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Author: Phirom Toeng
Publisher:
ISBN:
Category :
Languages : en
Pages : 176
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Introduction:Cambodia has set a goal to test at least 95% of all pregnant women for HIV. Thanks to Cambodia's "Boosted Linked Response" strategy, the HIV testing rate among pregnant women attending antenatal care (ANC) has gradually increased but plateaued out at approximately 90% for the past several years. Moreover, since 2012, the strategy has failed to test more than one-fourth of male partners of ANC-attending pregnant women. Therefore, we examined factors associated with HIV testing during ANC among pregnant women and their male partners. In addition, we also explored men's barriers to attending ANC with their pregnant partners, and their perspectives on three HIV testing alternative strategies (home-based HIV testing, free-of-charge pregnant woman-delivered HIV self-testing, and out-of-pocket community pharmacy-delivered HIV self-testing. Methods: In Study 1, we pooled together three Cambodia Demographic Health Surveys (2005, 2010, and 2014) and adopted Anderson's Behavioral Model of Health Services to guide our data analysis. The study population consisted of all Cambodian women aged 15-49 years with one or more live births in the three years preceding each survey who attended ANC for the most recent birth (weighted N=11,181). In Study 2, we conducted a Case-Control study. The study population consisted of men who attended ANC with their pregnant partners from September 2020 to December 2020. The outcome was defined as declining or accepting an HIV test as part of ANC. 132 cases and 264 controls were recruited from three government-run ANC health facilities in Phnom Penh (the National Maternal and Child Health Center, Chaktomuk Referral Hospital, and Posenchey Health Center). An Extended Theory of Planned Behavior (ETPB) was applied to guide our data analysis. In Study 3, a qualitative study was nested within the Case-Control study. The study population consisted of 30 men (10 HIV testing decliners, 10 acceptors, and 10 ANC non-attendees). All participants were recruited using consecutive sampling from ANC and postpartum departments of the National Maternal and Child Health Center. Results: In Study 1, HIV testing rates as part of ANC increased significantly by year (15.5% in 2005, 46.2% in 2010, and 77.4% in 2014, p
Author: Phirom Toeng
Publisher:
ISBN:
Category :
Languages : en
Pages : 176
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Book Description
Introduction:Cambodia has set a goal to test at least 95% of all pregnant women for HIV. Thanks to Cambodia's "Boosted Linked Response" strategy, the HIV testing rate among pregnant women attending antenatal care (ANC) has gradually increased but plateaued out at approximately 90% for the past several years. Moreover, since 2012, the strategy has failed to test more than one-fourth of male partners of ANC-attending pregnant women. Therefore, we examined factors associated with HIV testing during ANC among pregnant women and their male partners. In addition, we also explored men's barriers to attending ANC with their pregnant partners, and their perspectives on three HIV testing alternative strategies (home-based HIV testing, free-of-charge pregnant woman-delivered HIV self-testing, and out-of-pocket community pharmacy-delivered HIV self-testing. Methods: In Study 1, we pooled together three Cambodia Demographic Health Surveys (2005, 2010, and 2014) and adopted Anderson's Behavioral Model of Health Services to guide our data analysis. The study population consisted of all Cambodian women aged 15-49 years with one or more live births in the three years preceding each survey who attended ANC for the most recent birth (weighted N=11,181). In Study 2, we conducted a Case-Control study. The study population consisted of men who attended ANC with their pregnant partners from September 2020 to December 2020. The outcome was defined as declining or accepting an HIV test as part of ANC. 132 cases and 264 controls were recruited from three government-run ANC health facilities in Phnom Penh (the National Maternal and Child Health Center, Chaktomuk Referral Hospital, and Posenchey Health Center). An Extended Theory of Planned Behavior (ETPB) was applied to guide our data analysis. In Study 3, a qualitative study was nested within the Case-Control study. The study population consisted of 30 men (10 HIV testing decliners, 10 acceptors, and 10 ANC non-attendees). All participants were recruited using consecutive sampling from ANC and postpartum departments of the National Maternal and Child Health Center. Results: In Study 1, HIV testing rates as part of ANC increased significantly by year (15.5% in 2005, 46.2% in 2010, and 77.4% in 2014, p
Author: Alfred Onyango Osoti
Publisher:
ISBN:
Category :
Languages : en
Pages : 21
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Book Description
HIV testing of male partners of pregnant women is important to decrease HIV transmission to women and to support HIV-infected women in taking prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) settings. We hypothesized that home visits to male partners of women attending ANC would be feasible and would increase HIV testing of partners. Pregnant women attending ANC were enrolled, interviewed using smartphone audio-computer assisted self-interviews (ACASI), and randomized to home visits or written invitations for male partners to come to clinic. Enrolled men were interviewed (ACASI) and offered couples HIV counseling and testing (CHCT). Participants underwent follow-up ACASI six weeks post-enrollment. Prevalence of CHCT, male HIV, couple discordance, intimate partner violence were compared using intent-to-treat analysis. Results Among 495 women screened, 312 (63.0%) were eligible, of whom 300 were randomized to clinic-based or home-based HCT. Median age was 22 years [interquartile range (IQR) 20,26]; most were monogamous (87%) and 11% reported condom use and did not differ between trial arms. Male CHCT was substantially and significantly higher in the home-visit than the clinic-invitation arm (87% vs. 36%, p
