Dataset Information

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe.

ABSTRACT:

Objectives

Female condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries.

Design

A cross-sectional study using a nationally representative survey.

Setting

All facilities that provide family planning or HIV/sexually transmitted infection (STI) services.

Participants

National probability sample of 1444 nurses and physicians who provide family planning or HIV/STI services.

Primary and secondary outcome measures

Female condom practices with different female patients, including adolescents, married women, women using hormonal contraception and by HIV status. Using multivariable logistic analysis, we measured variations in condom counselling by provider characteristics.

Results

Most providers reported offering female condoms (88%; 1239/1415), but perceived a need for novel female barrier methods for HIV/STI prevention (85%; 1191/1396). By patient type, providers reported less frequent female condom counselling of adolescents (55%; 775/1411), women using hormonal contraception (65%; 909/1409) and married women (66%; 931/1416), compared to unmarried (74%; 1043/1414) or HIV-positive women (82%; 1161/1415). Multivariable results showed providers in South Africa were less likely to counsel women on female condoms than in Zimbabwe (OR=0.48, 95% CI 0.35 to 0.68, p?0.001). However, South African providers were more likely to counsel women on male condoms (OR=2.39, 95% CI 1.57 to 3.65, p?0.001). Nurses counselled patients on female condoms more frequently than physicians (OR=5.41, 95% CI 3.26 to 8.98, p?0.001). HIV training, family planning training, location (urban vs rural) and facility type (hospital vs clinic) were not associated with greater condom counselling.

Conclusions

Female condoms were integrated into provider counselling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible. Providers should be included in HIV training efforts to raise awareness of new and existing products, and encouraged to educate all women.

SUBMITTER: Holt K

PROVIDER: S-EPMC3612751 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe.

Holt Kelsey K Blanchard Kelly K Chipato Tsungai T Nhemachena Taazadza T Blum Maya M Stratton Laura L Morar Neetha N Ramjee Gita G Harper Cynthia C CC

BMJ open 20130318 3

<h4>Objectives</h4>Female condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries.<h4>Design</h4>A cross-sectional study using a nationally representative survey.<h4>Setting</h4>All facilities that provide family planning or HIV/sexually transmitted infection (STI) services.<h4>Participants</h4>National probability sample of 14 ...[more]

PMID: 23512836

Similar Datasets

Project description:BackgroundChildren living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe.Methods and findingsOver the course of 2 years (January 2013-January 2015), 7 primary health clinics (PHCs) in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT) tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8%) children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%), and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%). Similarly, among the subsample of 2,643 (48.2%) participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%). Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified between 18% and 42% of previously undiagnosed children in the community. The main limitation is that prevalence of undiagnosed HIV was defined using a combination of 3 measures (OMT, self-report, and urine test), none of which were perfect.ConclusionsFacility-based approaches are inadequate in achieving universal coverage of HIV testing among older children and adolescents. Alternative, community-based approaches are required to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of diagnosing 90% of those living with HIV by 2020 in this age group.

Project description:OBJECTIVES:We aimed to analyse the healthcare seeking behaviours (HSB) of populations with different migration status and examine the relationship between migration status and HSB. DESIGN:A secondary analysis of cross-sectional data of China Labor-force Dynamics Survey wave 2016, which was conducted by the Sun Yat-sen University every 2 years since 2010. SETTING:29 provinces/cities/autonomous regions in mainland China, excluding Tibet and Hainan province. PARTICIPANTS:3522 respondents in a condition in the previous 2 weeks or during the last 12 months were analysed. MAIN OUTCOME MEASURES:The migration status included internal migrants (IMs), returned population, rural residents and urban residents. The HSB including health services utilisation and choice of health facilities for their health services. Multivariable logistic regressions were used to examine the association between migration status and HSB. RESULTS:2193 and 1898 of 3522 respondents were in need of outpatient services (having a condition in the previous 2 weeks) or inpatient services (being asked to use the inpatient services during the last 12 months). Compared with urban residents, the returned population (OR=0.66, 95% CIs 0.49 to 0.89) and rural residents (OR=0.65, 95% CIs 0.51 to 0.82) were less likely to have an unmet need for outpatient services. The latter tended to choose lower-level hospitals, while the IMs preferred the lowest-level healthcare facilities for health services. After controlling for confounding factors, the results above did not reach any statistical significance. CONCLUSION:Association between migration status and HSB might be through enabling resource and needs. Returned population, IMs and rural residents tended to choose low-level hospitals for their health service needs, but this association was mainly associated with their poorer social and economic resources. Improving their social and economic resources would be helpful for reducing the barriers of HSB.

Project description:BackgroundMalaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation.MethodsWe conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates.ResultsPrivate primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71-0.96).ConclusionsTargeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare resources. Nonetheless, geographic expansion alone is inadequate to achieve effective coverage in a dichotomous primary care system, and the role of the private sector in primary care delivery should not be overlooked.

Dataset Information

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets