scholarly journals Family planning and PMTCT services: Examining interrelationships, strengthening linkages

2003 ◽  
Keyword(s):  
Family Planning ◽  
Hiv Transmission ◽  
Hiv Positive ◽  
Number Of Children ◽  
Voluntary Counseling And Testing ◽  
Unintended Pregnancies ◽  
Hiv Positive Women ◽  
Counseling And Testing ◽  
Pregnancy And Lactation ◽  
Mother To Child

Preventing unintended pregnancy among HIV-positive women through family planning (FP) services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women would yield a reduction in infections among infants and a reduction in the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. This brief focuses on findings from Horizons studies on the extent to which voluntary counseling and testing (VCT) and PMTCT programs address family planning. In Kenya and Zambia, the Horizons Program collaborated with NARESA and the MTCT Working Group, respectively, and UNICEF to document the acceptability, operational barriers, costs, and impact of pilot PMTCT services.

scholarly journals Unintended Repeat Pregnancies Among HIV Positive Women in Rio De Janeiro, Brazil

2018 ◽  
Vol 12 (1) ◽  
pp. 174-180
Author(s):  
Bernardo B. Wittlin ◽  
Alice W. Carvalho ◽  
Giulia P. Lima ◽  
Rune Andersson ◽  
Susanne Johansson ◽  
...  
Keyword(s):  
Viral Load ◽  
Family Planning ◽  
Antenatal Care ◽  
Unintended Pregnancy ◽  
Rio De Janeiro ◽  
Hiv Positive ◽  
Continuous Family ◽  
Unintended Pregnancies ◽  
Illegal Abortion ◽  
Hiv Positive Women

Introduction: High rates of unintended pregnancies among HIV positive women have been reported by several studies. Among repeated pregnancies, these rates may be higher. Our aim was to describe the unintended pregnancy rate in repeat gestations of the same group of HIV-positive women. Methodology: From a prospective cohort of HIV-infected pregnant women followed-up from 1995 to 2013 in an Antenatal Clinic (ANC) in Rio de Janeiro, we selected women who had at least two consecutive pregnancies. Patient data were prospectively obtained from standardized questionnaires. The main dependent variable was if the pregnancy was intended or unintended. Some of the other variables were: age, the interval between pregnancies, household income, CD4 cells count at admission in the ANC and at delivery, viral load<1000 copies/ml at admission and close to delivery, and attempts to illegal abortion. Results: From a total of 287 women included, the number of unintended pregnancies increased from 138 (63.6%) at first pregnancy to 198 (81.8%) at second pregnancy (p < 0.01). At first pregnancy, we observed 8 women who had made an attempt to illegal abortion (7 with an unintended pregnancy and 1 with a wanted pregnancy, p = 0.06), while at second pregnancy, 34 of them had made an attempt (33 with unintended pregnancy and 1 with a wanted pregnancy, p < 0.01). Regarding viral load suppression close to delivery, there was no statistic difference between first and second pregnancies (72,7% vs. 70,5%, p = 0.36) as well as between intended and unintended pregnancies (in first pregnancy: 80% vs. 86%, p = 0.4; in second pregnancy: 72% vs. 83%, p = 0,1). Conclusion: High rates of unintended pregnancies and illegal abortion attempts, along with their increase from one pregnancy to the subsequent, reinforce the need for continuous family planning practices in HIV-infected patients. The majority of the women were able to reach undetectable viral load at the end of the pregnancy, including those with unintended pregnancies. Implications: HIV infected patients presenting in antenatal care for sequential unintended pregnancies. Despite the fact that abortion is illegal in this country, a substantial number of women, still attempt it before attending antenatal care. Family planning actions should be performed during the antenatal care.

