scholarly journals Reproductive Counseling by Clinic Healthcare Workers in Durban, South Africa: Perspectives from HIV-Infected Men and Women Reporting Serodiscordant Partners

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
L. T. Matthews ◽  
T. Crankshaw ◽  
J. Giddy ◽  
A. Kaida ◽  
C. Psaros ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Behavioral Interventions ◽  
Unplanned Pregnancy ◽  
Reproductive Age ◽  
Safer Conception ◽  
Men And Women ◽  
Related Information ◽  
Patient Reported ◽  
Reproductive Counseling

Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals.Methods. We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year) and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs). Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes.Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information.Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age.

scholarly journals DEPRESSION, FUNCTIONAL DISABILITY, AND ACCESSING HEALTH CARE AMONG OLDER MEN AND WOMEN IN GHANA AND SOUTH AFRICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Candidus C Nwakasi ◽  
J Scott Brown
Keyword(s):  
South Africa ◽  
Health Care ◽  
Socioeconomic Factors ◽  
South African ◽  
Functional Disability ◽  
Older Men ◽  
Mild Depression ◽  
Men And Women ◽  
South Africans ◽  
Older Men And Women

Abstract Objectives. To inform a preventive approach to mild depression among older Ghanaians and South Africans, this study will investigate the association and possible variabilities between mild depression, functional disability, accessing health care, sociodemographic, and socioeconomic factors across genders in both countries. Methods. Cross-sectional wave 1 (2007-2010) data from WHO’s Study on Global Ageing and Adult Health (SAGE) are used, and a sample of 3871 for Ghana and 3076 for South Africa are analyzed. Binary multiple logistic regression is used to identify the association between mild depression, functional disability status, socioeconomic and sociodemographic factors, and health status. Results. The proportion of mild depression (MD) is 3.78% and 8.15% for older Ghanaian men and women, and 2.29% and 11.91% for South African older men and women, respectively. At 95% CI, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older men and women. Apart from South African older men, older people in the study who do not receive healthcare when needed have increased odds of MD. Sociodemographic and socioeconomic factors are also associated with MD. Discussion. An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since, mental health care is lacking in both countries, this study recommends policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression. Thus, this study’s findings may provide relevant information for managing depression among older Ghanaians and South Africans.

scholarly journals Intersection of Migration and Access to Health Care: Experiences and Perceptions of Female Economic Migrants in Canada

2020 ◽  
Vol 17 (10) ◽  
pp. 3682
Author(s):  
Solina Richter ◽  
Helen Vallianatos ◽  
Jacqueline Green ◽  
Chioma Obuekwe
Keyword(s):  
South Africa ◽  
Health Care ◽  
Access To Care ◽  
Health Care System ◽  
Access To Health Care ◽  
Social Connectedness ◽  
Reproductive Age ◽  
African Countries ◽  
Access To Health ◽  
Care System

More people are migrating than ever before. There are an estimated 1 billion migrants globally—of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women’s access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

scholarly journals The Impact of Scaling up Dolutegravir on Antiretroviral Resistance in South Africa

2019 ◽  
Author(s):  
Anthony Hauser ◽  
Katharina Kusejko ◽  
Leigh F. Johnson ◽  
Huldrych F. Günthard ◽  
Julien Riou ◽  
...  
Keyword(s):  
South Africa ◽  
Drug Resistance ◽  
Scale Up ◽  
Scaling Up ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Genetic Barrier ◽  
Men And Women ◽  
Nnrti Resistance ◽  
The Impact

