Pregnant and breastfeeding women’s prospective acceptability of two biomedical HIV prevention approaches in Sub Saharan Africa: A multisite qualitative analysis using the Theoretical Framework of Acceptability

HIV infection during pregnancy and breastfeeding has implications for maternal health. Between May- November 2018, we explored prospective acceptability of two novel HIV Pre-exposure Prophylaxis (PrEP) products, oral pills and vaginal rings, through focus group discussions with 65 pregnant and breastfeeding women in Malawi, South Africa, Uganda, Zimbabwe. Qualitative analysis was completed, guided by the Theoretical Framework of Acceptability (TFA). First, a deductive thematic analysis was applied to relevant coded data, into the seven TFA constructs (Affective Attitude; Burden; Ethicality, Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Next, an iterative analysis was completed to generate themes within each of the TFA constructs. Women’s positive attitudes towards daily oral PrEP highlighted the familiarity of taking pills, understanding the purpose of taking pills, and the perception that it is an effective method to protect mothers and babies from HIV during pregnancy and breastfeeding. Women emphasized the ease of using the ring given its monthly duration that lowers burden on the user, its discreetness and invisibility once in place. The TFA analysis highlighted how acceptability of both methods could be enhanced by focusing on perceptions of the end users (i.e. the women) and not just the products themselves. This approach provided insights into how to refine the intervention materials and plans for implementation.

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Biomedical prevention: what is the current status?

Asian Biomedicine ◽

10.2478/abm-2010-0089 ◽

2010 ◽

Vol 4 (5) ◽

pp. 679-682

Author(s):

David D. Celentano ◽

Wendy W. Davis ◽

Chris C. Beyrer

Keyword(s):

Male Circumcision ◽

Hiv Transmission ◽

Sub Saharan Africa ◽

Current Status ◽

Post Exposure Prophylaxis ◽

Biomedical Hiv Prevention ◽

Hiv Prevention Strategies ◽

Biomedical Prevention ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

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Ask the Way From Those Who Have Walked It Before – Grandmothers’ Roles in Health-related Decision Making and HIV Pre-exposure Prophylaxis (PrEP) Use Among Pregnant and Breastfeeding Women in Africa

10.21203/rs.3.rs-459256/v1 ◽

2021 ◽

Author(s):

Krishnaveni Reddy ◽

Doreen Kemigisha ◽

Miria Chitukuta ◽

Sufia Dadabhai ◽

Florence Mathebula ◽

...

Keyword(s):

Hiv Prevention ◽

Sub Saharan Africa ◽

Sources Of Information ◽

Maternal Experience ◽

Biomedical Hiv Prevention ◽

Health Related ◽

Sub Saharan ◽

Hiv Acquisition ◽

The Right ◽

Exposure Prophylaxis

Abstract Background: HIV acquisition among pregnant and breastfeeding women in sub-Saharan Africa (SSA) and vertical transmission rates remain high despite established strategies for HIV prevention. Methods: We explored grandmothers’ (mothers/mothers-in-law) influence on pregnant and breastfeeding women’s health-related decisions and their potential to support use of HIV prevention products utilizing qualitative data collected from grandmothers, HIV-uninfected, currently/recently pregnant or breastfeeding women and male partners of currently/recently pregnant or breastfeeding women during the MTN-041/MAMMA study. Results: Grandmothers were described as important sources of information, playing both supportive and influencer roles, due to personal maternal experience and generational knowledge. Grandmothers expressed willingness to support pre-exposure prophylaxis (PrEP) use and agreed with other groups that this decision should be made by women themselves and/or with partners. Conclusion: With the right framing and approach, grandmothers’ supportive roles can optimise uptake and adherence to biomedical HIV prevention and reduce HIV acquisition among pregnant and breastfeeding women in these communities.

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Prevalence and Correlates of Pregnancy Self-Testing Among Pregnant Women Attending Antenatal Care in Western Kenya

10.21203/rs.3.rs-78174/v1 ◽

2020 ◽

Author(s):

Nina Njeri Nganga ◽

Julia Dettinger ◽

John Kinuthia ◽

Jared Baeten ◽

Grace John-Stewart ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Sub Saharan Africa ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Western Kenya ◽

Self Testing ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) attendance. Understanding the characteristics of women who use pregnancy self-tests may facilitate early access to ANC and preventive interventions in pregnancy. We conducted a cross-sectional survey on an ongoing pre-exposure prophylaxis (PrEP) implementation study which enrolled pregnant women to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall in our study population, the prevalence of pregnancy self-testing was 22% and higher among women who were employed, currently in school, had previous pregnancy complications, received services from urban health facilities, and had partners who had at least attended secondary school. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and lack of money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing.

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Health system adaptations and considerations to facilitate optimal oral pre-exposure prophylaxis scale-up in sub-Saharan Africa

The Lancet HIV ◽

10.1016/s2352-3018(21)00129-6 ◽

2021 ◽

Author(s):

Daniel K Were ◽

Abednego Musau ◽

Kaitlyn Atkins ◽

Prakriti Shrestha ◽

Jason Reed ◽

...

