Medicine and Health Sciences Commons^™

Cost-Effectiveness Analysis Of Alternative Screening Strategies For The Detection Of Cervical Cancer Among Women In Rural Areas Of Western Kenya, Christopher Lobin, Elkanah Omenge, Edwin Were, Kapten Muthoka, Kavita Singh, Manuela De Allegri, Konrad Obermann, Magnus Doeberitz, Hermann Bussmann

Obstetrics and Gynaecology, East Africa

While the incidence of cervical cancer has dropped in high-income countries due to organized cytology-based screening programs, it remains the leading cause of cancer death among women in Eastern Africa. Therefore, the World Health Organization(WHO) now urges providers to transition from widely prevalent but low-performance visual inspection with acetic acid (VIA) screening to primary human papillomavirus(HPV) DNA testing. Due to high HPV prevalence, effective triage tests are needed to identify those lesions likely to progress and so avoid over-treatment. To identify the optimal cost-effective strategy, we compared the VIA screen-and-treat approach to primary HPV DNA testing with p16/Ki67 dual-stain cytology …

Integrating Human Papillomavirus Testing As A Point-Of Care Service Using Genexpert Platforms: Findings And Lessons From A Kenyan Pilot Study (2019–2020), Valerian Mwenda, Joan-Paula Bor, Mary Nyangasi, James Njeru, Sharon Olwande, Patricia Njiri, Marc Arbyn, Philippe Tummers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization’s Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out.

Methods: The …

Adverse Maternal, Fetal, And Newborn Outcomes Among Pregnant Women With Sars-Cov-2 Infection: An Individual Participant Data Meta-Analysis, Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Kacey Ferguson, Fouzia Farooq, Yalda Afshar, Mia Ahlberg, Homa Ahmadzia, Victor Akelo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.

Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.

Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.

Pregnant women with …

Understanding Maternity Care Providers’ Use Of Data In Southern Tanzania, Regine Unkels, Fadhlun Alwy Al-Beity, Zamoyoni Julius, Elibariki Mkumbo, Andrea B. Pembe, Claudia Hanson, Helle Molsted-Alvesson

Obstetrics and Gynaecology, East Africa

Introduction: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

Methods: We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand …

The Covid-19 Pandemic And Disruptions To Essential Health Services In Kenya: A Retrospective Time-Series Analysis, Helen Kiarie, Marleen Temmerman, Mutono Nyamai, Nzisa Liku, Wangari Thuo, Violet Oramisi, Lilly Nyaga, Janette Karimi, Phidelis Wamalwa, Gladwell Gatheca

Obstetrics and Gynaecology, East Africa

Background: Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya.

Methods: Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers’ …

Exploring The Impact Of Health Worker Strikes On Maternal And Child Health In A Kenyan County, Abdu Mohiddin, Eva Langat, James Orwa, Violet Naanyu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that …

Cervical Cancer Programme, Kenya, 2011–2020: Lessons To Guide Elimination As A Public Health Problem, Valerian Mwenda, Woki Mburu, Joan-Paula Bor, Mary Nyangasi, Marc Arbyn, Steven Weyers, Philippe Tummers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.

Methods: We searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in …

Are Kenyans Likely To Use Covid-19 Self-Testing Kits? Results From A Cross-Sectional Survey, Griffins Manguro, Sonjelle Shilton, Sharon Omenda, Patrica Owira, Deepshikha Batheja, Abhik Banerji, Sophie Chabeda, Marleen Temmerman, Walter Jako, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objectives: To understand the public’s perceptions around rapid SARS-CoV-2 antigen self-testing in Kenya, including the drivers of acceptability, willingness to pay, and adherence to hygiene and prevention recommendations following a positive self-test.

Methods: A household-based, cross-sectional survey, using a 35-item questionnaire, was conducted in Mombasa and Taita–Taveta counties, Kenya, during August 2021. Individuals aged ≥18 years were enrolled using a stratified sampling approach.

Results: There were 419 participants (mean age 35.7 years). A minority (10.5%) had ever tested for SARS-CoV-2. If SARS-CoV-2 self-testing were available, 39.9% and 41.5% would be likely and very likely, respectively, to use it. If unavailable …

Differences In Hiv, Sti And Other Risk Factors Among Younger And Older Male Sex Workers Who Have Sex With Men In Nairobi, Kenya, Nicholas Muraguri, Jerry Okoth Okal, Marleen Temmerman, Helgar Musyoki, Peter Gichangi

Obstetrics and Gynaecology, East Africa

Introduction: Previous surveys of male sex workers (MSW) in sub-Saharan Africa have not fully documented the HIV and sexually transmitted infections (STIs) rates and vulnerabilities by age category.

Methods: The bio-behavioral survey of MSW in Nairobi, Kenya, utilized respondent-driven sampling to recruit MSW. Structured interviews captured MSW's behavioral aspects, and biological tests for HIV and other STIs.

Results: Analysis of the two age categories, 18–24 years (younger MSW) and 25 years and above (older MSW), shows that of all participants, a significantly higher proportion of younger MSW (59.6% crude, 69.6% RDS-adjusted) were recruited compared to older MSW …

Nevirapine Hair And Plasma Concentrations And Hiv-1 Viral Suppression Among Hiv Infected Ante-Partum And Post-Partum Women Attended In A Mother And Child Prevention Program In Maputo City, Mozambique, Rosa Marlene Cuco, Osvaldo Loquiha, Adelino Juga, Aleny Couto, Bindiya Meggi, Adolfo Vubil, Esperança Sevene, Nafissa Osman, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Introduction: Prevention of mother to child transmission of HIV (PMTCT) is frequently challenged by irregular access to more effective anti-retroviral therapy. Nevirapine single dose (sdNVP), sdNVP+AZT+3TC for MTCT prophylaxis and NVP+ AZT+3TC for treatment and PMTCT were withdrawn due to low genetic resistance barrier and low efficacy. However current PMTCT lines in Mozambique include DTG+3TC+TDF, TDF+3TC+EFV, DTG +ABC+3TC, and AZT + NVP syrup prophylaxis for exposed babies. We assessed NVP hair and plasma concentrations and association with HIV-1RNA suppression among HIV+ ante-partum and post-partum women under PMTCT in Maputo, Mozambique.

Methods: From December 2013 to November 2014, prospectively …

Young Key Populations Left Behind: The Necessity For A Targeted Response In Mozambique, Makini A. S. Boothe, Cynthia Semá Baltazar, Isabel Sathane, Henry F. Raymond, Erika Fazito, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Introduction: The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15–24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)–men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP.

Methods: Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated …

Determinants Of Preconception Care Among Pregnant Women In An Urban And A Rural Health Facility In Kenya: A Qualitative Study, Joan Okemo, Dorothy Kamya, Mukaindo Mwaniki, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could con- tribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya.

Methods: A qualitative approach was …

Cesarean Section: More Than A Maternal Health Issue, Marleen Temmerman, Abdu Mohiddin

Obstetrics and Gynaecology, East Africa

A cesarean section (CS) can be a lifesaving intervention when medically indicated, but it may also lead to adverse short- and long-term health effects for women and children

Maternal Sociodemographic Factors And Antenatal Stress, Maheshwari Andhavarapu, James Orwa, Marleen Temmerman, Wangira Musana

Obstetrics and Gynaecology, East Africa

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, …

Digital News Media Coverage On Sexual And Gender-Based Violence In Kenya: Scoping The Impact Of The Covid-19 Pandemic, Clara Broekaert, Ceri-Lune Renneboog, Ferdinand Okwaro, Abdu Mohiddin, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Sexual and gender-based violence (SGBV) in Kenya is frequently covered in digital news media. As a powerful influencer of public opinion, news media coverage can have a significant societal impact. This scoping review identifies the extent, nature, and themes of all available digital news media coverage on SGBV in Kenya from June 2019 to July 2020. It analyzes changes in coverage since the start of the COVID-19 pandemic.

