In spite of the expansion of HIV treatment options, women still experience challenges in both adherence to antiretroviral therapy (ART) and achieving viral suppression. Evidence demonstrates that experiences of violence against women are strongly linked to difficulties in adhering to prescribed antiretroviral therapy for HIV. This study examines the relationship between sexual violence and adherence to antiretroviral therapy among women living with HIV, and investigates whether this association differs based on pregnancy or breastfeeding status.
A pooled analysis across WLH from cross-sectional Population-Based HIV Impact Assessment surveys (2015-2018) was undertaken in nine sub-Saharan African countries. To investigate the link between lifetime sexual violence and suboptimal antiretroviral therapy (ART) adherence (defined as missing a single day of medication in the past month) among women of reproductive age on ART, logistic regression was employed. This analysis also explored potential interactions with pregnancy/breastfeeding status, controlling for important confounding factors.
5038 WLH in ART projects were encompassed in the analysis. Within the group of women studied, the prevalence of sexual violence was 152% (confidence interval [CI] 133%-171%), and the prevalence of suboptimal ART adherence was 198% (95% CI 181%-215%). Amongst pregnant and breastfeeding women, the prevalence of sexual violence stood at 131% (95% confidence interval 95%-168%), and the prevalence of suboptimal ART adherence reached 201% (95% confidence interval 157%-245%). Among the women studied, a pattern emerged linking sexual violence and a less-than-optimal adherence to antiretroviral therapy (ART), with an adjusted odds ratio (aOR) of 169 (95% confidence interval [CI] 125-228). Evidence pointed to a distinction in the link between sexual violence and ART adherence based on pregnancy/lactation status (p = 0.0004). Biosorption mechanism Compared to pregnant and breastfeeding women without a history of sexual violence, those with such a history had a substantially higher adjusted odds ratio for suboptimal ART adherence (411, 95% confidence interval 213-792). Among non-pregnant, non-breastfeeding women, this association was considerably attenuated (adjusted odds ratio 139, 95% confidence interval 100-193).
Sexual violence negatively correlates with antiretroviral therapy adherence among women in sub-Saharan Africa, impacting pregnant and breastfeeding women living with HIV the most. To advance women's HIV health and eliminate perinatal HIV transmission, policy interventions must prioritize violence prevention within maternity care and HIV treatment services.
In sub-Saharan Africa, sexual violence influences a woman's adherence to ART protocols; this relationship is more significant amongst pregnant and lactating women. Eliminating vertical transmission of HIV and enhancing women's HIV outcomes requires making violence prevention in maternity services and HIV treatment a policy imperative.
The Kimberley Dental Team (KDT), a not-for-profit, volunteer organization in Western Australia, serving remote Aboriginal communities, is the subject of this process evaluation study.
A logic model was established to give a detailed account of the practical setting encompassing the KDT model. Afterwards, the implementation fidelity (the degree to which the program components were executed as planned), dosage (types and quantities of services), and program reach (characteristics and scope of communities served) of the KDT model were evaluated using service data, de-identified clinical records, and volunteer rosters that KDT had maintained during the period from 2009 to 2019. Total counts and proportional data were employed to analyze the service provision trends and patterns chronologically. The evolution of surgical treatment rates over time was explored using a Poisson regression model. Employing correlation coefficients and linear regression, a study investigated the interconnections between volunteer activity and the provision of services.
Within the Kimberley region, care was delivered to 6365 patients (98% Aboriginal or Torres Strait Islander) across 35 distinct communities during a 10-year period. Services were preferentially offered to school-aged children, in accordance with the program's stated intentions. Among the demographic groups, school-aged children demonstrated the highest rate of preventive interventions, while young adults showed the highest rate of restorative interventions, and older adults had the highest rate of surgical interventions. Analysis revealed a trend of declining surgical procedure rates between 2010 and 2019, demonstrating statistical significance (p<.001). The volunteer profile exhibited a considerable diversity, transcending the traditional dentist-nurse framework, with 40% comprising repeat volunteers.
