Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: a cross-sectional survey

Abstract Background Family planning (FP) is an essential health service and an important part of comprehensive HIV care. However, there is limited information about the contraceptive needs of people living with HIV in sub-Saharan Africa, which in turn has hampered efforts to expand and integrate FP services into existing HIV programs. Methods We performed a cross-sectional survey to determine FP prevalence and predictors among HIV-positive women and men attending 18 public antiretroviral therapy (ART) clinics in Lusaka, Zambia. Trained peer counselors administered the 10-question survey to those seeking care for five days at each of the target sites. Results From February to April 2014, we surveyed 7,046 HIV-infected patients receiving routine HIV services. Use of modern contraception was reported by 69 % of female ART patients and 79 % of male ART patients. However, highly effective contraceptive use and dual method use were low among women (38 and 25 %, respectively) and men (19 and 14 %, respectively). HIV disclosure status (adjusted odds ratio (AOR) = 4.91, 95 % confidence interval (CI) = 3.32–7.24 for women, AOR = 3.58, 95 % CI = 2.39–5.38 for men) and sexual activity in the last 6 months (AOR = 5.80, 95 % CI = 4.51–7.47 for women, AOR = 6.24, 95 % CI = 3.51–11.08 for men) were associated with modern contraceptive use in multivariable regression. Most respondents said they would access FP services if made available within ART clinic. Conclusions While FP-ART integration may be a promising strategy for increasing FP service uptake, such services must focus on assessing sexual activity and advocating for dual method use to increase effective contraceptive use and prevent unintended pregnancies

Issues périnatales et suivi prénatal en Guadeloupe

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocABYMES-CHRUPPA-BU (971202102) / SudocSudocFranceF

Decreasing uplift rates and Pleistocene marine terraces settlement in the central lesser Antilles fore-arc (La Desirade Island, 16 degrees N)

International audienceThis study investigates the Lesser Antilles fore-arc at the latitude of Guadeloupe Archipelago and evidences that La Désirade Island, the eastermost island of the forearc, displays a staircase coastal sequence including four uplifted marine terraces and an upper reefal platform with mean shoreline angle elevations ranging from 10 to 210 m above sea level (asl). The platform paleobathymetry is constraint by a detailed analysis of the sediments. We propose a revised morphostratigraphy for this coastal sequence including 5 paleo-shorelines based on six U/Th dating from aragonitic corals from the three lowest terraces combined with paleobathymetric analysis of the fossil corals present in the upper platform. Terrace and upper platform carving of construction periods occurred during Marine Isotopic Stages MIS 5e, MIS 9, and during the intervals MIS 15–17, MIS 19–25 and MIS 31–49 (upper coral reef platform). Our results evidence a bulk decreasing uplift rate since early Calabrian to Present-Day, clearly documented since 310 ka (MIS 9) (from 0.14 to 0.19 to ca 0 mm/y). Our data are consistent with first the transient influence of the subducting oceanic Tiburon ridge during Calabrian, then with other parametres of the subduction zone since late Calabrian to Present-Day (dip of the slab, basal erosion of the upper plate, inherited structures …)

Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy

ObjectiveThe objective of this study is to assess whether antiretroviral therapy (ART) may diminish the effectiveness of hormonal contraceptive methods.MethodsUsing data from 5153 HIV-infected women followed prospectively for 1-3 years in three HIV prevention studies in Africa, we compared incident pregnancy rates by contraceptive method (implant, injectable, oral or none) and ART use. Multivariable Cox regression models were used to determine adjusted hazard ratios (aHRs) and test interactions between each method and ART use.ResultsDuring follow-up, 9% of women ever used implants, 40% used injectables and 14% used oral contraceptives; 31% of women ever used ART, mostly nevirapine (75% of ART users) or efavirenz-based (15%). Among women not using contraception, pregnancy rates were 13.2 and 22.5 per 100 women-years for those on and not on ART, respectively. Implants greatly reduced the incidence of pregnancy among both women on ART [aHR 0.06, 95% confidence interval (95% CI) 0.01-0.45] and not on ART (aHR 0.05, 95% CI 0.02-0.11). Injectables (aHR 0.18 on ART and aHR 0.20 not on ART) and oral contraceptives (aHR 0.37 on ART and aHR 0.36 not on ART) also reduced pregnancy risk, though by lesser degrees. ART use did not significantly diminish contraceptive effectiveness, although all methods showed nonstatistically significant reduced effectiveness when concurrently using efavirenz.ConclusionHormonal contraceptive methods are highly effective in reducing pregnancy risk in HIV-infected women, including those concurrently using ART. Studies of potential interactions between ART and contraceptives should evaluate real-world effectiveness of contraceptive methods; in this study, implants were the most effective method to prevent pregnancy, even during ART use

Characterizing the Neogene tectono-sedimentary evolution of the Northern Lesser Antilles forearc: a land-sea study

International audienceIn the frame of the ANR program GAARanti, aiming to track regional emersion surfaces and potential timing of land emersion or drowning, we conducted new field studies in islands belonging to the Anguilla Bank (Saint Barthélémy, Saint Martin, Tintamarre and Anguilla), the northernmost bank located in the forearc of the Lesser Antilles subduction zone and south of the Anegada passage. Our new micropaleontological, sedimentological and paleoenvironmental investigations allow a highly accurate calibration of the Neogene successions using large benthic foraminifers, planktonic foraminifers and calcareous nannofossils. We determine three main regional unconformities cropping out on the islands of the Anguilla bank.Interpretations of seismic lines acquired during the AntiTheSis (2016) and GARANTI (2017) cruises allow to reconstruct the tectono-sedimentary evolution of the offshore forearc basins, between South Saba Bank and Sombrero Basin. We use our well constrained onshore dataset and petroleum industry wells drilled in the Saba Bank to propose a constrained sismostratigraphy of offshore basins and onshore-offshore correlations.At regional scale, we identify three main unconformities dated: (1) Late Eocene, (2) Mid Miocene (ca 15 Ma) and (3) Zanclean (4 Ma).The Late Eocene unconformity is related to compressional tectonics and led to the emergence of most of our study area. Then subsidence occurred and topographic depressions were infilled by Oligocene to Early Miocene deposits, partly controlled by extensional fault activity along NW-SE and ENE-WSW faults systems bounding the Kalinago Basin and Anguilla Bank, respectively. The Mid Miocene unconformity is related to tectonics with increasing importance from south to north, thus probably related to the onset of the opening of Anegada Passage. This unconformity is related to emergence and erosion on the Anguilla and Saba Banks. The northern Antilles then subsided and most of basins reveal passive infilling during Middle Miocene to Pliocene. The Zanclean unconformity is related to localized uplifts that led to the final emergence of Anguilla, Tintamarre and St Martin carbonate platforms