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Abstract Background Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings. Methods This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings. Results Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance. Conclusions Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system.

A correction to this paper has been published: https://doi.org/10.1007/s10461-021-03298-6 [ABSTRACT FROM AUTHOR]

The Latin American and Caribbean adolescent fertility rates are among the highest in the world: about 1.7 million children are born to teen mothers every year, and most of them are declared unintended pregnancies. The region also has the highest rate of unintended pregnancy of any world region, and nearly half of such pregnancies end in abortion. However, fewer than 18 percent of the region's women live in countries where abortion is broadly legal. This paper estimates the causal effect of abortion legalization on adolescent fertility in Uruguay using official data on legal abortions provided after the 2012 reform. We employed a difference‐in‐differences strategy, classifying states by whether they are responsive or unresponsive to the reform. The results suggest that abortion reform had a negative impact on the adolescent birth rate by 2.5–2.8 births per thousand adolescents aged 15–19 (a 4 percent decrease from the preintervention average). Additionally, we exploited variation in reform implementation intensity through the estimation of fixed‐effect linear regression models and found consistent results. Our findings are robust to controlling for a concurrent large‐scale program of contraceptive implants. We conclude that legislation aimed at enhancing rights and reducing avoidable deaths and complications from unsafe abortions may also have spillover effects that help reduce adolescent fertility. [ABSTRACT FROM AUTHOR]

Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants' interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW's perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach. [ABSTRACT FROM AUTHOR]

While HIV stigma has received significant attention, limited work has been conducted on the measurement of intersecting stigmas. We developed the Experiences of Sex Work Stigma (ESWS) scale in the Dominican Republic (DR) and Tanzania. We conducted in-depth interviews with 20 female sex workers (FSW) per country to identify scale domains followed by cognitive debriefing interviews to assess content validity. Items were administered in a survey to FSW in DR (n = 211) and Tanzania (n = 205). Factor analysis established four sex work stigma domains including: shame (internalized), dignity (resisted), silence (anticipated) and treatment (enacted). Reliability across domains ranged from 0.81 to 0.93. Using item response theory (IRT) we created context-specific domain scores accounting for differential item functioning between countries. ESWS domains were associated with internalized HIV stigma, depression, anxiety, sexual partner violence and social cohesion across contexts. The ESWS is the first reliable and valid scale to assess multiple domains of sex work stigma and can be used to examine the effects of this form of intersectional stigma on HIV-related outcomes across settings. [ABSTRACT FROM AUTHOR]

Long-acting injectable antiretroviral therapy (LA ART) may be an alternative for people living with HIV (PLHIV) with adherence challenges or who prefer not to take pills. Using in-depth interviews, this study sought to understand the experiences of PLHIV (n = 53) participating in Phase 3 LA ART trials in the United States and Spain. The most salient consideration when contemplating LA ART was its clinical efficacy; many participants reported wanting to ensure that it worked as well as daily oral ART, including with less frequent dosing (every 8 versus 4 weeks). While injection side effects were often reported, most participants felt that regimen benefits outweighed such drawbacks. Participants described the main benefit of LA ART as the "freedom" it afforded both logistically and psychosocially, including through reduced HIV stigma. Findings highlight the importance of patient-provider communication related to weighing potential benefits and side effects and the continued need to address HIV stigma. [ABSTRACT FROM AUTHOR]

