Conceptualizing and Testing a New Measure of Fertility Intentions: A Mixed Methods Exploration of Factors that Affect the Achievement of Childbearing Plans

Understanding fertility intentions is crucial for reproductive health research and programs. While quantitative research has identified factors associated with fertility intentions and simple measures of intentions predict pregnancy moderately well, discrepancies between stated intentions and behavior are common and understanding of fertility decision making remains imperfect. Knowledge of factors that enable some women to achieve plans for pregnancy while others fail could advance understanding of unintended pregnancy, unmet need for family planning and contraceptive discontinuation. Two analyses were conducted to explore factors affecting the achievement of fertility intentions among Honduran women of reproductive age seeking health services in four Honduran cities. First, focus group discussions and individual in-depth interviews were conducted to examine reproductive decision making and factors thought to affect intentions. Locus of motivation for fertility decision making, the ability to pursue educational and occupational opportunities and the ability to care for family were found to be relevant to childbearing decision making. Individual and community-level factors affecting intentions were identified and results provide evidence that the formation and operationalization of intentions are distinct processes, influenced by different factors. Second, longitudinal data from 671 contraceptive users was used to explore aspects thought to influence the attainment of intentions. Using factor analysis, a multi-dimensional measure of motivation to avoid pregnancy was proposed and compared to the standard measure of fertility intentions using multivariate logistic regression to see which predicted contraceptive continuation and pregnancy better. Three dimensions of motivation were identified: Control Locus, Expectations and Feelings. Decreased expectations to use contraception were found to diminish the chances of continuing contraceptive use. Overall, the multidimensional measure performed similarly to the standard categories in the prediction of contraceptive use and pregnancy. Findings suggest factors likely to influence fertility intentions in other developing country settings. Future research should explore the role of motivation among a wider population in order to further assess the role of attitudinal factors in fertility and contraceptive decision making. Improved knowledge of fertility decision making will increase understanding of unmet need for family planning, contraceptive discontinuation and unintended pregnancy and, ultimately, help determine how best to address these issues

Contraceptive Discontinuation and Unintended Pregnancy: An Imperfect Relationship

Contraceptive discontinuation is a common event. We hypothesize that a significant proportion of contraceptive discontinuations are associated with low motivation to avoid pregnancy; this will be reflected in a significant proportion of pregnancies following discontinuation being reported as intended

Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners

Interventions to increase demand for medical male circumcision are urgently needed in eastern and southern Africa. Following promising evidence that providing economic compensation can increase male circumcision uptake in Kenya, there is a need to understand the role of this intervention in individuals' decision-making regarding circumcision and explore perceptions of the intervention and concerns such as coercion

Creating opportunities out of challenges: assessment of adaptations to maintain uninterrupted access to antiretroviral therapy for HIV clients in West Africa during the first year of the COVID-19 pandemic

# Background The COVID-19 pandemic imposed challenges to HIV service provision in Africa. The Ending AIDS in West Africa project (#EAWA), implemented in Burkina Faso and Togo, took measures to mitigate service provision disruptions due to COVID-19. We document the project’s strategies for ensuring an uninterrupted service provision to people living with HIV (PLHIV) during the COVID-19 pandemic. # Methods Using reports from project staff, we summarized #EAWA’s service provision strategies during the pandemic. This finding was complemented by a descriptive analysis of routine program data collected from December 2019 to April 2021 to evaluate how well these measures performed. # Results COVID-19-related travel restrictions, lockdowns, logistical challenges, and fear of health facilities restricted access to HIV care. Building on shifting policy environments in both countries, #EAWA adopted a contingency plan to accelerate the multi-month dispensing of ARVs (MMD) and differentiated drug delivery (DDD). Quantitative results show that the pandemic briefly disrupted ARV refills and MMD dispensation. The implementation of EAWA’s contingency plan corresponded to a rapid increase in drug refills and MMD in both countries. # Conclusions Examination of programmatic data from this HIV program shows that COVID-19 provided the impetus to embrace MMD to ensure continuity of care. Despite an extremely challenging and shifting environment, the #EAWA project was able to respond nimbly to ensure clients stayed on treatment

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya: A Randomized Clinical Trial

Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy

Rectal screening displays high negative predictive value for bloodstream infections with (ESBL-producing) gram negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

Objectives We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. Methods We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. Results We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4–28.0%] and 20.6% (95% CI 16.0–26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. Conclusions The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile

Women and ARVâ based prevention: opportunities and challenges

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138349/1/jia29419.pd

High-Grade B-cell Lymphoma, Not Otherwise Specified: A Multi-Institutional Retrospective Study

In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ( double hit ). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase \u3e3 × upper limit of normal, and a dual-expressor immunophenotype. Age \u3e60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS

Session 22: Lightning talk: Stupid genius: utilising podcasts to build thriving communities and enhance student experience

With digitalisation transforming the way we work in academia technological advancements can be used to nurture communities and engage staff and students both on and off campus. Podcasting, as a means to building community and enhancing student experience, is one creative means of digitalisation that is increasing in popularity. Stupid Genius is a fast-growing academia-related podcast with global reach that strives to disseminate research in interesting and engaging ways, build a thriving academic community and enhance the student experience. With 50 episodes released and over 7000 downloads as of January 2022, Stupid Genius discusses a range of interesting academia-related topics with a focus on enhancing the postgraduate student experience through sharing informal advice and lived experiences. Some of the topics covered include preparing to pass the VIVA, navigating networking, managing conflict with supervisors and becoming a lecturer. Stupid Genius has developed a flourishing online community with approximately 5000 members. The podcast also gives a platform to and promotes the inclusion of underrepresented groups and issues. For instance, it has welcomed guest speakers to discuss their work on dwarfism awareness, LGBT+ equalities, the marginalisation of black women in academia and men’s mental health. The session will include an overview of the benefits of utilising podcasts to build community and to enhance student experience, for those both within and outside of the institution. We will also share qualitative feedback from members of the Stupid Genius community, demonstrating the positive impact podcasting can have in both of these areas. Delegates will take away practical advice on how to begin and sustain a successful podcast that can support their academic endeavours whilst fostering and promoting LJMU’s values. Stupid genius: utilising podcasts to build thriving communities and enhance student experience PowerPoint. Only LJMU staff and students have access to this resource

Contraceptive Discontinuation and Unintended Pregnancy: An Imperfect Relationship

CONTEXT: Contraceptive discontinuation is a common event. We hypothesize that a significant proportion of contraceptive discontinuations are associated with low motivation to avoid pregnancy; this will be reflected in a significant proportion of pregnancies following discontinuation being reported as intended. METHODS: We use Demographic and Health Survey (DHS) data from 6 countries to explore the extent to which women report pregnancies following contraceptive discontinuation as intended and to identify the characteristics of women who report pregnancies following contraceptive failure or discontinuation for non-pregnancy reasons as intended. RESULTS: We found that relatively high percentages of births are reported as intended following contraceptive failure and discontinuation for non-pregnancy reasons (16–50% for failure and around 40% for discontinuation for reasons other than desire for pregnancy). While there were few consistent patterns in socio-economic factors associated with reporting births following discontinuation and failure as intended, stronger and more consistent associations were found with variables expected to be linked to motivation such as number of living children, reason for discontinuation, and the time elapsed between discontinuation and pregnancy. CONCLUSIONS: These findings suggest that underlying variation in motivation to avoid pregnancy is an important factor in contraceptive discontinuation