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New modalities of Pre-exposure Prophylaxis (PrEP) such as long-acting injectable PrEP (LAI-PrEP) promise increased prevention of HIV transmission; however, similar biomedical interventions have not been met with universal adoption by healthcare providers or populations most affected by HIV. This qualitative study explores healthcare provider considerations for the rollout of LAI-PrEP. Eleven key-informant in-depth interviews were conducted with clinicians who prescribe daily oral PrEP. Participants reviewed a currently proposed LAI regimen and were asked to reflect on its implications for their clinical practice. Interviews were transcribed verbatim and thematically coded, with results organized using the Consolidated Framework for Implementation Research (CFIR). All participants expressed interest in prescribing LAI-PrEP and anticipated that at least some patients would be interested. Participants identified characteristics of the intervention, inner intervention setting, and outer intervention setting that will be influential in bringing LAI-PrEP to scale. Clinicians in the South have unique insights into the challenges of and opportunities for successful rollout of future PrEP regimens. Bringing these insights into a CFIR framework highlights the nuances surrounding LAI-PrEP, including structural concerns such as cost barriers and access to in-person healthcare services. It is critical to address these challenges to ensure successful implementation of new PrEP formulations. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. Methods: A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. Results: This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Conclusions: Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women's autonomy and fistula risk undergo further investigation. [ABSTRACT FROM AUTHOR]

The health and social effects of women's microfinance participation remain debated. Using propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018–01/2019. Participants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes. Microfinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives. Policy Implications. Microfinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women. • Health and social effects of women's participation in microfinance are debated. • Effects on intrinsic voice/mobility, instrumental, and collective agency were positive. • Effects on IPV, depressive symptoms, and attitudinal intrinsic agency were null. • Microfinance can empower Bangladeshi wives without adverse health effects. • Social-norms programming may be needed to change gender attitudes in women and men. [ABSTRACT FROM AUTHOR]