Frontiers in reproductive health最新文献

{"title":"Spatial distribution and urban-rural disparity of unmet need for family planning among married/in-union women in Ethiopia: a spatial and decomposition analysis.","authors":"Shimels Derso Kebede, Daniel Niguse Mamo, Jibril Bashir Adem, Agmasie Damtew Walle, Yawkal Tsega, Elsabeth Addisu, Zinabu Bekele Tadese, Ermias Bekele Enyew","doi":"10.3389/frph.2024.1416280","DOIUrl":"10.3389/frph.2024.1416280","url":null,"abstract":"<p><strong>Background: </strong>High unmet need for family planning combined with other factors, such as high early marriage and teenage pregnancy, increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban-rural disparities of unmet need for family planning among married/in-union women in Ethiopia.</p><p><strong>Methods: </strong>The study was conducted on secondary data from a cross-sectional survey that was conducted nationally between September and December 2019 using a two-stage cluster design on a total of 265 enumeration areas. A total weighted sample of 5,349 married/in-union women was included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Finally, multivariable decomposition analysis via a logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence.</p><p><strong>Results: </strong>Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25 (<i>p</i>-value = 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and the southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition results revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, <i>p</i>-value < 0.001). Endowment and coefficient factors accounted for the urban-rural disparity, contributing 68.32% and 31.68%, respectively. Household size, husband's opinion of family planning, community acceptance of family planning, woman's age at first sexual intercourse, and the woman's age were key determinants of the urban-rural disparity.</p><p><strong>Conclusion: </strong>The results revealed a significant disparity in the unmet need for family planning based on place of residence, with a clustered spatial distribution across the study area and notable hotspot areas. Thus, targeted interventions should focus on mobilizing resources to high-risk areas and addressing the needs of high-risk groups to reduce the observed variation.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1416280"},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial scratching and intralipid treatment-no general recommendations.","authors":"Paolina Mrosk, Nathallie Sandi-Monroy, Friedrich Gagsteiger, Thomas Wolfram Paul Friedl, Katharina Hancke, Karin Bundschu","doi":"10.3389/frph.2024.1505842","DOIUrl":"10.3389/frph.2024.1505842","url":null,"abstract":"<p><strong>Objectives: </strong>Endometrial scratching (ES) and/or intravenous intralipid therapy (in cases of increased uterine natural killer cells, uNKs) are still conducted in several fertility centers as \"add-on\" treatments in patients undergoing ART, although convincing evidence for beneficial effects is lacking.</p><p><strong>Study design: </strong>In this retrospective study, associations between ES treatment or additional intralipid therapy and pregnancy and live birth rates of 1,546 patients undergoing 2,821 IVF-/ICSI-treatment cycles with fresh or frozen embryo transfers in a German fertility-center between 1st January 2014 and 31th May 2017 were analyzed.</p><p><strong>Results: </strong>Overall pregnancy and live birth rates for all 2,821 treatment cycles (468 cycles with ES) were 32.8% and 23.5%. There were no statistically significant differences in pregnancy or live birth rates between first treatment cycles with and without ES (<i>p</i> = 0.915 and <i>p</i> = 0.577) or between second cycles following an unsuccessful first cycle with and without ES (<i>p</i> = 0.752 and <i>p</i> = 0.623). These results were confirmed using multivariable generalized estimating equations (GEE) models accounting for non-independency of multiple treatment cycles per patients that included all cycles and showed no significant effect of ES on pregnancy (<i>p</i> = 0.449) or live birth rates (<i>p</i> = 0.976). Likewise, a GEE model revealed no significant effect of intralipid treatment on pregnancy (<i>p</i> = 0.926) and live birth rates (<i>p</i> = 0.727).</p><p><strong>Conclusions: </strong>Our results reveal no evidence that ES increases the pregnancy or live birth rates in women undergoing their first or further IVF cycle with fresh or frozen embryo transfer. Intralipid treatment was also not beneficial. Even if patients explicitly ask for it, these procedures are not recommended outside of clinical studies.