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Background: Human immunodeficiency virus continues to be a major global public health issue. Body mass index is a general indicator of nutritional status and has emerged as a powerful predictor of morbidity and mortality among adult PLHIV initiating antiretroviral therapy in resource-limited settings. However, there is a dearth of information regarding longitudinal changes in body mass index and its predictors among adult PLHIV in Ethiopia, particularly in the study area. This study aimed to assess body mass index changes and their predictors among adults living with HIV/AIDS who were receiving on antiretroviral therapy at Chiro General Hospital, Eastern Ethiopia from August 15, 2023 to September 30, 2023. Methods: A Facility-based retrospective cohort study was implemented among 1049 randomly selected charts of adults living with HIV/AIDS. The data were collected by reviewing charts of clients and antiretroviral therapy registers. The data were entered into Epi data statistical software version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were used to describe the characteristics of the patients. A linear mixed effect model was used to identify the predictors of body mass index change. A P value of less than 0.05 was considered statistically significant. Results: Generally, in this study patients presented a linear increase in the mean BMI from 19 kg/m2 baseline to 21.2 kg/m2 at the 5th year of follow up. Moreover, the following variables were identified as independent predictors of BMI change: age (β = 0.58, 95% CI; 0.043, 0.072), marital status (β = -0.275, 95% CI: -0.457,-0.093), advanced WHO stage (β = -0.496, 95% CI: -0.548, -0.443), CD4 count (β = 0.001, 95% CI: 0.001, 0.001), duration of antiretroviral therapy (β = 0.005, 95% CI: 0.001,0.009), time of follow up (β = 0.205, 95% CI: 0.198,0.212), no ART shift (β = -0.844, 95% CI: -1.135, -0.552), no CPT (β = 0.591, 95% CI: 0.365,0.817), urban residence (β = 0.767, 95% CI:0.401,1.132) and good adherence to ART (β = 0.975, CI:0.302, 1.649). Conclusion: There was a significant improvement in the mean BMI over time and a reduction in the rate of undernutrition during the follow-up period. [ABSTRACT FROM AUTHOR]

Background: The burden of pediatric HIV/AIDS, mother-to-child transmission rate, and unintended pregnancy among HIV-positive women remain high in sub-Saharan Africa, including Ethiopia. Provision of contraceptives is an undeniable strategy to overcome the risks. However, pooled data to provide informed decisions on modern contraceptive use among HIV-positive women attending ART clinics in Ethiopia are meager. Hence, this review aimed to estimate the magnitude of modern contraception, and revisable long act contraceptives methods (RLCM) use and associated factors among HIV positive ART clinic attending women. Methods: A systematic review and meta-analysis was conducted using PubMed, Google, Cochrane library, Web of Science, Google Scholar, and Scopus database. A funnel plot and Egger's regression test were used to assess publication bias. Heterogeneity of studies was assessed using I-square statistics and the Joanna Briggs Institute (JBI) quality assessment tool was applied to ensure the quality of the included articles. We employed a random-effect model to pool the national utilization of modern contraceptives and the effect size of associated factors. We conducted sub-group analysis by regions to control heterogeneity and to detect variation. Results: A total of 21 studies were included in the meta-analysis. The magnitude of pooled utilization of modern contraceptive and RLCM was 60% [95% CI: 52–68] and 11%, [95% CI: 8–14], respectively. In the random effect model, young women [OR = 2.36, 95% CI: 1.78–3.13], attending secondary school and above [AOR = 1.34, 95% CI: 1.06–1.69], having two or more live children [AOR = 1.84, 95% CI: 1.46–2.34], discussion with a husband [AOR = 2.92, 95% CI: 2.39–3.57], CD4 > 250cells/mm3 [AOR = 1.59, 95% CI: 1.08–2.33], and using HAART [AOR = 1.71, 95% CI: 1.35–2.15] increased odds of modern contraceptive methods utilization. Conclusion: Overall the utilization of RLCM among modern contraceptive users HIV positive women is low. Therefore, to improve the uptake of RLCM among modern contraceptive users HIV positive women, policymakers and program designers need to take into account age and educational levels of women and programs which enhance reproductive health consultation habit between couples. Moreover, integration of family planning services to ART clinics needs to be strengthened. [ABSTRACT FROM AUTHOR]

Background: Advances in medical care and improved quality of life have fostered a growing desire for parenthood among people living with HIV (PLHIV). However, this desire remains inadequately addressed in China, highlighting a crucial research gap. Understanding the factors influencing fertility intentions in PLHIV is essential for informing policy development. Methods: We conducted a systematic review of English and Chinese literature, analyzing articles from 2000 to 2024. The odds ratio (OR) with 95% confidence intervals (CIs) was used for pooled measurement. Subgroup analyses based on regional factors were performed, and publication bias was assessed using Egger's test. Results: The review included 25 articles with 11,394 participants. Key factors associated with fertility intention included age (OR = 2.67, 95%CI: 2.04–3.48, P < 0.05), marital status (OR = 1.52, 95%CI: 1.14–2.02, P < 0.05), and number of children (OR = 5.28, 95%CI: 3.58–7.79, P < 0.05). Interestingly, education level did not significantly impact fertility desire (OR = 1.08, 95%CI: 0.72–1.41, P = 0.61). Subgroup analysis revealed that childlessness was a stronger influence in China (OR = 7.40, 95%CI: 3.76–14.58, P < 0.05) compared to developing and developed countries, where higher education levels had minimal or even negative effects on fertility intentions (OR = 0.98, 95%CI: 0.66–1.46, P = 0.93). No significant differences were observed regarding age and marital status between China and other regions. Conclusions: This study highlights the prominent roles of age, marital status, and number of children in shaping fertility intentions among PLHIV. In China, the social and national context uniquely influences these intentions. Given the limited number of studies and variability in educational classifications across countries, further in-depth research is warranted. [ABSTRACT FROM AUTHOR]

Objective: This study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied. Methods: We conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings. Plain Language Summary: Telling Healthcare Providers About HIV Status: How Women with HIV/AIDS in Vietnam Decide and What They Consider This study focuses on how women living with HIV/AIDS in Vietnam decide to share their HIV status with healthcare providers. We interviewed 30 women with HIV/AIDS in Vietnam and found that many choose to reveal their status only in certain situations, depending on the medical procedure and the setting. They weigh various factors before deciding to disclose, including the risk of facing stigma, the need to protect their privacy, how relevant their HIV status is to their other health issues, their wish to protect their healthcare providers and other patients, and how they have been advised by HIV specialists. Unfortunately, choosing not to disclose their status sometimes stops them from getting the full range of medical care they need. The findings stress the importance of helping these women make well-informed choices about disclosing their HIV status. We also need to provide them with additional support and navigational help through healthcare services. Moreover, reducing stigma in healthcare, enhancing providers' ability to gather necessary health information, and ensuring patient privacy are crucial to encouraging more open discussions of HIV status in medical settings. [ABSTRACT FROM AUTHOR]

Background: About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Methods: Data were obtained from the 2016– 17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/μL or 200 cells/μL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. Results: The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31– 40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14– 2.60), age ≥ 41 years (aOR = 1.79, 95% CI: 1.16– 2.76), male sex (aOR = 1.88, 95% CI: 1.29– 2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20– 5.76). Factors associated with AHD were age 31– 40 years (aOR = 2.12, 95% CI: 1.18– 3.81), age ≥ 41 years (aOR = 2.42, 95% CI: 1.32– 4.41), male sex (aOR = 1.77, 95% CI: 1.09– 2.87), formal education (aOR = 0.49, 95% CI: 0.30– 0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07– 5.77). Conclusion: Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care. [ABSTRACT FROM AUTHOR]

Background: Prevention of vertical (mother to child) transmission of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress over the past decade in Zambia, the country is yet to reach global and national target for elimination of vertical transmission of HIV. Avoidance of unintended pregnancy among women living with HIV is one of the cost-effective interventions in a comprehensive approach to prevent vertical transmission of HIV. Therefore, this study aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia. Methods: The study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 27,153 women aged 15–49 years over the three survey periods among whom 4,113 had an HIV positive result following a rigorous HIV testing algorithm of the demographic and health surveys, and these constituted our sample size of women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among women living with HIV. Results: Over the three survey points, unmet need for family planning among women living with HIV has largely remained unchanged from 20.8% in 2007 to 20.5% in 2013/14 and 21.1% in 2018 DHS. Residence, age of women, household wealth, woman's parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia. Conclusion: Preventing HIV infection in a child preserves life, contributes to improving quality of life from its early stages and averts lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of interventions to prevent vertical transmission of HIV including shaping programming regarding preventing unintended pregnancies among women living with HIV. Among other aspects, policy and practice need to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV. [ABSTRACT FROM AUTHOR]

The nature and burden of weight gain associated with antiretroviral treatment (ART) using a combination of Tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) among people living with HIV (PLWH) has not been thoroughly investigated in Ethiopia. Therefore, this study aimed to evaluate changes in body weight and body mass index (BMI) in adults who initiated TLD or switched to TLD compared to those who received a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapies. A retrospective cohort study was conducted among adult PLWH who had been receiving ART between February 2017 and October 2022 in Hawassa city administration, Sidama region. Linear mixed-effects model was used to examine BMI and body weight trends over time, while a binary logistic regression was performed to identify factors associated with a ≥ 10% weight gain. A total of 524 adult PLWH with a median age of 35 (interquartile range: 30–41) years were included. TLD-initiated arm experienced significantly greater mean weight (8.6 kg vs. 4.95 kg, p < 0.0001) and BMI (3.11 kg/m2 vs. 1.84 kg/m2, p < 0.0001) increase than the NNRTI-based arm at two years. However, the switched arm showed no significant difference in weight (5.6 kg) and BMI (2.13 kg/m2) compared to the NNRTI-based arm (p > 0.05). There was a significant interaction effect between ART regimens and time in predicting weight and BMI gain (p < 0.01). Initiating ART with TLD had higher odds of ≥10% body weight gain at two years (adjusted odds ratio [AOR]: 1.9; 95% CI: 1.19–3.04). Other baseline factors such as age ≥40 years (AOR: 2.02; 95% CI: 1.35–3.02), weight <50kg (AOR: 3.0; 95% CI: 1.86–4.84), advanced disease stages (AOR: 1.78; 95% CI: 1.1–2.86) and ambulatory-bedridden functional status (AOR: 2.0; 95% CI: 1.05–3.8) were also associated with ≥10% weight gain. Initiating ART with TLD was significantly associated with greater weight and BMI gain than the NNRTI-based regimens. Therefore, the cardio-metabolic implications of weight gain after the TLD initiation in this population should be monitored and thoroughly investigated. A significant interaction effect was observed between ART regimens and time in predicting weight and BMI gain. Starting ART with TLD was associated with a significant weight gain and treatment-emergent overweight/obesity than the NNRTI-based therapies. ART initiating with TLD had 1.9 times higher odds of >10% body weight gain than the NNRTI-based therapies [ABSTRACT FROM AUTHOR]

Background: Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. Objective: To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. Methods: Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan–Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. Results: The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. Conclusion: The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes. [ABSTRACT FROM AUTHOR]

Background: People living with the human immune deficiency virus (PLHIV) are an important group to address HIV prevention. Mostly, 90% of the HIV cases in children are usually through mother-to-child transmission. Dual contraception (barrier condoms i.e., male, and female condoms) are one of the most effective ways to avoid HIV transmission. Thus, the present study was carried out to establish the predictors associated with the use of dual contraceptives in sexually active HIV positive women in Hossana, Southern Ethiopia. Methods: An institution based unmatched case–control study among randomly selected 312 sexually active HIV positive women was conducted from February 2021 to May 2021. The data were collected through structured questionnaire and anti-retroviral treatment (ART) cards considering the case-to-control ratio of 1:3. The information was coded, entered into Epi-Info7.0 and exported to SPSS 20.0 for further analysis. A P-value < 0.25 in bi-variate analysis was further processed for multi-variate analysis and P-value < 0.05 was considered statistically significant. Results: A response rate of 97.2% was recorded. A significant difference was observed towards the use of dual contraceptives in sexually active HIV positive women living in urban vs rural areas (AOR = 0.28; 95% CI = 0.09–0.84), having sexual intercourse with a regular partner (AOR = 3.77; 95% CI = 1.48–9.55) and taking first initiation to use (AOR = 0.05; 95% CI = 0.02–0.11). Conclusion: The determinants associated with lower use of dual contraceptives were residing in rural areas, sexual intercourse with a regular partner and low initiation rate at first time for use of dual contraceptives. Therefore, we strongly recommend that open discussion about sexually transmitted infections like HIV and their prevention, providing adequate facilities in rural areas can help to prevent HIV transmission and reduce the disease burden. The health professionals are encouraged to organize awareness campaigns in rural areas for use of dual contraceptives among PLHIV. Plain language summary: HIV/AIDS has become a serious global threat to human beings. People living with HIV are an important group that needs attention. About 90% of the children get HIV infection through their mothers that involved mother-to-child transmission of HIV. Therefore, World Health Organization has focused on the use of condoms to prevent the transmission of sexually transmitted diseases (STDs) and to avoid unwanted pregnancies. Out of these contraceptives, the use of dual contraceptives has been considered the best to prevent the transmission of STDs/HIV. Therefore, the present study tried to identify the use of dual contraceptives (barrier condoms i.e., male, and female condoms) and factors associated with its use in sexually active HIV women in Hossana, SNNPR, Ethiopia. We conducted a case–control study and recruited 312 sexually active HIV positive women that were on antiretroviral therapy and visiting the ART clinics for their follow-ups. The present investigation revealed that women living in rural areas were not aware about the use of dual contraceptives when compared to urban areas. Also, it was observed that women, those involved in sexual activities with multiple partners and had an open discussion with their partners about using dual contraceptives at first were more when compared to others. Although, the use of dual contraceptives among HIV positive women living in Hossana was low. Hence, this needs more focused awareness programs in rural areas and people having sexual intercourse with regular partners. [ABSTRACT FROM AUTHOR]

Among Sub-Saharan African women living with HIV (WLWH), pregnancy creates unique stressors that may cause depression. We describe the prevalence of depression among WLWH enrolled in the African Cohort Study (AFRICOS) by pregnancy status and describe factors associated with depression. WLWH < 45 years of age underwent six-monthly visits with depression diagnosed using the Center for Epidemiological Studies-Depression scale. Visits were categorized as "pregnant;" "postpartum" (the first visit made after the last pregnancy visit), and "non-pregnant." The prevalence of depression was calculated for each visit type and compared using prevalence odds ratios (POR) with 95% confidence intervals (CI). Logistic regression with generalized estimating equations was used to evaluate sociodemographic factors associated with depression. From January 2013 to March 1, 2020, 1333 WLWH were enrolled, and 214 had pregnancies during follow-up. As compared to the prevalence of depression during "non-pregnant" visits (9.1%), depression was less common at "pregnant" (6.3%; POR = 0.68 [CI: 0.42, 1.09]) and "postpartum" (3.4%; POR = 0.36 [CI: 0.17, 0.76]) visits. When controlling for other factors, the visit category was not independently associated with depression. Visit number, study site, employment status, and food security were independently associated with decreased odds of depression. We observed a lower prevalence of depression during pregnancy and the postpartum period than has been previously described among WLWH during similar time points. We observed protective factors against depression which highlight the impact that holistic and consistent health care at HIV-centered clinics may have on the well-being of WLWH in AFRICOS. [ABSTRACT FROM AUTHOR]

Understanding the fertility intentions of people living with HIV can guide safer conception planning and prevention of mother-to-child transmission (PMTCT). Most research has addressed fertility intentions among women, rather than couples, at a single time point. This clinical trial of a PMTCT intervention in rural Mpumalanga province, South Africa, examined longitudinal fertility intentions among perinatal women living with HIV and their male partners. Study assessments and intervention and control sessions were conducted prenatally and postpartum. Longitudinal predictors of participants' (n = 360 men, n = 917 women) fertility intentions were similar between sexes. Younger age and male involvement in perinatal care were associated with reporting fertility intentions at both baseline and 12 months postpartum. Having an HIV-positive infant and discussing pregnancy plans with a healthcare provider by 12 months postpartum were associated with incident fertility intentions after reporting no plans for further children at baseline. Results highlight the important role of healthcare providers to educate men and women on issues surrounding conception, as well as the potential for incorporating PMTCT and safer conception education into HIV clinical services. [ABSTRACT FROM AUTHOR]

