“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda
Identifieur interne : 000C80 ( Main/Exploration ); précédent : 000C79; suivant : 000C81“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda
Auteurs : Lynn T. Matthews [États-Unis] ; Francis Bajunirwe [Ouganda] ; Jasmine Kastner [Canada] ; Naomi Sanyu [Ouganda] ; Cecilia Akatukwasa [Ouganda] ; Courtney Ng [États-Unis] ; Rachel Rifkin [États-Unis] ; Cecilia Milford [Afrique du Sud] ; Lizzie Moore [Afrique du Sud] ; Ira B. Wilson [États-Unis] ; David R. Bangsberg [États-Unis] ; Jennifer A. Smit [Afrique du Sud] ; Angela Kaida [Canada]Source :
- BioMed Research International [ 2314-6133 ] ; 2016.
Abstract
Url:
DOI: 10.1155/2016/4195762
PubMed: 27051664
PubMed Central: 4802028
Affiliations:
- Afrique du Sud, Canada, Ouganda, États-Unis
- Gauteng, Massachusetts, Rhode Island
- Johannesbourg
- Université du Witwatersrand
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Matthews</name><affiliation wicri:level="2"><nlm:aff id="I1">Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bajunirwe, Francis" sort="Bajunirwe, Francis" uniqKey="Bajunirwe F" first="Francis" last="Bajunirwe">Francis Bajunirwe</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Kastner, Jasmine" sort="Kastner, Jasmine" uniqKey="Kastner J" first="Jasmine" last="Kastner">Jasmine Kastner</name><affiliation wicri:level="1"><nlm:aff id="I3">McGill University Research Centre, Montreal, QC, Canada H3H 2R9</nlm:aff><country>Canada</country><wicri:regionArea>McGill University Research Centre, Montreal, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Sanyu, Naomi" sort="Sanyu, Naomi" uniqKey="Sanyu N" first="Naomi" last="Sanyu">Naomi Sanyu</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Akatukwasa, Cecilia" sort="Akatukwasa, Cecilia" uniqKey="Akatukwasa C" first="Cecilia" last="Akatukwasa">Cecilia Akatukwasa</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Courtney" sort="Ng, Courtney" uniqKey="Ng C" first="Courtney" last="Ng">Courtney Ng</name><affiliation wicri:level="2"><nlm:aff id="I4">Harvard T.H. 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Wilson</name><affiliation wicri:level="2"><nlm:aff id="I7">Brown University School of Public Health, Providence, RI 02903, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Brown University School of Public Health, Providence, RI 02903</wicri:regionArea><placeName><region type="state">Rhode Island</region></placeName></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><affiliation wicri:level="2"><nlm:aff id="I5">Massachusetts General Hospital, Center for Global Health, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Center for Global Health, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Smit, Jennifer A" sort="Smit, Jennifer A" uniqKey="Smit J" first="Jennifer A." last="Smit">Jennifer A. Smit</name><affiliation wicri:level="4"><nlm:aff id="I6">University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Kaida, Angela" sort="Kaida, Angela" uniqKey="Kaida A" first="Angela" last="Kaida">Angela Kaida</name><affiliation wicri:level="1"><nlm:aff id="I8">Simon Fraser University, Burnaby, BC, Canada V5A 1S6</nlm:aff><country>Canada</country><wicri:regionArea>Simon Fraser University, Burnaby, BC</wicri:regionArea><wicri:noRegion>BC</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27051664</idno><idno type="pmc">4802028</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802028</idno><idno type="RBID">PMC:4802028</idno><idno type="doi">10.1155/2016/4195762</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002300</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002300</idno><idno type="wicri:Area/Pmc/Curation">002299</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002299</idno><idno type="wicri:Area/Pmc/Checkpoint">000367</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000367</idno><idno type="wicri:Area/Ncbi/Merge">003713</idno><idno type="wicri:Area/Ncbi/Curation">003713</idno><idno type="wicri:Area/Ncbi/Checkpoint">003713</idno><idno type="wicri:doubleKey">2314-6133:2016:Matthews L:i:always:worry</idno><idno type="wicri:Area/Main/Merge">000C80</idno><idno type="wicri:Area/Main/Curation">000C80</idno><idno type="wicri:Area/Main/Exploration">000C80</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda</title><author><name sortKey="Matthews, Lynn T" sort="Matthews, Lynn T" uniqKey="Matthews L" first="Lynn T." last="Matthews">Lynn T. Matthews</name><affiliation wicri:level="2"><nlm:aff id="I1">Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bajunirwe, Francis" sort="Bajunirwe, Francis" uniqKey="Bajunirwe F" first="Francis" last="Bajunirwe">Francis Bajunirwe</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Kastner, Jasmine" sort="Kastner, Jasmine" uniqKey="Kastner J" first="Jasmine" last="Kastner">Jasmine Kastner</name><affiliation wicri:level="1"><nlm:aff id="I3">McGill University Research Centre, Montreal, QC, Canada H3H 2R9</nlm:aff><country>Canada</country><wicri:regionArea>McGill University Research Centre, Montreal, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Sanyu, Naomi" sort="Sanyu, Naomi" uniqKey="Sanyu N" first="Naomi" last="Sanyu">Naomi Sanyu</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Akatukwasa, Cecilia" sort="Akatukwasa, Cecilia" uniqKey="Akatukwasa C" first="Cecilia" last="Akatukwasa">Cecilia Akatukwasa</name><affiliation wicri:level="1"><nlm:aff id="I2">Mbarara University of Science and Technology, Mbarara, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mbarara University of Science and Technology, Mbarara</wicri:regionArea><wicri:noRegion>Mbarara</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Courtney" sort="Ng, Courtney" uniqKey="Ng C" first="Courtney" last="Ng">Courtney Ng</name><affiliation wicri:level="2"><nlm:aff id="I4">Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. Chan School of Public Health, Boston, MA 02115</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Rifkin, Rachel" sort="Rifkin, Rachel" uniqKey="Rifkin R" first="Rachel" last="Rifkin">Rachel Rifkin</name><affiliation wicri:level="2"><nlm:aff id="I5">Massachusetts General Hospital, Center for Global Health, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Center for Global Health, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Milford, Cecilia" sort="Milford, Cecilia" uniqKey="Milford C" first="Cecilia" last="Milford">Cecilia Milford</name><affiliation wicri:level="4"><nlm:aff id="I6">University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Moore, Lizzie" sort="Moore, Lizzie" uniqKey="Moore L" first="Lizzie" last="Moore">Lizzie Moore</name><affiliation wicri:level="4"><nlm:aff id="I6">University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Wilson, Ira B" sort="Wilson, Ira B" uniqKey="Wilson I" first="Ira B." last="Wilson">Ira B. Wilson</name><affiliation wicri:level="2"><nlm:aff id="I7">Brown University School of Public Health, Providence, RI 02903, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Brown University School of Public Health, Providence, RI 02903</wicri:regionArea><placeName><region type="state">Rhode Island</region></placeName></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><affiliation wicri:level="2"><nlm:aff id="I5">Massachusetts General Hospital, Center for Global Health, Boston, MA 02114, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Center for Global Health, Boston, MA 02114</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Smit, Jennifer A" sort="Smit, Jennifer A" uniqKey="Smit J" first="Jennifer A." last="Smit">Jennifer A. Smit</name><affiliation wicri:level="4"><nlm:aff id="I6">University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Kaida, Angela" sort="Kaida, Angela" uniqKey="Kaida A" first="Angela" last="Kaida">Angela Kaida</name><affiliation wicri:level="1"><nlm:aff id="I8">Simon Fraser University, Burnaby, BC, Canada V5A 1S6</nlm:aff><country>Canada</country><wicri:regionArea>Simon Fraser University, Burnaby, BC</wicri:regionArea><wicri:noRegion>BC</wicri:noRegion></affiliation></author></analytic><series><title level="j">BioMed Research International</title><idno type="ISSN">2314-6133</idno><idno type="eISSN">2314-6141</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Background.</italic> We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.<italic> Methods.</italic> We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.<italic> Results.</italic> Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.<italic> Discussion.</italic> Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Beyeza Kashesya, J" uniqKey="Beyeza Kashesya J">J. Beyeza-Kashesya</name></author><author><name sortKey="Ekstrom, A M" uniqKey="Ekstrom A">A. M. Ekstrom</name></author><author><name sortKey="Kaharuza, F" uniqKey="Kaharuza F">F. Kaharuza</name></author><author><name sortKey="Mirembe, F" uniqKey="Mirembe F">F. 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Bangsberg</name></author><author><name sortKey="Narasimhan, M" uniqKey="Narasimhan M">M. Narasimhan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Canada</li><li>Ouganda</li><li>États-Unis</li></country><region><li>Gauteng</li><li>Massachusetts</li><li>Rhode Island</li></region><settlement><li>Johannesbourg</li></settlement><orgName><li>Université du Witwatersrand</li></orgName></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Matthews, Lynn T" sort="Matthews, Lynn T" uniqKey="Matthews L" first="Lynn T." last="Matthews">Lynn T. Matthews</name></region><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><name sortKey="Ng, Courtney" sort="Ng, Courtney" uniqKey="Ng C" first="Courtney" last="Ng">Courtney Ng</name><name sortKey="Rifkin, Rachel" sort="Rifkin, Rachel" uniqKey="Rifkin R" first="Rachel" last="Rifkin">Rachel Rifkin</name><name sortKey="Wilson, Ira B" sort="Wilson, Ira B" uniqKey="Wilson I" first="Ira B." last="Wilson">Ira B. Wilson</name></country><country name="Ouganda"><noRegion><name sortKey="Bajunirwe, Francis" sort="Bajunirwe, Francis" uniqKey="Bajunirwe F" first="Francis" last="Bajunirwe">Francis Bajunirwe</name></noRegion><name sortKey="Akatukwasa, Cecilia" sort="Akatukwasa, Cecilia" uniqKey="Akatukwasa C" first="Cecilia" last="Akatukwasa">Cecilia Akatukwasa</name><name sortKey="Sanyu, Naomi" sort="Sanyu, Naomi" uniqKey="Sanyu N" first="Naomi" last="Sanyu">Naomi Sanyu</name></country><country name="Canada"><noRegion><name sortKey="Kastner, Jasmine" sort="Kastner, Jasmine" uniqKey="Kastner J" first="Jasmine" last="Kastner">Jasmine Kastner</name></noRegion><name sortKey="Kaida, Angela" sort="Kaida, Angela" uniqKey="Kaida A" first="Angela" last="Kaida">Angela Kaida</name></country><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Milford, Cecilia" sort="Milford, Cecilia" uniqKey="Milford C" first="Cecilia" last="Milford">Cecilia Milford</name></region><name sortKey="Moore, Lizzie" sort="Moore, Lizzie" uniqKey="Moore L" first="Lizzie" last="Moore">Lizzie Moore</name><name sortKey="Smit, Jennifer A" sort="Smit, Jennifer A" uniqKey="Smit J" first="Jennifer A." last="Smit">Jennifer A. 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