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1505842"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risky sexual practices and associated factors among taxi drivers in the Finoteselam town, northwest Ethiopia, 2023: a community-based cross-sectional study.","authors":"Melaku Laikemariam, Yetwale Fetene","doi":"10.3389/frph.2024.1436615","DOIUrl":"10.3389/frph.2024.1436615","url":null,"abstract":"<p><strong>Background: </strong>Risky sexual practices among taxi drivers pose a significant threat to public health, contributing to the spread of sexually transmitted infections (STIs) and HIV/AIDS. The nature of their profession often exposes taxi drivers to factors that increase their vulnerability to engaging in risky sexual practices. Although research on sexual health in general is readily available, studies specifically focused on this population are limited. Understanding the contributing factors behind risky sexual practices among taxi drivers is crucial to developing targeted interventions that address their unique needs and vulnerabilities.</p><p><strong>Objectives: </strong>To assess the prevalence and associated factors of risky sexual practices among taxi drivers in Finoteselam town, northwest Ethiopia, 2023.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 359 taxi drivers in the Finoteselam town. Data were collected using pre-tested questionnaires and analyzed using SPSS. Bivariate and multivariable analyses were performed to identify factors associated with risky sexual practices. In the bivariate analysis, a <i>p</i>-value ≤ 0.25 at 95% CI was used to consider the variables in the multivariate analysis. Finally, statistical significance was declared with a <i>p</i>-value of less than 0.05 with a 95% CI.</p><p><strong>Results: </strong>The prevalence of risky sexual practices among taxi drivers was 32.9 (95% CI: 28.01, 38.7). Living alone (AOR = 3.47, 95% CI: 1.86, 6.48), taxi ownership (AOR = 2.08, 95% CI: 1.01, 4.25), neglecting the discussion of the SRH issue (AOR = 2.05, 95% CI: 1.08, 4.00), substance use (AOR = 1.56, 95% CI: 1.04, 2.09), attending night clubs (AOR = 6.04, 95% CI: 1.97, 18.55) and watching pornographic materials (AOR = 4.44, 95% CI: 2.14, 9.19) were significantly associated with risky sexual practices.</p><p><strong>Conclusions and recommendation: </strong>This study revealed a high prevalence of risky sexual practices among taxi drivers in Finoteselam town. Therefore, a comprehensive approach involving different stakeholders is required for reducing risky sexual practices. Information dissemination, awareness creation (about risks of attending nightclubs, substance use, and watching pornography), and encouraging knowledge sharing about sexual health are some of the interventions required to reduce risky sexual practices among taxi drivers.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1436615"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and perceptions of blood donors of the Western Cape Blood Services, South Africa, toward vaginal sample donation for biobanking.","authors":"Shantelle Claassen-Weitz, Brian Kullin, Elloise du Toit, Sugnet Gardner-Lubbe, Jo-Ann S Passmore, Heather Jaspan, Anna-Ursula Happel, Greg Bellairs, Caroline Hilton, Anika Chicken, Kirsten Welp, Hannah Livingstone, Adrian Brink","doi":"10.3389/frph.2024.1446809","DOIUrl":"10.3389/frph.2024.1446809","url":null,"abstract":"<p><strong>Introduction: </strong>Depletion of <i>Lactobacillus</i> species and an overgrowth of anaerobes in the vaginal tract bacterial vaginosis (BV)], is associated with non-optimal reproductive health outcomes, and increased susceptibility to sexually transmitted infections (STIs). BV is currently treated with antibiotics, although these provide suboptimal cure levels and high recurrence rates. Vaginal microbiota transplantation (VMT), the transfer of vaginal fluid from healthy donors with an optimal vaginal microbiota to a recipient with BV, has been proposed as an alternative treatment strategy.</p><p><strong>Methods: </strong>Here, we investigated knowledge and perceptions of blood donors to the concept of an optimal vaginal microbiome and VMT via the Western Cape Blood Service (WCBS) clinics in Cape Town, South Africa, by a self-administered questionnaire.