Author: Daisy Krakowiak
Publisher:
ISBN:
Category :
Languages : en
Pages : 71
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Male partner involvement has been recognized as an important component of prevention-of-mother-to-child transmission of HIV (PMTCT); however, male antenatal attendance has been difficult to achieve. Home-based testing among pregnant couples may be an effective strategy to test men. Women attending their first antenatal visit at Kisumu District Hospital in Kenya were screened for eligibility and randomized to home-based education and HIV testing (HOPE) or to written invitations for male partners to attend clinic (INVITE). Of 1101 women screened, 620 were eligible and 601 were randomized either to HOPE (n=306) or INVITE (n=295). At 6 months postpartum, male partners were more than twice as likely (RR=2.10; 95% CI: 1.81-2.42) to have been HIV tested in the HOPE arm (n=233, 87%) compared to the INVITE arm (n=108, 39%). Couples in the HOPE arm (n=192, 77%) were three times more likely (RR=3.17; 95% CI: 2.53-3.98) to have been tested as a couple than the INVITE arm (n=62, 24%) and women in the HOPE arm (n=217, 88%) were also twice as likely (RR=2.27; 95% CI: 1.93-2.67) to know their partner’s HIV status as the INVITE arm (n=98, 39%). More serodiscordant couples (RR=3.38; 95% CI: 1.70-6.71) were identified in the HOPE arm (n=33, 13%) than in the INVITE arm (n=10, 4%). In qualitative interviews with participants, it was found that home-based couple HIV testing and counseling facilitated partner testing and disclosure, was preferable due to privacy and quality time, and helped participants overcome their fear of testing. Couples also appreciated the efficiency and appropriateness of partner involvement and joint education, and spoke of intervention influence on partner support in pregnancy and postpartum as well as improved relationship due to disclosure. Couples overwhelmingly had positive feedback for the intervention, although had preferences in terms of health advisors, especially having non-local advisors. Home-based HIV testing among pregnant couples resulted in higher uptake of male testing and couple testing as well as rates of disclosure and identification of serodiscordant couples. This intervention not only has implications for PMTCT, but also for testing men as part of overall HIV testing strategies to reach the UNAIDS 90-90-90 targets by 2020.
Author: Shyamala Nataraj
Publisher:
ISBN:
Category :
Languages : en
Pages : 609
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ABSTRACTTesting pregnant women for HIV in order to prevent transmission from infected women to infants is increasingly advocated as a routine part of antenatal care, and the HIV test is viewed on par with other antenatal tests. Requirements for informed consent to the test have been relaxed to promote testing and treatment to reduce the risk of transmission from infected women to infants and for their own health. Women have the right to refuse the test, and this right is viewed as adequate to protect them from potential stigma and discrimination associated with a positive result.However unlike other antenatal tests, testing positive for HIV puts women at significant risk of stigma and discrimination, especially if they are tested and diagnosed before their male partners as is often the case. Furthermore, there is a large gap between the numbers of women diagnosed with HIV within the programme to prevent parent-to-child transmission (PPTCT) and access to effective antiretroviral treatment to reduce risk of transmission to infants and for their own health. Acknowledging these risks, UNAIDS/WHO (2007), and the Indian government (NACO 2007) recommend promoting the autonomy of women in decision-making about the test, and testing women only after obtaining their informed and voluntary consent to the test.In this thesis, I draw upon the capabilities approach to examine the extent to which policies by UN agencies and by the Government of India, and the practice of obtaining informed in antenatal care facilities in Tamil Nadu, India, promote women's ability to make an informed and voluntary decision about the test. Data for the thesis were drawn from research conducted between 2006 and 2010. Both qualitative and quantitative methods were used. Qualitative methods included content analysis of policy recommendations for informed consent to an antenatal HIV test, and of guidelines to prevent parent-to-child transmission; and an ethnographic study among stakeholders in India between August 2007 and July 2008. A total of 28 focus group discussions, 56 in-depth interviews, four case studies, and 70 semi-structured observations were conducted among women accessing antenatal care at selected health facilities, husbands, community members, and heads of non-government organizations, healthcare providers, and state and #national level policy makers the quantitative method used to collect data was a questionnaire survey among 380 women who accessed antenatal care at selected healthcare facilities between May 2007 and January 2008.Results showed that global and Indian policy recommendations for an antenatal test to prevent parent-to-child transmission targetted women to the virtual exclusion of male partners, and severely restricted women's capabilities related to autonomous decision-making about the test. Furthermore, the PPTCT programme focused almost entirely on testing and