Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi

To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART)

Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study

Abstract Background Malawi has the highest cervical cancer incidence and mortality in the world with age-standardized rate (ASR) of 75.9 and 49.8 per 100,000 population respectively. In response, Ministry of Health established a cervical cancer screening programme using visual inspection with acetic acid (VIA) and treatment of precancerous lesions with cryotherapy. This paper highlights the roll out, integration with family planning services and HIV ART Programme, uptake and challenges of VIA and Cryotherapy programme. Methods We analyzed program data, supportive supervision, quarterly and annual reports from the National Cervical Cancer Control Program. We evaluated the uptake and challenges of screening services by age, HIV serostatus and trends over a five year period (2011–2015). Results Between 2011 and 2015, number of cervical cancer screening sites, number of women screened and coverage per annum increased from 75 to 130, 15,331 to 49,301 and 9.3 % to 26.5 % respectively. In this five year period, a total of 145,015 women were screened. Of these, 7,349 (5.1 %) and 6,289 (4.3 %) were VIA positive and suspect cancer respectively. Overall 13,638 (9.4 %) were detected to be VIA positive or had suspect cancer. Of the 48,588 women with known age screened in 2015; 13,642 (28.1 %), 27,275 (56.1 %) and 7,671 (15.8 %) were aged 29 or less, 30–45, 46 years or more. Among 39,101 women with data on HIV serostatus; 21,546 (55.1 %) were HIV negative, 6,209 (15.9 %) were HIV positive and 11, 346 (29.0 %) status was unknown. VIA positivity rate and prevalence of suspect cancer were significantly higher in HIV positive than HIV negative women (8.8 % vs 5.0 %, 6.4 % vs 3.0 %); in women aged 30–45 years than women aged 29 years or less (5.6 % vs 2.3 %, 2.6 % vs 1.2 %) respectively, all p <0.05). The main challenge of the programme was failure to treat VIA positive women eligible for cryotherapy. Over the five year period, the programme only treated 1,001 (43.3 %) out of 2,311 eligible women and only 266 (31.8 %) of the 836 women with large lesion or suspect cancer who were referred, received the health care at the referral centre. The reasons for failure to provide cryotherapy treatment were stock out of gas, faulty/broken cryotherapy machine (usually connectors or probes) or no cryotherapy machine at all in the whole district. For women with large lesion or suspect cancer; lack of loop electrosurgical excision procedure (LEEP) machine or inadequate gynaecologists at the referral centre, were the major reasons. Cancer radiotherapy services were not available in Malawi. Conclusions This study provided data on VIA positivity rate, prevalence of suspect cancer, failure rate of cryotherapy and challenges in the provision of cryotherapy and LEEP treatment in Malawi. These data could be used as baseline for monitoring and evaluation of Human Papillomavirus (HPV) vaccination programme which the country introduced in 2013, the linkage of cervical cancer screening and women on HIV ART and the long term effect of ART, voluntary male medical circumcision on the prevalence and incidence of cervical cancer

Assessing the impact of COVID-19 on maternity services in Malawi: preliminary findings from a rapid qualitative study

