An evaluation of Population Services Zimbabwe’s mobile outreach model

This report documents a service evaluation of Population Services Zimbabwe’s (PSZ) mobile outreach program in four provinces of Zimbabwe. The evaluation was conducted by the Population Council between September and October 2013. It provides key findings on the quality of the PSZ outreach program in expanding choice and access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception, as well as recommendations for PSZ and other family planning programs to consider in scaling up and strengthening mobile outreach services. The evaluation, conducted by the Population Council, was designed to focus on various components of quality including adequate information and counseling on methods and services, good clinical procedure with minimal occurrence of adverse events, and client health-seeking behavior and client satisfaction. The level of integration of HIV and other SRH-related services into the family planning program was also evaluated

Involving men in maternity care: Health service delivery issues

Men in South Africa have traditionally not been involved in the reproductive health care of their partners. They do not normally accompany their partners to family planning or antenatal care consultations, and are mostly absent during labour and delivery. Partner notification and treatment for sexually transmitted infections have also remained problematic due to several factors, including poor power relations between men and women, lack of knowledge and men’s interest in their partner’s reproductive health, and poor couple communication. | In 2001, the Reproductive Health Research Unit (RHRU) of Witwatersrand University, in partnership with the FRONTIERS Program of Population Council and the KwaZulu-Natal Department of Health, began a three-year operations research study, to incorporate men in their partners’ maternity care, in order to improve couples’ reproductive health and pregnancy outcomes. | This study showed that it was indeed acceptable and feasible to involve men in the reproductive health care of their partners. Both men and women were interested in men’s involvement during maternity care. However, there remain a number of health service delivery challenges that need to be addressed within the South African context before maternity services become more male friendly

Policy and programme considerations for ARV-based prevention for women: Insights from key opinion leaders in Zimbabwe about tenofovir gel

Zimbabwe has seen a tremendous shift in the HIV landscape in the last decade, particularly regarding prevalence. Yet many people, especially women, are still at high risk and efforts to identify and implement additional HIV-prevention options remain critical. After nearly 20 years of microbicides research, 1 percent tenofovir gel is the first vaginal microbicide to show promise. Since 2011, Zimbabwe has been scaling up use of tenofovir-based regimens as first-line therapy for adults infected with HIV. A randomized, placebo-controlled, double-blind trial demonstrated that women assigned to use 1 percent tenofovir gel had a 39 percent lower risk of HIV infection compared with women in the placebo arm. Policymakers and other stakeholders need information to guide decision-making regarding introduction of new HIV-prevention products. The Population Council developed a toolkit to assist policymakers and program managers in identifying strategic opportunities for introducing tenofovir gel. The toolkit consists of a landscape analysis, discussion guide, and program planning guide. A key element of the toolkit development process has been to test it among key opinion leaders (KOLs) in several countries, including Zimbabwe. This report describes the process and outcomes of a systematic inquiry among KOLs in Zimbabwe

The role of traditional leaders in preventing and addressing sexual and gender-based violence: Findings from KwaZulu-Natal, Northwest and Limpopo provinces in South Africa

The Population Council, in partnership with the Ubuntu Institute, embarked on a program to engage traditional Leaders in three South African provinces (North West, KwaZulu-Natal and Limpopo) to address sexual and gender-based violence (SGBV) in rural communities. The overarching goals of the program were to strengthen linkages between the Population Council and traditional communities, generate and share strategic information on SGBV, strengthen prevention and response to child sexual assault, engage new partners to address prevention of and access to SGBV services, and expand access to comprehensive post-rape services by working with traditional leadership structures. Some of the key findings reflect a variety of cross-cutting lessons that can inform future SGBV prevention and response activities with traditional leaders

Sexual and reproductive health and rights knowledge, perceptions, and experiences of adolescent learners from three South African townships: qualitative findings from the Girls Achieve Power (GAP Year) Trial [version 2; peer review: 2 approved]

Background: Adolescence is a time of psycho-social and physiological changes, with increased associated health risks including vulnerability to pregnancy, HIV, sexually transmitted infections, and gender-based violence. Adolescent learners, from three townships in South Africa, participated in a 44 session, after-school asset-building intervention (GAP Year), over 2 years providing sexual and reproductive health (SRH) education. This paper explores adolescent learners’ SRH, sexual risk and rights knowledge; perceptions about transactional sex; and contraceptive method preferences and decision-making practices. Methods: The intervention was conducted in 13 secondary schools across Khayelitsha, Thembisa, and Soweto, South Africa. A baseline survey collected socio-demographic data prior to the intervention. Overall, 26 focus group discussions (FGDs): 13 male and 13 female learner groups, purposively selected from schools, after completing the intervention (2 years after baseline data collection). Descriptive analyses were conducted on baseline data. Qualitative data were thematically coded, and NVivo was used for data analysis. Results: In total, 194 learners participated in the FGDs. Mean age at baseline was 13.7 years (standard deviation 0.91). Participants acquired SRH and rights knowledge during the GAP Year intervention. Although transactional sex was viewed as risky, some relationships were deemed beneficial and necessary for material gain. Negative healthcare provider attitudes were the main barrier to healthcare service utilisation. There was awareness about the benefits of contraceptives, but some myths about method use. The injectable was the preferred contraceptive method, followed by the implant, with equal preference for condoms and oral pill. Conclusions: An afterschool intervention at school is a viable model for the provision of SRH and rights education to learners. Recommendations include the need for risk reduction strategies in the curriculum, dealing with misconceptions, and the promotion of informed decision making. Endeavours to ensure health services are youth friendly is a priority to limit barriers to accessing these services