</p><p><strong>Results & discussion: </strong>Analysis of responses from 106 eligible women showed that 86% (91/106) would consider donating samples. Responses significantly associated with willingness to donate vaginal samples included: (1) belief that helping others outweighs the inconvenience of donating vaginal sample (<i>p</i> = 1.093e^-05) and (2) prior knowledge of the concept of a healthy vaginal microbiome (<i>p</i> = 0.001). Most potential donors (59/91; 65%) were willing to receive a VMT themselves if needed. Participants who were unwilling to donate vaginal samples (15/106; 14%) indicated that vaginal sample collection would be unpleasant and/or embarrassing. The benefits of a collaboration with WCBS for this project include the naturally altruistic nature of blood donors, the constant in-flow of donors to WCBS clinics, and the infrastructure and logistical aspects in place. Data from this observational study highlight factors affecting the willingness of blood donors to become vaginal sample donors.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1446809"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Opportunities and challenges of human preconception research.","authors":"Linda G Kahn, Evelyn Loo, Gita D Mishra, Joseph B Stanford","doi":"10.3389/frph.2024.1508151","DOIUrl":"10.3389/frph.2024.1508151","url":null,"abstract":"","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1508151"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ecology meets reproductive medicine in HIV prevention: the case for geography-informed approaches for bacterial vaginosis in Africa.","authors":"Jo-Ann S Passmore, Sinaye Ngcapu, Serah Gitome, Brian R Kullin, Kirsten Welp, Darren P Martin, Disebo Potloane, Monalisa T Manhanzva, Moses M Obimbo, Katherine Gill, Mellissa Le Fevre, Anna-Ursula Happel, Heather B Jaspan, Margaret Kasaro, Elizabeth A Bukusi","doi":"10.3389/frph.2024.1431306","DOIUrl":"10.3389/frph.2024.1431306","url":null,"abstract":"<p><strong>Purpose of review: </strong>Women in Africa bear the burden of the HIV epidemic, which has been associated with the high prevalence of bacterial vaginosis (BV) in the region. However, little progress has been made in finding an effective cure for BV. Drawing on advances in microbiome-directed therapies for gastrointestinal disorders, similar live-biotherapeutic based approaches for BV treatment are being evaluated. Here, we summarize current knowledge regarding vaginal microbiota in BV, explore geographical differences in vaginal microbiota, and argue that novel BV therapeutics should be tailored specifically to meet the needs of African women.</p><p><strong>Recent findings: </strong>Cervicovaginal microbiota dominated by <i>Lactobacillus crispatus</i> are optimal, although these are uncommon in African women. Besides socio-behavioural and environmental influences on the vaginal microbiota, host and microbial genetic traits should be considered, particularly those relating to glycogen metabolism. Novel microbiome-directed approaches being developed to treat BV should employ transfers of multiple microbial strains to ensure sustained colonization and BV cure.</p><p><strong>Summary: </strong>Improving the efficacy and durability of BV treatment with microbiome-directed therapies by appropriately accounting for host and microbial genetic factors, could potentially reduce the risk of HIV infection in African women.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1431306"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the barriers towards menstrual hygiene management: evidence from a qualitative study among school communities: lessons from Bahir Dar city in northwest Ethiopia.","authors":"Yimenu Adane, Argaw Ambelu, Muluken Azage, Yalemtsehay Mekonnen","doi":"10.3389/frph.2024.1445862","DOIUrl":"10.3389/frph.2024.1445862","url":null,"abstract":"<p><strong>Background: </strong>The challenges of safe menstrual hygiene management practices in low-income settings, including the study areas are pressing. However, Studies specifically focusing on barriers that schoolgirls face in managing monthly menstruation in schools of Bahir Dar are inadequate and scarce.</p><p><strong>Method: </strong>To ensure the robustness of the findings, a comprehensive study was conducted among schoolgirls and boy students aged 12-20 in three schools. This study employed focus group discussions and in-depth interviews with students and leaders of the school gender club. A word cloud generator was used to visually represent frequently mentioned keywords, and the data generated from interviews were analyzed using the Open Code 4.03 tool.