Keyword(s):

Health System ◽

Scale Up ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Exposure Prophylaxis

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Languages and National Identity in Sub-Saharan Africa: A Multilevel Approach

The Economics of Language Policy ◽

10.7551/mitpress/9780262034708.003.0008 ◽

2016 ◽

Author(s):

Katalin Buzási

Keyword(s):

Positive Relationship ◽

Multilevel Models ◽

Sub Saharan Africa ◽

Explanatory Variables ◽

Country Level ◽

National Identification ◽

Positive Attitudes ◽

Language Knowledge ◽

French Colonies ◽

Sub Saharan

This chapter contributes to the recent strand of the empirical political and economic literature that attempts to reveal the determinants of national identification in Sub-Saharan Africa. Although previous survey-based studies provide evidence that the socio-economic characteristics of individuals, the properties of ethnic groups they belong to, and certain country-level variables influence the probability of having positive attitudes toward the ethnic group or the nation, the role of languages has not been studied in this context yet. Inspired by findings of psycholinguistics and related disciplines, we utilize the fourth round of the Afrobarometer Project (surveyed in 2008 and 2009) to conduct analysis on the possible positive relationship between language knowledge and identification in national versus ethnic terms. We introduce two language-related explanatory variables. First, the Index of Communication Potential (ICP) reflects the probability that an individual can communicate with another randomly selected person within the society relying on commonly spoken languages. Second, we take into account the number of spoken languages in one’s repertoire. The multilevel models show that although speaking more than two languages increases the chance of identifying in national compared to ethnic terms, the ICP is not significant in this sense on the whole sample. But, when we consider the nationality of the former colonizers, the ICP exhibits positive relationship with national identification on the sub-sample of the former French colonies.

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Where to deploy pre-exposure prophylaxis (PrEP) in sub-Saharan Africa?

Sexually Transmitted Infections ◽

10.1136/sextrans-2012-050891 ◽

2013 ◽

Vol 89 (8) ◽

pp. 628-634 ◽

Cited By ~ 22

Author(s):

Stéphane Verguet ◽

Meg Stalcup ◽

Julia A Walsh

Keyword(s):

Sub Saharan Africa ◽

Sub Saharan ◽

Exposure Prophylaxis

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Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽

10.1071/sh13094 ◽

2014 ◽

Vol 11 (2) ◽

pp. 126 ◽

Cited By ~ 9

Author(s):

Ying-Ru Lo ◽

Masaya Kato ◽

Nittaya Phanuphak ◽

Masami Fujita ◽

Duong Bui Duc ◽

...

Keyword(s):

Hiv Transmission ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

The Pacific ◽

Prep Implementation ◽

Sub Saharan ◽

Hiv Acquisition ◽

Operational Issues ◽

Exposure Prophylaxis ◽

Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

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Integrating Oral PrEP Into Family Planning Services for Women in Sub-saharan Africa: Findings From a Multi-Country Landscape Analysis

Frontiers in Reproductive Health ◽

10.3389/frph.2021.667823 ◽

2021 ◽

Vol 3 ◽

Author(s):

Neeraja Bhavaraju ◽

Rose Wilcher ◽

Regeru Njoroge Regeru ◽

Saiqa Mullick ◽

Imelda Mahaka ◽

...

Keyword(s):

Family Planning ◽

Service Delivery ◽

Health Care Providers ◽

Sub Saharan Africa ◽

Management Service ◽

Care Providers ◽

Road Map ◽

Sub Saharan ◽

Exposure Prophylaxis ◽

Oral Prep

Integration of HIV and family planning (FP) services is a renewed focus area for national policymakers, donors, and implementers in sub-Saharan Africa as a result of high HIV incidence among general-population women, especially adolescent girls and young women (AGYW), and the perception that integrating HIV pre-exposure prophylaxis (PrEP) into FP services may be an effective way to provide comprehensive HIV and FP services to this population. We conducted a focused desk review to develop a PrEP-FP integration framework across five key categories: plans and policies, resource management, service delivery, PrEP use, and monitoring and reporting. The framework was refined via interviews with 30 stakeholders across seven countries at varying stages of oral PrEP rollout: Kenya, Lesotho, Malawi, South Africa, Uganda, Zambia, and Zimbabwe. After refining the framework, we developed a PrEP-FP integration matrix and assessed country-specific progress to identify common enablers of and barriers to PrEP-FP integration. None of the countries included in our analysis had made substantial progress toward integrated PrEP-FP service delivery. Although the countries made progress in one or two categories, integration was often impeded by lack of advancement in other areas. Our framework offers policymakers, program implementers, and health care providers a road map for strategically assessing and monitoring progress toward PrEP-FP integration in their contexts.

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“I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

PLoS ONE ◽

10.1371/journal.pone.0244226 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244226

Author(s):

Makobu Kimani ◽

Elise M. van der Elst ◽

Oscar Chirro ◽

Elizabeth Wahome ◽

Fauz Ibrahim ◽

...

Keyword(s):

Risk Behaviour ◽

Healthcare Services ◽

Transgender Women ◽

Situational Factors ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

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Neonatal care practices in Buikwe District, Uganda: A qualitative study

10.21203/rs.3.rs-70855/v1 ◽

2020 ◽

Author(s):

Marte Bodil Roed ◽

Ingunn Marie Stadkleiv Engebretsen ◽

Robert Mangeni

Keyword(s):

Qualitative Method ◽

Post Partum ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Group Discussions ◽

Kangaroo Care ◽

Cord Clamping ◽

Hands On ◽

Care Practices ◽

Sub Saharan

Abstract Background: Sub-Saharan Africa is the region with the highest neonatal mortality rate, with 27 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period, both in cases of normal as well as complicated births.Methods: The study used a qualitative method with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis.Results: The study found various discrepancies between performed hands-on-procedures and the UCG related to neonatal care practices, including uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of kangaroo care.Conclusions: Continued focus on systemic strategies for further implementation of the UCG is recommended

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