For the last ten years, a robust emphasis within the KDT program's service provision for school-aged children was on educational and preventative components of the care given. PLX5622 The process evaluation concluded that the KDT model's dose and reach displayed an escalating trend related to increasing resources and were responsive to discerned community requirements. Structural alterations, taking place gradually, were shown to increase the model's overall fidelity.
The KDT program, during the past ten years, prioritized service provision to school-aged children, emphasizing educational and preventive care as core components of its offerings. The process evaluation concluded that the KDT model exhibited an increase in both dose and reach, corresponding with resource enhancements, and was responsive to the perceived community need. Through successive structural refinements, the model's overall fidelity was demonstrably improved.
The inadequate number of trained fistula surgeons poses a constant problem for sustainable obstetric fistula (OF) care. In spite of a consistent training plan for OF repairs, the data documenting this training experience is restricted.
A study of available publications was conducted to determine the availability of data on the number of cases or training time needed for achieving competence in OF repair, and whether these data are categorized by trainee background or the repair's complexity.
Systematic searches were performed across the electronic databases MEDLINE, Embase, and OVID Global Health, in conjunction with a review of gray literature.
Every English source from all years, irrespective of the income status of the country of origin—whether low-, middle-, or high-income—was suitable. The identified titles and abstracts were scrutinized, and this was succeeded by a careful review of the full-text articles.
A descriptive summary of data collection and analysis was organized according to training case numbers, training duration, trainee backgrounds, and repair complexities.
Out of the 405 sources located, 24 were incorporated into the present study. The 2022 International Federation of Gynecology and Obstetrics Fistula Surgery Training Manual presented the only definitive guidance, recommending 50-100 repairs for Level 1, 200-300 repairs for Level 2, and entrusting trainer judgment for evaluating Level 3.
Data stratified by trainee background and repair complexity, particularly case- or time-based information, would be beneficial for fistula care implementation and expansion at the individual, institutional, and policy levels.
Case-based or time-based data, further stratified by trainee background and repair complexity, would be instrumental in improving fistula care implementation and expansion at individual, institutional, and policy levels.
The HIV epidemic in the Philippines disproportionately affects transfemine adults, and the recent introduction of pre-exposure prophylaxis (PrEP), including long-acting injectable forms (LAI-PrEP), presents a promising opportunity for this vulnerable population. Enteric infection Our analysis of PrEP awareness, discussion, and interest in LAI-PrEP among Filipina transfeminine adults aimed to inform the implementation process.
Employing secondary data from the #ParaSaAtin survey, which sampled 139 Filipina transfeminine adults, we performed a series of multivariable logistic regressions, incorporating lasso selection, to identify independent correlates of PrEP outcomes, encompassing awareness, discussions with trans friends, and interest in LAI-PrEP.
In a study on Filipina transfeminine respondents, 53 percent indicated awareness of PrEP, 39 percent had discussed it with their trans friends, and 73 percent expressed interest in LAI-PrEP. Awareness of PrEP was correlated with not identifying as Catholic (p = 0.0017), a history of previous HIV testing (p = 0.0023), discussion of HIV services with a healthcare provider (p<0.0001), and a high level of HIV knowledge (p=0.0021). Older age (p = 0.0040), experiences of healthcare discrimination due to a transgender identity (p = 0.0044), prior HIV testing (p = 0.0001), and discussions about HIV services with a provider (p < 0.0001) were all associated with the discussion of PrEP with friends. Living in Central Visayas (p = 0.0045), discussing HIV services with a provider (p = 0.0001), and discussing HIV services with a sexual partner (p = 0.0008) were all significantly correlated with an interest in LAI-PrEP.
Systemic changes, encompassing personal, interpersonal, social, and structural levels, are indispensable for the successful adoption of LAI-PrEP in the Philippines. This includes developing healthcare settings with providers trained in transgender health and equipped to address social and structural drivers of trans health disparities, including the barriers to accessing LAI-PrEP and HIV prevention.
The implementation of LAI-PrEP in the Philippines depends on addressing systemic issues impacting healthcare access across personal, interpersonal, social, and structural levels. Key elements include developing healthcare settings with providers trained in transgender health and actively addressing social and structural determinants of trans health disparities, including HIV, and barriers to LAI-PrEP access.