Willingness of Clinicians to Integrate Microbicides into HIV Prevention Practices in Southern Africa

Harper, Cynthia C.; Holt, Kelsey; Nhemachena, Taazadza; Chipato, Tsungai; Ramjee, Gita; Stratton, Laura; Blum, Maya; McCulloch, Charles E.; Mgweba, Sibongile; Blanchard, Kelly

doi:10.1007/s10461-011-0109-6

Cited by 4 publications

(6 citation statements)

References 25 publications

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“…The methods have been described in detail previously. 10,11 Survey items covered clinicians’ demographic and professional characteristics, practice setting, patient population and contraceptive knowledge, attitudes and practices. A series of patient vignettes, including a nulliparous adolescent (aged 16 years), a nulliparous unmarried young woman (aged 24 years), a nulliparous unmarried HIV-positive young woman (aged 24 years) and a parous (two children) married young woman (aged 24 years), were presented to clinicians for their contraceptive recommendations.…”

Section: Methodsmentioning

confidence: 99%

Provision of long‐acting reversible contraception in HIV‐prevalent countries: results from nationally representative surveys in southern Africa

Morse

Chipato

Blanchard

et al. 2013

BJOG

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Objective To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings. Design Nationally representative survey of clinicians. Setting HIV-prevalent settings in South Africa and Zimbabwe. Population Clinicians in South Africa and Zimbabwe. Methods Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. Main outcome measure Multivariable logistic regression of contraceptive provision and clinician training needs. Results Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians’ perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. Conclusions Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.

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Section: Methodsmentioning

confidence: 99%

Provision of long‐acting reversible contraception in HIV‐prevalent countries: results from nationally representative surveys in southern Africa

Morse

Chipato

Blanchard

et al. 2013

BJOG

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“…Microbicides are antimicrobial agents that are self-applied on the vagina or rectum to protect against STIs [ 19 , 62 , 63 ]. Hence they act as chemical, biological and/or physical barriers that prevent transmission of pathogens during sexual intercourse [ 62 , 64 , 65 ]. They may be in gel, creams, rings, or films form and can be used with condoms, thus offering additional protection or used alone especially by those who do not appreciate the use of condoms [ 19 ].…”

Section: Nanoparticles Microbicides Activitiesmentioning

confidence: 99%

Nanoparticles as potential new generation broad spectrum antimicrobial agents

2015

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The rapid emergence of antimicrobial resistant strains to conventional antimicrobial agents has complicated and prolonged infection treatment and increased mortality risk globally. Furthermore, some of the conventional antimicrobial agents are unable to cross certain cell membranes thus, restricting treatment of intracellular pathogens. Therefore, the disease-causing-organisms tend to persist in these cells. However, the emergence of nanoparticle (NP) technology has come with the promising broad spectrum NP-antimicrobial agents due to their vast physiochemical and functionalization properties. In fact, NP-antimicrobial agents are able to unlock the restrictions experienced by conventional antimicrobial agents. This review discusses the status quo of NP-antimicrobial agents as potent broad spectrum antimicrobial agents, sterilization and wound healing agents, and sustained inhibitors of intracellular pathogens. Indeed, the perspective of developing potent NP-antimicrobial agents that carry multiple-functionality will revolutionize clinical medicine and play a significant role in alleviating disease burden.

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“…Survey items were informed by formative research which included qualitative interviews with 60 providers and by previous survey research and the literature on contraception [8]. The surveys were pilot tested in each country for content and comprehension, and the final instrument covered professional training, practice setting, patient population, and provider knowledge, attitudes and clinical practices.…”

Section: Methodsmentioning

confidence: 99%

“…The surveys were pilot tested in each country for content and comprehension, and the final instrument covered professional training, practice setting, patient population, and provider knowledge, attitudes and clinical practices. The methods have been described in detail previously [8,10]. …”

Section: Methodsmentioning

confidence: 99%

Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article

et al. 2014

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Objectives To assess clinician provision of hormonal contraception for HIV positive and at-risk women in Southern Africa. Study Design We conducted a nationally representative survey of clinicians (n=1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based contraceptive care and clinician views of hormonal contraceptives for HIV positive and at-risk women. Multivariable logistic regression was used to analyze differences in contraceptive provision by professional training and practice setting. Results Most providers offered oral contraceptives (85%), but only a small minority considered them appropriate for women at risk of HIV (27%) or HIV positive women (25%). A higher proportion of clinicians considered injections appropriate for women at risk of HIV (42%) or HIV positive women (46%). Very few considered emergency contraceptives appropriate (13%). Multivariable results showed that family planning training and clinic as compared to hospital practices, were associated with evidence-based attitudes about contraception for HIV positive or at-risk women, and greater provision. There were no differences, however, between physicians and nurses or by HIV training. Conclusions These findings emphasize the need to improve clinicians’ awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations. Implications Oral and injectable hormonal contraception are appropriate for HIV positive and at-risk women; women and clinicians need evidence-based information to ensure women have access to these effective contraceptive methods.

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Willingness of Clinicians to Integrate Microbicides into HIV Prevention Practices in Southern Africa

Cited by 4 publications

References 25 publications

Provision of long‐acting reversible contraception in HIV‐prevalent countries: results from nationally representative surveys in southern Africa

Provision of long‐acting reversible contraception in HIV‐prevalent countries: results from nationally representative surveys in southern Africa

Nanoparticles as potential new generation broad spectrum antimicrobial agents

Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article

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