Background: The first case of COVID-19 in Malawi was reported on 2nd April 2020. This report details accounts of the early impacts of COVID-19 on women and healthcare professionals engaged in maternity services elicted by semi-structured interviews conducted 2nd to 14th July 2020. Views from healthcare providers looking after pregnant women on the changes that have been made in health service delivery and their working environment during the pandemic. (At that point) many healthcare providers reported not having received training in COVID- 19. Lack or shortages of PPE were reported. Changes in clinic operations (split teams, cap on daily client numbers, closures in waiting homes and stoppage of post-natal check-ups) were considered to be impacting negatively on access to services. Views on future practice: PPE provision needs to improve and should be carried forward into post-COVID practice. Hygiene and social distancing measures were positive developments that would have benefit post-COVID. The quota on patient numbers at clinic should end. Post-natal check- ups should resume to prevent avoidable post-natal complications. However, some nurses noted that reducing numbers at the clinic had in some instances enabled them to work more efficiently with their patients and in a more targeted manner. Views from currently or recently pregnant women about changes that have been made in their antenatal care, birth plans and health seeking behaviours during the pandemic. View on antenatal clinics: Some women were sent home without being seen. The journey was perceived as risky and tiring. Reduced service was reported e.g. limited testing, scanning and examination. Specialist advice was hard to access. Views on birth: In some facilities labour procedures were adapted, numbers of guardians and visitors were limited, the woman:midwife ratio was affected by quarantining staff and closure of other facilities due to COVID-19 cases. Views on future care: Women were keen to see an end to the practice of sending women back from clinic – proposal that clinics should expand their opening times. More washing facilities an mandatory mask wearing was requested. There was support for the continuation of the heightened hygiene measures. Some voiced support for the continuation of patient quotas attending clinic to enable better care. Summary: COVID-19 has been very disruptive to maternity services. Capacities have been limited. Services were re-configured in ways which unsettle both care providers and users. COVID-19 prevention measures have been put in place, but not always achieved. COVID-19 has brought significant anxiety to both women and staff. Staff want more training and PPE. Women want to be seen and not to be sent home. Increased hygiene practices praised by both staff and women. Further evaluation of the impact of the Malawi Ministry of Health COVID-19 guidelines for Maternal and Newborn Health Services introduced in June 2020 is needed

Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi.

Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic.200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment

Fertility intentions, unplanned pregnancy, contraception and condom use among HIV+ clients enrolled in study.

<p>OCP = Oral contraceptive Use, DMPA = Depot medroxyprogesterone acetate, IUD = Intrauterine device, N/A = not applicable.</p><p>Fertility intentions, unplanned pregnancy, contraception and condom use among HIV+ clients enrolled in study.</p

Factors associated with consistent condoms in last year and condom usage at last intercourse, unadjusted and adjusted odds ratios with significant variables from bivariate evaluation included in the model.

<p>*Statistically significant.</p><p>¹history of use of hormonal contraceptives or IUD.</p><p>²current use of hormonal contraceptives or IUD.</p><p>OR = Odds Ratio, FP = Family planning, ART = Antiretroviral therapy, STI = Sexually transmitted infection.</p><p>Factors associated with consistent condoms in last year and condom usage at last intercourse, unadjusted and adjusted odds ratios with significant variables from bivariate evaluation included in the model.</p

Characteristics of 200 women enrolled in study.

<p>N/A = not applicable, ART = Antiretroviral therapy, STI = Sexually transmitted infection.</p><p>Characteristics of 200 women enrolled in study.</p

Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi

OBJECTIVE: To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART). METHODS: All HIV-infected women who received ART and sought contraceptive services at the Lighthouse clinic, an integrated HIV/ART clinic in Lilongwe, Malawi, between August and December 2010 were invited to participate in a structured interview. Eligibility and preference for the following contraceptive methods were assessed: combined hormonal contraceptives, progestogen-only pills, copper IUD, injectable depot medroxyprogesterone acetate (DMPA), and contraceptive implants. RESULTS: The final sample included 281 women; five were pregnant. The remaining 276 women were eligible for at least three contraceptive methods, with 242 (87.7%) eligible for all five methods evaluated. After counseling, 163 (58.0%) selected DMPA and 98 (34.9%) selected an IUD as their preferred contraceptive method. Regardless of their method of choice, 222 (79.0%) women agreed to have an IUD placed on the same day. CONCLUSION: Most methods of contraception are safe for use by HIV-infected women. Approximately 80% of the women were willing to receive an IUD. Efforts must be made to increase education about, and access to, long-acting reversible methods that may be acceptable and appropriate contraceptive options for HIV-infected women

Pregnancy Prevention and Condom Use Practices among HIV-Infected Women on Antiretroviral Therapy Seeking Family Planning in Lilongwe, Malawi

BackgroundPrograms for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic.Methods200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.ResultsMost women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.DiscussionHigh rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment