conyugal 13.0%, tenía conocimiento sobre prevención del VIH 38.8%, satisfacía su demanda de planificación familiar con métodos modernos 62.0%; recibió atención profesional al parto 81.1%; y mostró autonomía 10.3%. Las oportunidades relativas ajustadas (ORa) de violencia conyugal eran mayores en mujeres que la justificaban ORa=1.92;IC95%:1.09-3.39); el conocimiento sobre prevención del VIH aumentaba con la escolaridad (ORa=1.13;IC95%:1.04-1.22); la satisfacción de la demanda con métodos modernos era menor si justificaban la violencia conyugal (ORa=0.42; IC95%:0.20-0.85) y mayor en aquellas con una mayor percepción de empoderamiento (ORa=2.33;IC95%:1.15-5.00). Las ORa de atención profesional en el último parto disminuyen cuando aumentaba la edad (ORa=0.72;IC95%:0.62-0.84), y era menor si experimentaron matrimonio infantil (ORa=0.43;IC95%:0.19-0.95). Las ORa de mayor autonomía resultaron menores en casadas (ORa=0.22;IC95%:0.10-0.47) y amas de casa (ORa=0.53;IC95%:0.28-0.98). Conclusiones: El ejercicio de DSSR y sus factores asociados constituyen desafíos al diseño de políticas públicas.</p><p>Abstract</p><p>Introduction: Sexual and reproductive health rights (SRHR) are basic, and women capacity to exert them influence achieving development goals. Objectives: Estimate indicators of SRHR in women aged 20-29 years, identifying associated factors. Methods: A total of 1206 married/cohabitant women (908 with need for family planning, 1082 with children and 978 contraceptive users) were analyzed with data from National Sexual and Reproductive Health Survey 2014-2015. It was obtained the proportion of conjugal violence victims in the last year, with knowledge about VIH prevention, family planning needs satisfied by modern contraceptive methods, with professional care at delivery and with autonomy. Multivariate logistic regression was used to test associations. Results: The 13.0% of women suffered conjugal violence, 38.8% had knowledge about HIV prevention, 62.0% used modern contraceptives for satisfying family planning needs, 81.1% received professional care at delivery, and 30.7% made informed decisions about SRH. Adjusted odds ratio (AOR) for conjugal violence were greater when women justified violence (AOR=1.92;95%CI:1.09-3.39); knowledge about HIV prevention increases with schooling (AOR=1.13;95%CI:1.04-1.22); family planning met with modern contraceptives methods was lower, if they justified violence (AOR=0.42;95%CI 0.20-0.85) and higher in women with a higher empowerment perception (AOR=2.33;95%CI:1.15-5.00). The AOR for professional care at last delivery decrease with increasing age (AOR=0.72;95%CI:0.62-0.84) and was lower if they experienced child marriage (AOR=0.43;95%CI:0.19-0.95). The AOR for autonomy was lower in married women (AOR=0.22;95%CI:0.10-0.47) and housewives (AOR=0.53;95%CI:0.28-0.98). Conclusions: The exert of SRHR and its associated factors challenge public policies design.</p>

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