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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Provision of long-acting reversible contraception in HIV-prevalent countries: Results from nationally representative surveys in southern Africa
BJOG: An International Journal of Obstetrics and Gynaecology, Volume 120, No. 11, Year 2013
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Description
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. © 2013 RCOG.
Authors & Co-Authors
Morse, Jessica E.
United States, Durham
Duke University
Chipato, Tsungai
Zimbabwe, Harare
Uz-ucsf Collaborative Program in Women's Health
Blanchard, Kelly
United States, Cambridge
Ibis Reproductive Health
Nhemachena, Taazadza
South Africa, Tygerberg
South African Medical Research Council
Ramjee, Gita A.
United States, San Francisco
University of California, San Francisco
McCulloch, Charles E.
United States, San Francisco
University of California, San Francisco
Blum, Maya
United States, Los Angeles
University of California, Los Angeles
Saleeby, E.
United States, San Francisco
University of California, San Francisco
Harper, Cynthia C.
United States, Los Angeles
University of California, Los Angeles
Statistics
Citations: 29
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1111/1471-0528.12290
ISSN:
14700328
e-ISSN:
14710528
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
South Africa
Zimbabwe
Participants Gender
Female