UNMET NEED FOR CONTRACEPTION AMONG HIV-POSITIVE WOMEN IN LESOTHO AND IMPLICATIONS FOR MOTHER-TO-CHILD TRANSMISSION

2009 ◽  
Vol 41 (2) ◽  
pp. 269-278 ◽  
Author(s):  
TIMOTHY ADAIR
Keyword(s):  
Family Planning ◽  
Unmet Need ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Hiv Status ◽  
Child Transmission ◽  
Childbearing Age ◽  
Hiv Positive Women ◽  
Mother To Child ◽  
Unmet Need For Contraception

SummaryIn Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26·4%), low knowledge of HIV status and a total fertility rate of 3·5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15–49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.

scholarly journals HIV voluntary counseling and testing: An essential component in preventing mother-to-child transmission of HIV

2003 ◽  
Keyword(s):  
Pregnant Women ◽  
Hiv Transmission ◽  
Antiretroviral Drugs ◽  
Hiv Counseling And Testing ◽  
Hiv Counseling ◽  
Couple Communication ◽  
Serostatus Disclosure ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Mother To Child

Positive results from clinical trials of the anti-retroviral medications zidovudine and nevirapine created the possibility of offering an affordable and feasible intervention worldwide to reduce HIV transmission from an infected pregnant woman to her infant. Governmental and nongovernmental health services in many highly affected areas of Africa, Asia, Latin America, and Eastern Europe have responded by piloting and rapidly expanding programs for the prevention of mother-to-child HIV transmission (PMTCT). Since their inception in 1999, programs have offered voluntary HIV counseling and testing (VCT) to more than 800,000 pregnant women around the world. An important objective of VCT is to identify which pregnant women are HIV-positive so they can receive antiretroviral drugs to prevent transmitting HIV to their infants. HIV counseling and testing also offer an opportunity to promote HIV prevention, encourage serostatus disclosure, and foster couple communication on HIV and PMTCT. This brief focuses on VCT in the antenatal care setting, examining service utilization by pregnant women, their perceptions of services, client outcomes as a result of undergoing HIV counseling and testing, and strategies for improving quality and coverage of VCT as a key component of PMTCT programs.

scholarly journals Private Midwives’ Perceptions on Barriers and Enabling Factors to Voluntary Counselling and HIV Test (VCT) in Bali, Indonesia

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Dinar Saurmauli Lubis ◽  
LPL Wulandari ◽  
Ni Luh Putu Suariyani ◽  
Kadek Tresna Adhi ◽  
Sari Andajani
Keyword(s):  
Pregnant Women ◽  
Thematic Analysis ◽  
Hiv Transmission ◽  
Institutional Barriers ◽  
Enabling Factors ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Hiv Test ◽  
Mother To Child ◽  
Depth Interviews

In Indonesia, more than half of pregnant women seek antenatal care (ANC) at private midwifery clinics. The midwives play an important role in advocating for voluntary counseling and testing (VCT) uptake among pregnant women during ANC. This study examined midwives’ perception of barriers and enabling factors with regards to refer pregnant women for HIV testing. The study was conducted in Denpasar City and Badung District, two localities in Bali with high HIV prevalence. Two focus groups discussions with 15 private midwives and five in-depth interviews were conducted. Data were transcribed verbatim and thematic analysis methods were used to examine patterns emerging from the data. Results showed that private midwives face personal barriers in the form of stigma as well as institutional barriers such as VCT operational hours that limit how and when they refer women for VCT. Barriers are strengthened by lack of support or reward from the health office. However, opportunities for integrated and comprehensive support systems within the health system and supportive social environment which would make it easy and rewarding for midwives to refer women to VCT clinics were seen as enabling factors. Increasing uptake of VCT is a necessity for eliminating mother to child HIV transmission. 

scholarly journals Evidence for the importance of community involvement: Implications for initiatives to prevent mother-to-child transmission of HIV

2001 ◽  
Keyword(s):  
Community Involvement ◽  
Hiv Transmission ◽  
Perinatal Transmission ◽  
Companion Paper ◽  
Lessons Learned ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Mother To Child

