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Background: The opioid epidemic remains a serious issue in the United States and presents additional challenges for women of childbearing age. An increasingly common complication of opioid use is neonatal abstinence syndrome (NAS), or infant withdrawal from in utero exposure to opioids. Purpose: The objective of our qualitative study was to identify service needs and barriers to care in the NAS epidemic in Ohio, which has among the highest rates of opioid use and NAS in the nation. Methods: Drawing on interviews with 18 healthcare providers, we investigated the challenges, opportunities, and service gaps in treating NAS. Open-ended questions covered opioid misuse and drug treatment, provision of and barriers to healthcare, and suggestions to improve prevention and programming. Content analysis identified major themes. Findings: Providers were primarily women (67%) and included individuals working in healthcare administrative positions, hospital settings, clinics, and social support positions for pregnant women or new mothers. Our results suggest that rather than an acute diagnosis, NAS is better conceptualized as a “cascade of care” including (1) prevention, (2) prenatal care, including drug treatment, (3) labor and delivery, and (4) aftercare. Providers identified challenges and opportunities at each stage of the cascade that could influence NAS outcomes. Implications for Practice: Our results suggest that greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS. Implications for Research: Framing NAS as a cascade of care allows researchers to identify points along a cascade where mothers and infants require enhanced care and access to social and health services.

Background: Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves.Methods: From March-May 2019, we conducted a concurrent, mixed methods study of patients receiving cervical cancer care in Botswana. Structured questionnaires captured beliefs and knowledge related to cervical cancer screening and HIV. Clinical data were abstracted from medical records and confirmed by participants. Semi-structured interviews examined patients’ understanding of and experiences with cervical cancer screening. Quantitative data were analyzed using descriptive and bivariate statistics. Qualitative data were analyzed using deductive and inductive content analysis and triangulated with quantitative data to identify areas of convergence and divergence.Results: Forty-two women were interviewed, 64% of whom were living with HIV. Median age was 45 years in women living with HIV (LWH) and 64 years in those without HIV. Overall screening rates prior to symptomatic disease were low (24%). Median time from most proximal screening to diagnosis was 52 median days (IQR: 15-176), with no significant differences by HIV status. General screening knowledge was higher among women living with HIV versus those without (100% vs 73%), but knowledge about specific risk factors including HPV was low in both groups. In interviews, participants expressed limited awareness of needing to be screened prior to symptoms. Additionally, participants reported significant delays in receipt of screening results and in obtaining referrals for follow-up care. However, participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges. Conclusion: Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.