Suchergebnisse

Background: The high prevalence of trau­ma and its negative impact on health among people living with HIV underscore the need for adopting trauma-informed care (TIC), an evidence-based approach to address trauma and its physical and mental sequelae. However, virtually nothing is known about factors internal and external to the clinical environment that might influence adoption of TIC in HIV primary care clinics.Methods: We conducted a pre-implemen­tation assessment consisting of in-depth interviews with 23 providers, staff, and ad­ministrators at a large urban HIV care center serving an un-/under-insured population in the southern United States. We used the Consolidated Framework for Implementa­tion Research (CFIR) to guide qualitative coding to ascertain factors related to TIC adoption.Results: Inner setting factors perceived as impacting TIC adoption within HIV primary care included relative priority, compatibility, available resources, access to knowledge and information (ie, training), and networks and communications. Relevant outer setting factors included patient needs/resources and cosmopolitanism (ie, connections to external organizations). Overall, the HIV care center exhibited high priority and compatibility for TIC adoption but displayed a need for system strengthening with regard to available resources, training, communica­tions, cosmopolitanism, and patient needs/ resources.Conclusions: Through identification of CFIR inner and outer setting factors that might influence adoption of TIC within an HIV primary care clinic, our findings begin to fill key knowledge gaps in understand­ing barriers and facilitators for adopting TIC in HIV primary care settings and highlight implementation strategies that could be employed to support successful TIC imple­mentation. Ethn Dis. 2021;31(1):109-118; doi:10.18865/ed.31.1.109

Youth-centered health services have become a global practice and South Africa is no exception. This paper describes a project conducted in Mangaung in 2018 using cultural consensus modeling. We conducted 25 interviews and used a combination of hermeneutics, phenomenology theory, and thematic analysis. Our research found that girls in our sample have confidentiality concerns associated with the stigma of attending a clinic and cannot talk openly about sex and HIV. Themes related to negative experiences included the lack of confidentiality, the stigma of HIV, the lack of professional neutrality, failure to understand adolescents, poor service, systemic problems (long queues), and administrative problems. Positive themes included believing that clinics could help prevent pregnancy, provide information, create a safe space, and help with moral support. Moreover, some interviewees reported that services were good and that they provided products and support that were not available from home. However, many said they had to attend public clinics because they could not afford private alternatives. Some said the clinics offered a safe space and staff have positive attitudes. In the absence of discussions about sex at home, the clinics ultimately perform an important function, but systemic problems remain. More can be done by schools and households to reduce the stigma associated with sex and HIV.

AbstractSocial and economic changes in Vietnam since the economic restructuring of the 1980s have caused a shift in norms about premarital sex. While expectations of female chastity remain, sex before marriage is becoming more common among young people. As the formative phase of a parent randomized controlled trial, the present study examined the normative context of sex in dating relationships from the perspectives of young women and men in Vietnam. Men (n = 12) and women (n = 9) studying at two universities in Hanoi participated in semi-structured interviews that explored perspectives on sexual relationships and sexual coercion among their peers. Thematic analysis synthesized participant narratives into broader themes. Our findings confirmed that, as social norms evolve in Vietnam, young women must navigate shifting, and often contradictory, expectations about sex and dating relationships. Women and men expressed the belief that competing sexual expectations often can limit young women's sexual agency and contribute to the normalization of sexual coercion in dating relationships. However, some women were embracing greater sexual freedom and reframing norms in ways that reflected their sexual agency. Efforts are needed to address these conflicting expectations, to deepen young men's understanding of this conflict, and to prevent sexual coercion in young adulthood.

Background: Though the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable. Methods: In a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan. Discussion: Adaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This ...