Optimizing the pipeline of multipurpose prevention technologies: opportunities across women's reproductive lifespans

HIV/AIDS and maternal mortality are the two leading causes of death among women of reproductive age in sub-Saharan Africa. A growing body of research investigates opportunities for multipurpose prevention technologies (MPTs) that prevent unintended pregnancy, HIV, and/or other sexually transmitted infections (STIs) with a single product. More than two dozen MPTs are currently in development, most of them combining contraception with HIV pre-exposure prophylaxis, with or without protection from other STIs. If successful, such MPTs could offer women benefits at multiple levels: greater motivation for effective use; lower product administration burden; accelerated integration of HIV, STI, and reproductive health services; and opportunities to circumvent stigma by using contraception as a “fig leaf” for HIV and/or STI prevention. However, even if women find respite from product burden, lack of motivation, and/or stigma in contraceptive-containing MPTs, their use of MPTs will be interrupted, often multiple times, over the reproductive lifecourse due to desire for pregnancy, pregnancy and breastfeeding, menopause, and changes in risk. Interruptions to the benefits of MPTs could be avoided by combining HIV/STI prevention with other life-stage-appropriate reproductive health products. New product concepts could include combining prenatal supplements with HIV and STI prevention, emergency contraception with HIV post-exposure prophylaxis, or hormone replacement therapies for menopause with HIV and STI prevention. Research is needed to optimize the MPT pipeline based on the populations underserved by available options and the capacity of resource-constrained health systems to deliver novel preventative healthcare products

The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub : a systematic review and meta-analysis

BACKGROUND: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. METHODS: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December 2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. RESULTS: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI: 19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I2 =99.78%, P<0.001), even within individual countries. CONCLUSION: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/ STIs, as well as other risk strategies.http://journals.tbzmed.ac.ir/HPPpm2021School of Health Systems and Public Health (SHSPH

Learning from women about HIV risk, HIV testing behaviors, and prevention practices in Mpumalanga, South Africa: A descriptive study to inform microbicides introduction

The provision of any new prevention product in clinical trial settings is often vastly different from implementation in “real life” public sector settings. In addition, use of antiretrovirals (ARV), such as tenofovir gel, for pre-exposure prophylaxis requires regular HIV testing to ensure users are uninfected before initiating and continuing product use. Therefore, before any ARV-based prevention product can be introduced to women, information is needed on HIV testing practices, how best to integrate products into existing primary health care systems, and women’s risk perception and health-seeking behaviors. The Population Council, in partnership with Solutions IPPT, conducted a study to learn more about women’s experiences in routine primary health care centers in Mpumalanga, South Africa to inform microbicides introduction. This report discusses the issues explored in the study: service seeking, constellation of services, HIV testing behavior, self-assessment of risk, and interest in tenofovir gel

Introducing and pilot-testing the national guidelines on integrating the management of STIs/RTIs into reproductive health settings in Kenya

This report evaluated a project in ten Kenyan health facilities. It examined the feasibility, acceptability and effect of introducing reproductive tract infection and sexually transmitted infection (RTI/STI) guidelines on the quality of care provided, and the incremental costs of integrating these services into existing reproductive health (RH) services; it also disseminated the results and lessons learnt within Kenya. Overall, the results showed that integration of activities to screen for and manage STIs/RTIs into RH services is feasible, acceptable to clients and providers, and effective in improving the range and quality of services offered to clients

Developing comprehensive and evidence-based policy and guidelines for antenatal and postnatal care in KwaZulu-Natal

In May 2004, the Maternal Child and Women’s Health department of Kwazulu-Natal (KZN), South Africa requested technical assistance from the Population Council’s USAID-funded FRONTIERS project for developing standardized and comprehensive antenatal and postnatal (ANC/PNC) care policies and guidelines and supportive training and educational materials. The aims and objectives of this project were to: support the development of a comprehensive evidence-based antenatal and postnatal care program in KZN; consolidate lessons learned and evidence around delivery of comprehensive ANC and PNC; revise provincial guidelines to enable comprehensive ANC and PNC services that address PMTCT, partner involvement, syphilis screening, focused visits, and antiretrovirals; develop supportive systems for implementing new guidelines, monitoring and evaluation tools, job aides, and training materials; and build the capacity of healthcare providers and programs, thereby strengthening monitoring of ANC and PNC services. FRONTIERS adopted a participatory process, ensuring buy-in and ownership at all levels through the involvement of all key stakeholders. This approach has not only ensured that local, national, and international research-based evidence fed into the development of the provincial antenatal and postnatal care policies and guidelines, but also that buy-in and ownership were generated at all levels