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Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City. Methods We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 µg of misoprostol self-administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7-15 days later. We did an intention-to-treat analysis for risk differences between physicians' and nurses' provision for completion and the need for surgical intervention. Findings Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician- provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians' provision and 97.9% (425/434) for nurses' provision. The risk difference between the group was 0.5% (95% confidence interval, CI: -1.2% to 2.3%). There were no differences between providers for examined gestational duration or women's contraceptive method uptake. Both types of providers were rated by the women as highly acceptable. Conclusion Nurses' provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services. Objectif Examiner l'efficacite, la securite et l'acceptabilite de l'avortement medical precoce pratique par un(e) infirmier(iere) par rapport au meme acte realise par un medecin dans trois etablissements de la ville de Mexico. Methodes Nous avons mene un essai de non-inferiorite randomise sur l'avortement medical et le conseil en matiere de contraception pratiques par des medecins ou des infirmiers. Les participantes etaient des femmes enceintes souhaitant avorter a un terme de grossesse de 70 jours ou moins. Le protocole de l'avortement medical etait de 200 mg de mifepristone administres sur place par voie orale, suivis de 800 µg de misoprostol auto-administres par voie orale a la maison 24 heures plus tard. Les femmes avaient recu comme consigne de revenir a la clinique pour y etre suivies 7 a 15 jours plus tard. Nous avons effectue une analyse en intention de traiter pour les differences de risque entre l'avortement medical pratique par les medecins et par les infirmiers et le besoin d'une intervention chirurgicale. Resultats Parmi les 1 017 femmes eligibles, 884 femmes etaient incluses dans l'analyse en intention de traiter, 450 dans l'acte d'avortement pratique par un medecin et 434 dans l'acte d'avortement pratique par un(e) infirmier(iere). Les femmes qui ont subi un avortement medical sans avoir eu besoin d'une intervention chirurgicale etaient de 98,4% (443/450) pour l'avortement pratique par un medecin et de 97,9% (425/434) pour l'avortement pratique par un(e) infirmier(iere). La difference de risque entre les groupes etait de 0,5% (intervalle de confiance a 95%: de 1,2% a 2,3%). Il n'y avait pas de difference entre les professionnels de sante pour les termes de la grossesse examines ou la prise de methode contraceptive des femmes. Par ailleurs, les femmes acceptaient completement les deux types de professionnels de sante. Conclusion Dans ce contexte, l'avortement medical pratique par les infirmiers est aussi s-r, acceptable et efficace que celui pratique par les medecins. Autoriser les infirmiers a pratiquer l'avortement medical peut aider a repondre a la demande en matiere de services d'avortement securises. Objetivo Examinar la eficacia, seguridad y aceptabilidad de la actuacion de los enfermeros en los abortos con medicamentos en fases tempranas de la gestacion en tres centros de Ciudad de Mexico en comparacion con la actuacion los medicos. Metodos Se llevo a cabo un ensayo de no inferioridad aleatorio sobre la realizacion de abortos medicos y asesoramiento anticonceptivo por parte de medicos o enfermeros. Las participantes fueron mujeres embarazadas que buscaban interrumpir una gestacion de 70 dias o menos. El regimen para el aborto con medicamentos consistio en 200 mg demifeprlstona por via oral, administrados en el centro, seguidos de 800 µg de misoprostol autoadministrados por via oral en casa 24 horas mas tarde. Se indico a las mujeres que acudieran a la clinica para realizar un seguimiento entre 7y 15 dias mas tarde. Se realizo un analisis por intencion de tratar de las diferencias de riesgo entre la asistencia de los medicos y los enfermeros para el termino y la necesidad de una intervencion quirurgica. Resultados De 1017 mujeres elegibles, se incluyeron 884 en el analisis por intencion de tratar, 450 en el brazo atendido por medicos y 434 en el grupo atendido por enfermeros. De las mujeres que se sometieron al aborto con medicamentos, el 98,4 % (443/450) de las atendidas por medicos y el 97,9 % (425/434) de las atendidas por enfermeras no requirieron ninguna intervencion quirurgica. La diferencia de riesgo entre el grupo fue de 0,5 % (intervalo de confianza del 95 %: -1,2 % al 2,3 %). No hubo diferencias entre los proveedores para la duracion de la gestacion examinada o metodo anticonceptivo de las mujeres. Las mujeres calificaron ambos proveedores como muy aceptables. Conclusion Los enfermeros son tan seguros, aceptables y eficaces como los medicos a la hora de asistir un aborto con medicamentos. Autorizar a las enfermeras a realizar abortos con medicamentos puede ayudar a satisfacer la demanda de servicios para un aborto seguro., Introduction In Mexico City, early elective abortion to terminate pregnancy was legalized in April 2007. (1-3) Up to June 2013,100 000 abortions have been provided by trained physicians in Ministry [...]