Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa.
Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa.
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DOI：
10.1111/1471-0528.12290
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Harper CC
中科院分区：
文献类型：
--
作者：
Morse J;Chipato T;Blanchard K;Nhemachena T;Ramjee G;McCulloch C;Blum M;Saleeby E;Harper CC
分析目前提供的长效可逆避孕（LARC）和临床医生在艾滋病毒流行的环境中的培训需求。全国代表性的临床医生调查。南非和津巴布韦的艾滋病毒流行环境。南非和津巴布韦的临床医生。在南非和津巴布韦（n = 1444）进行了具有全国代表性的临床医生调查，以评估目前在艾滋病毒流行环境中提供LARC的临床实践。采用多变量logistic回归分析避孕措施提供和临床医生培训需求。避孕措施提供和临床医生培训需求的多变量logistic回归分析。最有效的可逆避孕药具的提供是有限的：只有14%的临床医生提供铜宫内节育器（IUD），4%的左炔诺孕酮释放IUD和16%的避孕植入。临床医生对患者使用宫内节育器的资格的看法过于严格，特别是与艾滋病毒风险有关。不到5%的人报告说，宫内节育器适用于艾滋病毒高危妇女或艾滋病毒阳性妇女，这与循证指南相反。只有15%的人认为植入物适合有艾滋病毒风险的妇女。然而，大多数临床医生（82%）认为患者未充分使用宫内节育器，超过一半的人希望接受LARC方法的额外培训。Logistic回归分析表明，LARC的提供主要限于医生，医院和城市地区。结果还表明，农村地区和诊所的临床医生，包括护士，对培训特别感兴趣。在南部非洲，由于艾滋病毒阳性和高危妇女很少使用LARC方法，意外怀孕率很高，因此临床医生提供LARC的能力很重要。尽管供应量低，但临床医生的兴趣很高，这表明需要增加LARC的循证培训，以减少意外怀孕和相关的发病率。
To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings. Nationally representative survey of clinicians. HIV-prevalent settings in South Africa and Zimbabwe. Clinicians in South Africa and Zimbabwe. Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. Multivariable logistic regression of contraceptive provision and clinician training needs. Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians’ perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.
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