</p><p><strong>Results: </strong>The findings, derived from focus group discussions and in-depth interviews, revealed several significant barriers that schoolgirls face in practicing safe menstrual hygiene management. These barriers, including sociocultural factors (133), inadequate use of menstrual hygiene management facilities (73), inadequate knowledge before menarche (59), and a general lack of support (35), underscore the multifaceted nature of the issues. Importantly, these findings emphasize the urgent need for targeted interventions to address these barriers and improve menstrual hygiene management among schoolgirls.</p><p><strong>Conclusion: </strong>Schoolgirls in Bahir Dar encounter numerous challenges in maintaining safe menstrual hygiene practices. Addressing the identified modifiable barriers represents crucial areas for intervention, requiring collaborative efforts from school communities and other relevant stakeholders to create an environment conducive to promoting and enhancing safe menstrual hygiene practices.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1445862"},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling barriers to reproductive health awareness among rural adolescents: a systematic review.","authors":"Sri Wahyuningsih, Sri Widati, Sarva Mangala Praveena, Mohammad Wavy Azkiya","doi":"10.3389/frph.2024.1444111","DOIUrl":"10.3389/frph.2024.1444111","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual and reproductive health (SRH) among adolescents is a critical aspect of global health. Rural adolescents often encounter significant barriers to reproductive health awareness, elevating their risks for unintended pregnancies, sexually transmitted infections (STIs), and other reproductive health issues. This systematic review seeks to identify and analyze the barriers hindering reproductive health awareness among rural adolescents.</p><p><strong>Methods: </strong>This review followed PRISMA guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Taylor & Francis, focusing on studies published from 2019 to 2024. Keywords included \"Adolescent,\" \"Rural,\" \"Reproductive Health,\" \"Awareness,\" and \"Barriers.\" Studies were screened based on eligibility criteria, and data were extracted and analyzed to identify key barriers at the individual, interpersonal, social/community, and health services levels.</p><p><strong>Results: </strong>Out of 669 records, 20 studies met the inclusion criteria. Identified barriers at the individual level included lack of knowledge, myths, misconceptions, and feelings of shame and fear. Interpersonal barriers were related to poor communication between parents and adolescents and misinformation from peers. Social and community barriers encompassed rigid social norms, stigma, and discrimination. Health services barriers included limited access and negative experiences with reproductive health services.</p><p><strong>Discussion: </strong>Rural adolescents face complex barriers to reproductive health awareness driven by factors at the individual, interpersonal, social, and health services levels. Comprehensive interventions, such as educational campaigns, training for healthcare providers, and improved access via mobile or online platforms, are essential to enhance reproductive health awareness and outcomes.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1444111"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risky sexual practice and associated factors among antiretroviral therapy attendees in public health facilities, Wolaita Zone, South Ethiopia: a multi-center cross-sectional study.","authors":"Sisay Petros Salato, Befekadu Bekele Besha, Esayas Aydiko Amele, Temesgen Lera Abiso","doi":"10.3389/frph.2024.1470574","DOIUrl":"10.3389/frph.2024.1470574","url":null,"abstract":"<p><strong>Background: </strong>The majority of people living with Human Immunodeficiency Virus (HIV) are in low- and middle-income countries, particularly in sub-Saharan Africa. Increased risky sexual practice puts people living with the human immune virus at higher risk of acquiring sexually transmitted infections other than the human immune virus and unplanned pregnancies. Sexually transmitted infections, particularly viral hepatitis (B and C), significantly impair antiretroviral therapy and the clinical outcome of the co-infected individual, leading to increased morbidity and mortality. The purpose of this study was to investigate the prevalence of risky sexual practices among antiretroviral therapy (ART) attendees in public health facilities within the Wolaita Zone of South Ethiopia.