Background: Ethiopia is one of the Sub-Saharan African countries with an increasingly risky sexual practice and mostly affected by the Human Immunodeficiency Virus (HIV) epidemic. Dual protection is an important preventive approach which can prevent both unwanted pregnancy and sexually transmitted infections including HIV/AIDS. Therefore, this study aimed to assess the dual contraceptive utilization and associated factors among reproductive-age women on Anti-Retroviral Therapy (ART) in central Ethiopia. Methods: An-institution based cross-sectional study was conducted among 311 women on ART at public hospitals of West Shewa Zone from June to September 2019. A systematic random sampling technique was used to select the study participants. A pretested structured interviewer-administered questionnaire was used for data collection. The data were entered into Epi data version 3.1 and exported to IBM SPSS statistical software version 25 for analysis. Bivariate and multivariable logistic regression analysis were computed. Odds ratio along with 95% confidence interval was computed to ascertain the association. Results: The prevalence of dual contraceptive utilization among women on ART was 21.4% (95% CI: 16.8– 25.9). Age of respondents between 15 and 24 years [AOR=8.35, (95% CI: 3.12– 17.78)], living in urban [AOR=2.59, 95% CI: 1.15– 4.22], separated women [AOR=2.28, 95% CI (1.26– 5.04)], had post-diagnosis counselling on family planning [AOR=5.33, 95% CI: 1.52– 18.68], disclosed HIV status [AOR=5.98, 95% CI: 1.63– 21.93], freely discuss with their husband [AOR=4.22, 95% CI, 1.84– 12.36], have no fertility desire [AOR=2.46, (95% CI: 1.34– 6.44)] were significantly associated with dual contraceptive utilization. Conclusion and Recommendation: The overall magnitude of dual contraceptive utilization among women on ART was found to be low. Factors like age, residence, marital status, post-diagnosis counselling, disclosure of HIV status, and free discussion with husband were significantly associated with dual contraceptive method utilization. Therefore, it is necessary to expand the range of strategies and tools available to married and single women's for protecting themselves from being infected with other strains and pregnancy. The concerned stakeholders also should emphatically consider those identified factors for intervention. [ABSTRACT FROM AUTHOR]

Introduction: due to increasing coverage of antiretroviral therapy (ART), more women living with HIV have improved health condition which also increases their chances of getting pregnant. However, the knowledge about pregnancy among women receiving ART in resource-constrained settings, like Ethiopia, is limited. The aim was to assess factors associated with pregnancy among women living with HIV in Ethiopia. Methods: a retrospective cohort study from 2005 through 2013 including a total of 809 women aged 15-49 years on ART was used. The study was conducted in eight hospitals and health centers in two regions of Ethiopia. The data was collected between March and June of 2014 from patients' pre-ART and ART registers by trained nurses, assisted by data entry clerks and supervised by senior physicians. Kaplan-Meier survival analysis and Cox regression analysis were used to examine the probability of becoming pregnant. Factors associated with pregnancy were presented with hazard ratios with 95% Confidence Interval (CI). Results: a total of 809 women were included in this analysis, their median age was 27 years, 90% were urban residents and 40.6% were married. Four hundred eighty three (60.6%) were in WHO stage III at initiation of ART. The median CD4 count was 162.5 cell/µl at initiation of ART. Eighty-one women became pregnant during 3069 person-years of observation. The overall incidence of pregnancy was 26.4 pregnancies per 1000 person-years of observation. Women under the age of 24, those in less advanced disease stage, women with no education and those with college education had higher rates of pregnancy. Conclusion: the results highlight that younger women, those in less advanced disease stage, either uneducated or highly educated ones have higher probability of becoming pregnant during HIV treatment. This suggests the need for integrating reproductive health services into HIV care services to meet the needs of women on ART. [ABSTRACT FROM AUTHOR]

Objectives: Female sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs. Study design: This cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need. Results: Among 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8–68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0–1.5), desire for (more) children (PR 1.3, 95%CI 1.1–1.5), and having 2–3 previous pregnancies compared to 0–1 prior pregnancies (PR 0.8, 95%CI 0.6–0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need. Conclusions: Unmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0–1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV. [ABSTRACT FROM AUTHOR]

Introduction: despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. Methods: the study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. Results: six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). Conclusion: this study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount. [ABSTRACT FROM AUTHOR]