treatment and ignored components related to primary prevention for women, and prevention of unintended pregnancies among infected women. A large proportion of pregnant women who tested positive, both globally and in India, did not receive antiretroviral prophylaxis to reduce the risk of transmission to the infant or antiretroviral treatment for their own heath. In India, infected women who did receive prophylactic treatment received the sub-optimal Nevirapine regimen that was less than 50% in the absence of exclusive breast feeding.The limitations in policy were exacerbated in practice. Although test acceptance among women was 100% test, this was not accompanied by their informed consent of women in the overwhelmingly vast majority of cases. In general, both policy makers and healthcare providers dismissed women's ability to make an informed and voluntary decision about the test, and questioned the feasibility of obtaining an informed consent in Indian settings. In contrast, women demonstrated their ability to make informed and pragmatic choices by identifying alternate approaches to the test that would help to protect infants from the risk of transmission, while also protecting infected women from potential stigma an discrimination, such as couple counselling and testing, and confidentiality of a positive test result.Furthermore, healthcare providers uniformly constructed the test as a compulsory requirement of antenatal care, withheld pre-test information about potential stigma and discrimination and about the right of the woman to refuse the test, and implicitly threatened to withhold access to ongoing antenatal care if women did not complete the test. They justified these actions as necessary to protect infants from the risk of acquiring the infection from infected mothers during pregnancy, delivery and breastfeeding, as well as to protect themselves from the risk of accidental exposure while providing care. In contrast, they did not discuss how women could protect themselves from HIV, even though all women respondents who tested positive reported acquiring HIV from infected husbands.Based on these findings, I suggest that promoting women's autonomy in antenatal testing, and in the broader context of HIV prevention and care in resource constrained settings such as India, is necessary both to protect their rights and to help them cope with their vulnerabilities to HIV and its consequences.
Author: Suzanne Maman
Publisher:
ISBN: 9789241590730
Category :
Languages : en
Pages : 65
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Book Description
This review paper synthesizes the current information available on HIV status disclosure in terms of rates barriers and outcomes of HIV status disclosure among HIV-infected individuals. Particular emphasis is placed on women's experiences with disclosure to sexual partners. The report also aims to identify major barriers and describe programmatic and policy strategies that have been adopted to address these barriers and support women through the disclosure process.
Author: Jane L. Parpart
Publisher: IDRC
ISBN: 0889369100
Category : Feminism
Languages : en
Pages : 232
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Book Description
Theoretical Perspectives on Gender and Development demytsifies the theory of gender and development and shows how it plays an important role in everyday life. It explores the evolution of gender and development theory, introduces competing theoretical frameworks, and examines new and emerging debates. The focus is on the implications of theory for policy and practice, and the need to theorize gender and development to create a more egalitarian society. This book is intended for classroom and workshop use in the fields ofdevelopment studies, development theory, gender and development, and women's studies. Its clear and straightforward prose will be appreciated by undergraduate and seasoned professional, alike. Classroom exercises, study questions, activities, and case studies are included. It is designed for use in both formal and nonformal educational settings.
Author: World Health Organization
Publisher:
ISBN: 9789241549912
Category : Medical
Languages : en
Pages : 0
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Book Description
Within the continuum of reproductive health care, antenatal care provides a platform for important health-care functions, including health promotion, screening and diagnosis, and disease prevention. It has been established that, by implementing timely and appropriate evidence-based practices, antenatal care can save lives. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. It aims to complement existing WHO guidelines on the management of specific pregnancy-related complications. The guidance captures the complex nature of the antenatal care issues surrounding healthcare practices and delivery, and prioritizes person-centered health and well-being --- not only the prevention of death and morbidity --- in accordance with a human rights-based approach.
Author: Deanna Kerrigan
Publisher: World Bank Publications
ISBN: 0821397753
Category : Medical
Languages : en
Pages : 344
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Book Description
A global economic analysis of HIV infection amongst sex workers, finding that evidence based and rights affirming interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be cost effective and deliver significant returns on investment.
Author:
Publisher:
ISBN:
Category : Children
Languages : en
Pages : 102
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Author: Robert Black
Publisher: World Bank Publications
ISBN: 1464803684
Category : Medical
Languages : en
Pages : 419
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Book Description
The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.