Method: The methodological framework for scoping reviews developed by Arksey and O’Malley (2005) guided the scoping review. The selected articles were analyzed using NVivo.

Results: Analysis of the 340 …

Gender Difference In Mortality Among Pulmonary Tuberculosis Hiv Co-Infected Adults Aged 15-49 Years In Kenya, Rose J. Kosgei, Steven Callens, Peter Gichangi, Marleen Temmerman, Anne-Beatrice Kihara, Gathara David, Eunice Nyaboe Omesa, Enos Masini, E. Jane Carter

Obstetrics and Gynaecology, East Africa

Setting: Kenya, 2012–2015

Objective: To explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya.

Design: Retrospective cohort of 9,026 smear-positive patients aged 15–49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count.

Results: Of the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, …

Health Care Workers’ Perspectives Of The Influences Of Disrespectful Maternity Care In Rural Kenya, Adelaide Lusambili, Stefania Wisofschi, Constance Shumba, Jerim Obure, Kennedy Mulama, Lucy Nyaga, Terrance J. Wade, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas …

Preconception Care Among Pregnant Women In An Urban And A Rural Health Facility In Kenya: A Quantitative Study, Joan Okemo, Marleen Temmerman, Mukaindo Mwaniki, Dorothy Kamya

Obstetrics and Gynaecology, East Africa

Preconception care (PCC) aims to improve maternal and fetal health outcomes, however, its utilization remains low in developing countries. This pilot study assesses the level and determinants of PCC in an urban and a rural health facility in Kenya. Unselected pregnant women were recruited consecutively at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The utilization of PCC was defined as contact with any health care provider before current pregnancy and addressing pregnancy planning and preparation. A cross-sectional approach was employed and data were analyzed using SPSS …

Prevalence And Risk Factors Associated With Hiv/Hepatitis B And Hiv/Hepatitis C Co-Infections Among People Who Inject Drugs In Mozambique, Cynthia Semá Baltazar, Makini Boothe, Timothy Kellogg, Paulino Ricardo, Isabel Sathane, Erika Fazito, Henry F. Raymond, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: There is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique. This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. We assess the prevalence of HIV, HBV and HCV co-infections as well as associated risk factors among PWID.

Methods: The first Bio-Behavioral Surveillance Survey was conducted in 2013-2014 among persons who self-reported to have ever injected drugs. Using respondent-driven sampling, PWID aged 18 years and older were recruited …

Does A History Of Sexual And Physical Childhood Abuse Contribute To Hiv Infection Risk In Adulthood? A Study Among Post-Natal Women In Harare, Zimbabwe, Simukai Shamu, Patience Shamu, Christina Zarowsky, Marleen Temmerman, Tamara Shefer, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.

Methods: A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or …

Mapping Maternal Mortality Rate Via Spatial Zero-Inflated Models For Count Data: A Case Study Of Facility-Based Maternal Deaths From Mozambique, Osvaldo Loquiha, Niel Hens, Leonardo Chavane, Marleen Temmerman, Nafissa Osman, Christel Faes, Marc Aerts

Obstetrics and Gynaecology, East Africa

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with …

Child Marriage Legislation In The Asia-Pacific Region, Elisa Scolaro, Aleksandra Blagojevic, Brigitte Fillion, Venkatraman Chandra-Mouli, Lale Say, Joar Svanemyr, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Child marriage is a human rights violation that robs a girl of her childhood, puts her health, growth, and development at risk, disrupts her education, limits her opportunities for empowerment and social development, and increases her risk of exposure to violence and abuse (for a review of the evidence on the negative effects of child marriage on girls and their children, see Parsons et al. 2015, in this issue). While child marriage is not mentioned specifically in the 1989 Convention on the Rights of the Child (CRC), the Convention does contain a provision requiring governments to abolish “traditional practices prejudicial …

Which Role Do Midwives And Gynecologists Have In Smoking Cessation In Pregnant Women?–A Study In Flanders, Belgium, Katrien De Wilde, Inge Tency, Sarah Steckel, Marleen Temmerman, Hedwig Boudrez, Lea Maes

Obstetrics and Gynaecology, East Africa

Objectives: The objectives of our study were (1) to explore knowledge, beliefs and practice among mid-wives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.