</p><p><strong>Methods: </strong>From September to October 2023, a facility-based cross-sectional study was conducted among adult people living with HIV on ART in the Wolaita zone. Data was collected through a pretested and structured questionnaire. Six diploma nurses were trained to collect data. Systematic sampling techniques were used to select a total of 398 ART patients. Data were collected by Open Data Kit (ODK) and analyzed with SPSS Version 25. Binary and multiple logistic regression analyses were used. All the variables with a <i>P</i>-value of 0.25 associated with risky sexual practices are considered candidate variables. Multicollinearity was checked. The fitness of the model was tested by the Hosmer-Lemshow goodness of fit test. Finally, statistical significance was declared at a <i>p</i>-value of 0.05.</p><p><strong>Result: </strong>A total of 398 respondents took part in this study. The prevalence of risky sexual practices in the past six months was 174 (43.7%) at 95% of the CI (38.9-48.7). The result of multiple logistic regression analysis showed that not disclosing HIV status (AOR = 1.8, 95% CI: 1.1-3.31), alcohol drinking (AOR = 3.1, 95% CI: 1.66-0.023), and poor social support (AOR = 1.9, 95% CI: 1.75-3.9) were statistically significantly associated with risky sexual practices.</p><p><strong>Conclusion: </strong>This study revealed that the risky sexual practice among ART clients was high and disclosure status, social support, and alcohol use were factors associated with risky sexual practice. The governmental and non-governmental bodies have to strengthen social support for ART clients, disclosure status for ART clients, and counseling to avoid alcohol.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1470574"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where do we go from here? Reconciling implementation failure of PrEP for Black women in the South. Leveraging critical realism to identify unaddressed barriers as we move forward.","authors":"Whitney C Irie, Anais Mahone, Renee Heffron, Latesha Elopre","doi":"10.3389/frph.2024.1449554","DOIUrl":"10.3389/frph.2024.1449554","url":null,"abstract":"<p><strong>Introduction: </strong>PrEP, a highly effective HIV prevention measure, provides autonomy to individuals in managing their HIV acquisition vulnerability. Despite its availability in tenofovir-based oral pills and injectable cabotegravir formulations, PrEP uptake among Black cisgender women in the U.S. South, a region with a high HIV burden, remains critically low. This demographic faces a disproportionately high rate of new HIV diagnoses, yet fewer than 10% of women in the US who could benefit from PrEP are currently receiving it.</p><p><strong>Methods: </strong>Utilizing a critical realism interpretative framework, this narrative review employed a tri-level analysis strategy to examine the empirical, actual, and real domains influencing PrEP implementation among Black women in the Southern U.S. The empirical level refers to observable events and data (e.g., PrEP uptake rates), the actual level encompasses experiences and actions that may not always be directly observed (e.g., healthcare interactions and community engagement), and the real level involves the deeper structures and mechanisms (e.g., systemic racism and cultural narratives) that shape these outcomes. A comprehensive search of peer-reviewed literature from PubMed and other sources was conducted to identify barriers and facilitators to PrEP uptake in this population.</p><p><strong>Results: </strong>The analysis revealed significant barriers, including structural violence, socioeconomic disparities, medical mistrust, stigma, and inadequate healthcare policies. Empirical data showed variability in PrEP awareness and interest among Black women, while actual experiences highlighted misaligned marketing strategies, financial constraints, and interpersonal dynamics. At the real level, underlying mechanisms such as systemic racism and cultural narratives were identified as critical impediments to PrEP uptake.</p><p><strong>Discussion: </strong>Addressing these multifaceted barriers requires a comprehensive, multi-level approach that integrates personalized, community-centric strategies. Emphasizing the need for healthcare providers, community leaders, researchers, and policymakers to collaborate, the review proposes actionable strategies to enhance PrEP implementation, focusing on education, structural reforms, and policy changes to improve access and acceptability among Black women in the South.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1449554"},"PeriodicalIF":2.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}