This paper offers lessons learned from a literature review of community involvement in biomedical and other technologies that can guide appropriate and effective introduction of services for prevention of mother-to-child transmission of HIV. A companion paper discusses research in Botswana and Zambia that showed gaps in community knowledge about HIV transmission, particularly from mother to child, and yielded insights into community perspectives about barriers to using voluntary counseling and testing services; stigma and fear associated with HIV; traditional norms on breastfeeding; and the role of family and community members in women’s decisions to participate in programs to prevent mother-to-child transmission of HIV. A separate publication (“Community involvement in the prevention of mother-to-child transmission of HIV: Insights and recommendations”) offers recommendations for community involvement strategies. Placed within the framework of community involvement, an intervention that addresses mother-to-child transmission of HIV offers an enormous opportunity to improve HIV prevention and care. Successful interventions can influence how AIDS is perceived by the community, reduce stigma, and have an effect beyond the immediate prevention of perinatal transmission.

scholarly journals Predictors of Unmet Need for Family Planning among HIV Positive Women in Care in Federal Teaching Hospital Gombe, Nigeria

2020 ◽  
pp. 26-33
Author(s):  
A. Mohammed ◽  
D. Chiroma ◽  
C. H. Laima ◽  
M. A. Danimoh ◽  
P. A. Odunze
Keyword(s):  
Family Planning ◽  
Unmet Need ◽  
Hiv Care ◽  
Hiv Positive ◽  
P Value ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Hiv Positive Women ◽  
History Of ◽  
Mother To Child

Background: Elimination of mother-to-child transmission (EMTCT) of Human Immunodeficiency Virus (HIV) requires adequate and continuous use of family planning commodities among women of reproductive age. This can be made possible by reducing the proportion of HIV positive women with unmet need for family planning. The study aims to determine the factors associated with having unmet need among women in HIV care. Methods: A cross sectional study was conducted using an interviewer administered questionnaire to study 325 women on HIV care. Cluster sampling technique was used to select the study respondents from the clinic. Results: Less than half of the respondents (40%) were currently using family planning, 35% had unmet need for family planning with 53.6% having unmet need for spacing while 46.4% having unmet need for limiting. Women with no history of previous use of family planning were fifteen times more likely to have unmet need for family planning than those with history of previous use of family planning (p value <0.001, CI 2.511-15.770). Also women with more than five deliveries were eight times more likely to have unmet need for family planning (p value 0.004, CI 0.001-0.279) while women with 2-5 deliveries are four times likely to have unmet need for family planning (p value 0.035, CI 0.005-0.832). Conclusion: A high proportion of women receiving ART care still have unmet need for family planning despite incorporating this service in HIV care. It is therefore important to target high risk groups to reduce the proportion of women with unmet need for family planning which will invariable reduce mother to child transmission of HIV.

scholarly journals Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

2019 ◽  
Author(s):  
JULIET NABIRYE ◽  
Joseph KB Matovu ◽  
John Baptist Bwanika ◽  
Fredrick Makumbi ◽  
Rhoda K. Wanyenze
Keyword(s):  
Family Planning ◽  
Reproductive Health ◽  
Critical Time ◽  
Hiv Care ◽  
Hiv Positive ◽  
Cross Sectional Survey ◽  
Time Points ◽  
Modern Contraception ◽  
Unintended Pregnancies ◽  
Hiv Positive Women

Abstract Introduction HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between FP counseling and current use of modern contraception to inform programming.Methods Data were drawn from a quantitative national cross-sectional survey of 5,198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counseling was defined as receipt of FP information by an HIV-positive woman during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counseling were done on 2,760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1.Results Overall, 2,104 (76.2%) HIV-positive women reported that they received FP counseling at any of the three critical time-points. Of the 24% ( n =656) who did not, 37.9% missed FP counseling at ANC; 41% missed FP counseling during delivery; while 54% missed FP counseling at the post-natal care visit. HIV-positive women who received any FP counseling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33).Conclusion Nearly one-quarter of HIV-positive women did not receive any form of FP counseling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counseling into HIV care at all critical time-points.

scholarly journals Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

2020 ◽  
Vol 9 (1) ◽  
pp. 81-92
Author(s):  
Cedrina L. Calder ◽  
Heather O ◽  
Mohammad Tabatabai ◽  
Celia J. Maxwell ◽  
Salisha Marryshow ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Self Report ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
North Central ◽  
Hiv Positive Women ◽  
Mother To Child

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria. Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ? 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample. Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]). Conclusion and Global Health Implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self- reported ethnicity, and partner

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