AbstractBackgroundRising resistance of HIV-1 to non-nucleoside reverse transcriptase inhibitors (NNRTIs) threatens the success of the global scale-up of antiretroviral therapy (ART). The switch to WHO-recommended dolutegravir (DTG)-based regimens could reduce this threat due to DTG’s high genetic barrier to resistance. We used mathematical modelling to examine the impact of the scale-up of DTG-based ART on NNRTI pre-treatment drug resistance (PDR) in South Africa, 2019-2040.Methods and resultsWe adapted the MARISA (Modelling Antiretroviral drug Resistance In South Africa) model, an epidemiological model of the transmission of NNRTI resistance in South Africa. We modelled the introduction of DTG in 2019 under two scenarios: DTG as first-line regimen for ART-initiators, or DTG for all patients, including patients on suppressive NNRTI-based ART. Due to safety concerns related to DTG during pregnancy, we assessed the impact of prescribing DTG to all men and in addition to i) women beyond reproductive age, ii) women beyond reproductive age or using contraception, and iii) all women. The model projections show that, compared to the continuation of NNRTI-based ART, introducing DTG would lead to a reduction in NNRTI resistance in all scenarios if both ART initiators are started on a DTG-based regimens and those on NNRTI-based regimens are rapidly switched to DTG. NNRTI resistance would continue to increase if DTG-based ART was restricted to men. When given to all men and women, DTG-based ART could reduce the level of NNRTI resistance from 58.5% (without DTG) to 14.8% (with universal DTG) in 2040. If all men and women beyond reproductive age or on contraception are started on or switched to DTG-based ART, NNRTI resistance would reach 35.1% in 2040.ConclusionsOur model shows the potential benefit of scaling up DTG-based regimens for halting the rise of NNRTI resistance. Starting or switching all men and women to DTG would lead to a sustained decline in resistance levels whereas using DTG-based ART in all men, or in men and women beyond childbearing age, would slow down the increase in levels of NNRTI resistance.

scholarly journals Impact of scaling up dolutegravir on antiretroviral resistance in South Africa: A modeling study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003397
Author(s):  
Anthony Hauser ◽  
Katharina Kusejko ◽  
Leigh F. Johnson ◽  
Huldrych F. Günthard ◽  
Julien Riou ◽  
...  
Keyword(s):  
South Africa ◽  
Drug Resistance ◽  
Scale Up ◽  
Scaling Up ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Genetic Barrier ◽  
Men And Women ◽  
Nnrti Resistance ◽  
The Impact

Background Rising resistance of HIV-1 to non-nucleoside reverse transcriptase inhibitors (NNRTIs) threatens the success of the global scale-up of antiretroviral therapy (ART). The switch to WHO-recommended dolutegravir (DTG)-based regimens could reduce this threat due to DTG’s high genetic barrier to resistance. We used mathematical modeling to predict the impact of the scale-up of DTG-based ART on NNRTI pretreatment drug resistance (PDR) in South Africa, 2020 to 2040. Methods and findings We adapted the Modeling Antiretroviral drug Resistance In South Africa (MARISA) model, an epidemiological model of the transmission of NNRTI resistance in South Africa. We modeled the introduction of DTG in 2020 under 2 scenarios: DTG as first-line regimen for ART initiators, or DTG for all patients, including patients on suppressive NNRTI-based ART. Given the safety concerns related to DTG during pregnancy, we assessed the impact of prescribing DTG to all men and in addition to (1) women beyond reproductive age; (2) women beyond reproductive age or using contraception; and (3) all women. The model projections show that, compared to the continuation of NNRTI-based ART, introducing DTG would lead to a reduction in NNRTI PDR in all scenarios if ART initiators are started on a DTG-based regimen, and those on NNRTI-based regimens are rapidly switched to DTG. NNRTI PDR would continue to increase if DTG-based ART was restricted to men. When given to all men and women, DTG-based ART could reduce the level of NNRTI PDR from 52.4% (without DTG) to 10.4% (with universal DTG) in 2040. If only men and women beyond reproductive age or on contraception are started on or switched to DTG-based ART, NNRTI PDR would reach 25.9% in 2040. Limitations include substantial uncertainty due to the long-term predictions and the current scarcity of knowledge about DTG efficacy in South Africa. Conclusions Our model shows the potential benefit of scaling up DTG-based regimens for halting the rise of NNRTI resistance. Starting or switching all men and women to DTG would lead to a sustained decline in resistance levels, whereas using DTG-based ART in all men, or in men and women beyond childbearing age, would only slow down the increase in levels of NNRTI PDR.

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