As access to antiretroviral therapy increases, more HIV-infected patients in sub-Saharan Africa may desire fertility. We conducted a cross-sectional study of reproductive health knowledge, attitudes and practices to identify factors associated with desired fertility among women and men receiving care at two large public HIV clinics in Lilongwe, Malawi. Research assistants administered questionnaires to participants. We performed descriptive, bivariable and multivariable analysis of factors related to desired fertility and of factors related to contraceptive non-use among participants who did not desire fertility. One-third of participants desired future children. Having a partner who desired fertility and having lower parity were associated with desiring children among both genders. For women, believing that pregnancy was unhealthy was associated with decreased fertility desire. Fifty-five percent of women and 69% of men who did not want children in the future reported using contraception at last intercourse. Increasing age, lower parity, and making the decision to use contraception herself were associated with contraceptive non-use among women who did not desire fertility. Having discussed family planning with his partner was associated with contraceptive use among men who did not desire fertility. Knowledge of these factors can guide reproductive health counseling and service provision. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to estimate the prevalence and examine the factors associated with reproductive desire among women living with HIV/AIDS (WLWHA) in Central Brazil. Methods: A cross-sectional study involving 274 WLWHA, aged 18 to 49 years, was conducted with the support of treatment services and non-governmental organizations that assist people living with HIV/AIDS. Data regarding sociodemographic characteristics, substance use, sexual behavior, and reproductive variables were collected through interviews. Poisson regression with robust variance was used to analyze the factors associated with reproductive desire. Results: The prevalence of reproductive desire was 25.9% (95.0% confidence interval [CI]: 21.1–31.4%). This outcome was associated with age < 30 years (adjusted prevalence ratio [APR]: 2.93; p < 0.001), black skin color or race (APR: 2.28; p = 0.017), partner's reproductive desire (APR: 7.55; p < 0.001), absence of children (APR: 2.13; p = 0.003), history of abortion (APR: 1.65; p = 0.045) and undetectable viral load at the time of data collection (APR: 1.92; p = 0.043). Conclusion: The prevalence of reproductive desire among WLWHA was relatively high. It is necessary to include fertility issues as part of assistance and counseling for women in referral services to support them with their feelings, goals, and needs regarding reproductive choices. [ABSTRACT FROM AUTHOR]

Introduction: Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. Discussion: There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. Conclusions: Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV continues to encounter unintended pregnancies with a concomitant risk of mother-to-child transmission of HIV infection. Preventing unintended pregnancy among HIV-infected women is one of the strategies in the prevention of new HIV infections among children. The aim of this analysis was to assess the practice of family planning (FP) among HIV-infected women and the influence of women's awareness of HIV positive status in the practice of FP. Methods: The analysis was made in the Malawi Demographic and Health Survey (DHS) data among 489 non-pregnant, sexually active, fecund women living with HIV. Multiple logistic regression analysis was performed using SPSS software to identify the factors associated with FP use. Adjusted odds ratios (AOR) with 95 % confidence intervals were computed to assess the association of different factors with the practice of family planning. Result: Of the 489 confirmed HIV positive women, 184 (37.6 %) reported that they knew that they were HIV positive. The number of women who reported that they were currently using FP method(s) were 251 (51.2 %). The number of women who reported unmet need for FP method(s) were 107 (21.9 %). In the multiple logistic regression analysis, women's knowledge of HIV positive status [AOR: 2.32(1.54, 3.50)], secondary and above education [AOR: 2.36(1.16, 4.78)], presence of 3-4 alive children [AOR: 2.60(1.08, 6.28)] and more than 4 alive children [AOR: 3.03(1.18, 7.82)] were significantly associated with current use of FP. Conclusion: Women's knowledge of their HIV-positive status was found to be a significant predictor of their FP practice. Health managers and clinicians need to improve HIV counselling and testing coverage among women of child-bearing age and address the FP needs of HIV-infected women. [ABSTRACT FROM AUTHOR]

Introduction: Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population. Methods: We conducted structured in-depth interviews with 40 providers at 21 Family AIDS Care & Education Services - supported clinics in Homabay, Kisumu and Migori counties in western Kenya from July to August 2014. Our interview guide explored the providers’ perspectives on contraceptive service provision to adolescent females living with HIV with the following specific domains: contraception screening and counselling, service provision, commodity security and clinic structure. Transcripts from the interviews were analyzed using inductive content analysis. Results: According to providers, interpersonal factors dominated the barriers adolescent females living with HIV face in accessing contraception. Providers felt that adolescent females fear disclosing their sexual activity to parents, peers and providers, because of repercussions of perceived promiscuity. Furthermore, providers mentioned that adolescents find seeking contraceptive services without a male partner challenging, because some providers and community members view adolescents unaccompanied by their partners as not being serious about their relationships or having multiple concurrent relationships. On the other hand, providers noted that institutional factors best facilitated contraception for these adolescents. Integration of contraception and HIV care allows easier access to contraceptives by removing the stigma of coming to a clinic solely for contraceptive services. Youth-friendly services, including serving youth on days separate from adults, also create a more comfortable setting for adolescents seeking contraceptive services. Conclusions: Providers at these facilities identified attitudes of equating seeking contraceptive services with promiscuity by parents, peers and providers as barriers preventing adolescent females living with HIV from accessing contraceptive services. Health facilities should provide services for adolescent females in a youth-friendly manner and integrate HIV and contraceptive services. [ABSTRACT FROM AUTHOR]