Method: We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A’s frame-work (Ask–Advise–Assess–Assist–Arrange).

Results: The national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise" were part of a standard prenatal consultation, the next three …

Use Of The Robson Classification To Assess Caesarean Section Trends In 21 Countries: A Secondary Analysis Of Two Who Multicountry Surveys, Joshua P. Vogel, Ana Pilar Betrán, Nadia Vindevoghel, João Paulo Souza, Maria Regina Torloni, Jun Zhang, Özge Tunçalp, Rintaro Mori, Naho Morisaki, Eduardo Ortiz-Panozo, Bernardo Hernandez, Ricardo Pérez-Cuevas, Zahida Qureshi, A Metin Gülmezoglu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.

Methods: We studied deliveries in 287 facilities in 21 countries that …

Commentary: Actions To End Violence Against Women: A Multi-Sector Approach, Claudia García-Moreno, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

No abstract provided.

Maternal And Perinatal Health Research Priorities Beyond 2015: An International Survey And Prioritization Exercise, Joao Paulo Souza, Mariana Widmer, Ahmet Metin Gülmezoglu, Theresa Anne Lawrie, Ebunoluwa Aderonke Adejuyigbe, Guillermo Carroli, Caroline Crowther, Sheena M. Currie, Therese Dowswell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.

Methods: We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international …

Implementation Of Evidence-Based Antenatal Care In Mozambique: A Cluster Randomized Controlled Trial: Study Protocol, Leonardo Chavane, Mario Merialdi, Ana Pilar Betrán, Jennifer Requejo-Harris, Eduardo Bergel, Alicia Aleman, Mercedes Colomar, Maria Luisa Cafferata, Alicia Carbonell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of …

Use Of Antenatal Corticosteroids And Tocolytic Drugs In Preterm Births In 29 Countries: An Analysis Of The Who Multicountry Survey On Maternal And Newborn Health, Joshua P. Vogel, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, Malinee Laopaiboon, Bukola Fawole, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks’ gestation and we excluded births that …

Who Guidance Grounded In A Comprehensive Approach To Sexual And Reproductive Health And Human Rights: Topical Pre-Exposure Prophylaxis, Manjula Lusti-Narasimhan, Rajat Khosla, Rachel Baggaley, Marleen Temmerman, Elizabeth Mcgrory, Tim Farley

Obstetrics and Gynaecology, East Africa

Introduction: Two new microbicide products based on topical (vaginal) application of antiretroviral drugs – 1% tenofovir gel and the dapivirine ring – are currently in late-stage clinical testing, and results on their safety and effectiveness are expected to become available in early 2015. WHO guidelines on the use of topical pre-exposure prophylaxis (topical PrEP) are important in order to ensure that these new prevention products are optimally used.

Discussion: Given that these new topical PrEP products are designed to be woman initiated and will likely be delivered in reproductive health settings, it is important to ensure that the …

The Impact Of Alcohol On Hiv Prevention And Treatment For South Africans In Primary Healthcare, Michelle Schneider, Matthew Chersich, Marleen Temmerman, Olivier Degomme, Charles D. Parry

Obstetrics and Gynaecology, East Africa

Background: Antiretroviral treatment (ART) has substantially reduced morbidity and mortality for HIV patients. In South Africa, with the largest ART programme globally, attention is needed not only on the further expansion of ART coverage, but also on factors which undermine its effectiveness, such as alcohol use.

Objective: Given the decentralised approach of nurse-initiated and -sustained ART in the South African primary health sector, it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV.

Method: This study comprised a narrative review of relevant literature.

Results: Alcohol acts through both …