Background: Over 90% of the children with Human Immunodeficiency Virus are infected through the mother to child transmission process according to literatures. Preventing unintended pregnancy by using contraceptive methods is crucial for reducing maternal and child mortality and morbidity. Here we set out to assess the prevalence and associated factors of modern contraceptive utilization among sexually active reproductive age women attending Anti-Retroviral Therapy clinics in Amhara Region referral hospitals in 2016.Methods: An institution based cross sectional study was carried out from April to July 2016 surveying women of reproductive age attending the Anti-Retroviral Therapy clinics in the five Amhara Region referral hospitals. A pretested and semi-structured questionnaire was used to collect data. EpiInfo7 and SPSS version 20 soft wares were used for data entry and analysis, respectively. Significant associations were identified on the basis of the adjusted odds ratio, with 95% Confidence Interval, and p value ≤0.05, was taken as statistically significant.Result: The proportion of women utilizing modern contraceptives was 47.7% with (95% CI: 43, 52.5%), the male condom being the most (64.2%) utilized method. The use of the contraceptive methods was most prevalent among women 15-24 years of age (AOR = 6.5, 95% CI: 2-10) and age of 25-34 (AOR = 3, 95% CI: 1.6-5.5), having an urban residence (AOR = 0.095, 95% CI: 0.03-0.28), having discussed contraceptives with partner (AOR = 7, 95% CI: 5.3-11.9), receiving counseling from health care providers (AOR = 4.8, 95% CI: 1.8-7), previous history of contraceptive utilization (AOR = 5.6, 95% CI: 2.6-8.3), and with CD4 count >500mm3/dl (AOR = 2.4, 95% CI: 1.3-4.3).Conclusion: The proportion of women utilizing contraceptive has been low in Amhara Region referral hospitals. Encouraging patients to discuss about contraception with partners and repeated counseling by health care providers may strengthen contraceptive utilization. [ABSTRACT FROM AUTHOR]

Background: Mother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living with HIV are found. Previous studies in Ethiopia present inconsistent and inconclusive findings on the prevalence and associated factors of MTCT of HIV. Therefore, this study was conducted to determine the pooled prevalence of MTCT of HIV and its associated factors in Ethiopia.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. All published studies were retrieved using relevant search terms in MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to critically appraise articles. STATA version 14 software was used to perform the Meta-analysis. The I2 statistics was used to test heterogeneity and publication bias was assessed using Begg's and Egger's tests. Odds ratio (OR) with 95% confidence interval (CI) was presented using forest plots.Results: A total of nine studies, 3688 mother-baby pairs, were included in this meta-analysis. The pooled prevalence of MTCT of HIV in Ethiopia was 9.93% (95% CI: 7.29, 12.56). The subgroup analysis showed a higher prevalence of MTCT of HIV in Dire Dawa City Administration (15.7%) and lowest in Southern Nations, Nationality and Peoples Region (SNNPR) (4.16%). Associated factors with MTCT of HIV include: mixed feeding, OR = 7.46 (95%CI: 4.71, 11.81), absence of infant ARV prophylaxis, OR = 7.89 (95%CI: 4.32, 14.42), home delivery, OR = 5.08 (95%CI: 2.32, 11.15), and absence of maternal PMTCT intervention, OR = 7.13 (95% CI: 3.31, 15.35).Conclusions: Almost one in ten HIV exposed infants become HIV positive in Ethiopia. Factors like: mixed feeding, the absence of infant ARV prophylaxis, home delivery and absence of mother's PMTCT intervention were significantly associated with MTCT of HIV. Therefore, the governmental and non-governmental organizations need to focus on the identified factors and work towards improving the prevention of mother to child transmission of HIV (PMTCT) program. [ABSTRACT FROM AUTHOR]