Frontiers in reproductive health最新文献

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Systematic review registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).

Background: 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.

Methods: 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 P-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 p-value of 0.05.

Result: 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.

Conclusion: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Introduction: Implementing sex education programs during adolescence is crucial for addressing the risks associated with sexuality. However, some of these interventions lack proper incorporation of a gender perspective and maintain a heteronormative and biologically-focused approach, potentially resulting in inequitable outcomes for adolescents. In response, comprehensive sex education is most effective due to its multidimensional view of sexuality. However, integrating a comprehensive perspective on sexuality and a gender lens that contributes to adolescent health equity presents challenges, especially in low and middle-income countries. This study aimed to develop a comprehensive and gender-transformative sex education program for adolescents in a middle-income country of Latin America, utilizing the Intervention Mapping Approach.

Methods: This exploratory sequential mixed-method study comprised two phases. In the first phase, a literature review, nine focus groups with high school students, and 14 interviews with school professionals were conducted to inform program design. Subsequently, the program underwent validation through expert judgment. In the second phase-as part of program development-a preliminary evaluation was conducted by implementing the program in two high schools with 30 students from public high schools, who were administered a pre-post ad hoc survey.

Results: A comprehensive and gender-transformative sex education program was designed based on literature review findings and input from students and school workers. The ad hoc survey revealed a statistically significant increase in protective skills in sexuality (W = 59, p = .01) among all participants.

Discussion: Designing a sex education intervention through Intervention Mapping allowed for the integration of evidence and the needs of the target population. The results of the preliminary evaluation suggest the potential of the developed program to enhance protective skills in sexuality and promote health equity through gender-equitable outcomes in adolescent sex education.

Background: University campus clinics provide crucial sexual health services to students, including STI/HIV screening, testing, contraception, and counseling. These clinics are essential for engaging young adults who may lack access to primary care or have difficulty reaching off-campus services. Dating apps are widely used by young adults, yet there is a lack of studies on how they affect sexual practices. This study aimed to evaluate the use of dating apps, engagement in condomless sexual activity, and the prevalence of STIs among young adult college students in Northern Texas.

Methods: A cross-sectional survey was conducted from August to December 2022 among undergraduate and graduate students aged 18-35 at a large university in Northern Texas. A total of 122 eligible participants completed the survey, which assessed demographics, sexual behaviors, dating app use, and STI/HIV testing practices. Descriptive statistics, bivariate analyses, and multivariate Poisson regression analyses with robust variance were performed to identify factors associated with dating app use and condomless sexual activity.

Results: Two-thirds of participants reported using dating apps. Significant differences were found between app users and non-users regarding demographic factors and unprotected sexual behaviors. Dating app users were more likely to report multiple sexual partners, inconsistent condom use, and a higher likelihood of engaging in unprotected sex. Poisson regression analysis indicated that app use was associated with residing in large urban areas, frequent use of campus STI/HIV screening services, and having multiple sexual partners (p < 0.05).

Conclusion: The study highlights a significant association between dating app use and engagement in condomless sexual activity among college students. University health clinics play a critical role in providing sexual health services and can enhance their impact by expanding access to testing, contraception, and inclusive, sex-positive education. Future research should explore the long-term effects of dating app use on sexual health and evaluate the effectiveness of app-based interventions in promoting safer sexual practices.

Introduction: The endometrium plays a crucial role in early human pregnancy, particularly in embryo implantation, survival, and growth. However, invasion and infection by pathogens can lead to endometritis, infertility, and poor reproductive outcomes. Understanding the mechanisms of endometritis and its impact on fertility remains limited. An infection model using patient-derived endometrial epithelial gland organoids (EEGOs) was established to advance in vitro studies on endometritis and related infertility.

Methods: An EEGOs infection model was constructed and characterized from human endometrium, treating the organoids with estrogen and progesterone to observe changes in the proliferative and secretory phases. The organoids were infected with E. coli, and the release of inflammatory cytokines in the supernatant was detected using ELISA. RNA-seq was employed to analyze the differences before and after E. coli treatment, and differential gene mRNA expression was validated using real-time quantitative PCR. Additionally, the effect of E2 in alleviating inflammation was assessed through markers of receptivity (PAEP, LIF, ITGβ), proliferation (Ki67), and barrier repair (ZO-1).

Results: The constructed human EEGOs exhibited long-term expansion capability, genetic stability, and characteristic hormonal responses, strongly expressing epithelial markers (MUC1, E-Cadherin). After E. coli infection, the expression levels of inflammatory cytokines TNF-α, IL-8, and IFN-γ increased significantly (P < 0.05). RNA-seq indicated that the MAPK signaling pathway was activated post-infection, with increased expression levels of heat shock proteins and transcription factor mRNA. E2 treatment post-infection significantly decreased the mRNA expression of inflammatory genes IL-1β, IL8, IL6 and TNF-α compared to the E. coli infected group (P < 0.05). Additionally, the expression of genes related to receptivity, proliferation, and barrier repair was enhanced in the E2-treated organoids.

Conclusions: Our findings demonstrate that patient-derived EEGOs are responsive to bacterial infection and are effective models for studying host-pathogen interactions in bacterial infections. These organoids revealed the anti-inflammatory potential of E2 in alleviating E. coli-induced inflammation, providing insights into the mechanisms of endometritis and its impact on infertility. The study supports the use of EEGOs as valuable tools for understanding endometrial health and developing targeted treatments.

Introduction: Mother-to-child transmission (MTCT) of HIV accounts for over 90% of annual HIV infections among children under the age of 15. Despite the introduction of the Option B+ strategy in Ethiopia in 2013, the rate of MTCT of HIV at 18 months was 15% in 2020. This study aimed to identify determinants of HIV infection among HIV-exposed infants (HEIs) in the context of prevention of MTCT (PMTCT) care in southern Ethiopia.

Methods: We conducted a retrospective facility-based study of 299 mother-baby pairs (HIV-infected women and their HEIs up to 18 months) enrolled in PMTCT care at three health facilities in Wolaita Sodo town, southern Ethiopia, from September 2015 to October 2021. Data was collected from medical charts and PMTCT registers. Logistic regression was used to identify determinants of HIV infection among HEIs.

Results: At enrolment into PMTCT care, most women were already on ART (75.3%) and in clinical stage I (89.6%) according to the World Health Organization's algorithm. Overall, 13 (4.3%, 95% CI: 2.5%-7.4%) HEIs were HIV-infected; the level was higher among HEIs born at home (17.9% (95% CI: 7.6%-36.5%). Being born to HIV-positive women with late WHO clinical stage (III and IV) of HIV (AOR = 9.1, 95%CI: 2.4, 34.5), being born at home (AOR = 4.8, 95%CI: 1.1-20.7), being born to women newly diagnosed with HIV (AOR = 4.8, 95%CI: 1.3-17.4), and low infant adherence to cotrimoxazole prophylaxis (AOR = 5.4, 95%CI: 1.4-20.4) increased the odds of MTCT.

Conclusion: HIV infection levels among breastfeeding HEIs in PMTCT care was <5%, meeting the WHO transmission rate targets. Strengthening PMTCT care to expand community-based PMTCT interventions such as improving women's and communities' awareness of HIV, PMTCT and promoting male involvement would reduce reduce HIV infection among children to reach the 95-95-95 targets to end HIV in Ethiopia.

Introduction: There is a high incidence of unsafe abortion among women in Nigeria and the DRC. Low knowledge of recommended abortion methods [i.e., surgical and medication abortion (MA) pills] is a barrier for women accessing safe abortions. Women often rely on friends for information about abortion methods. Understanding characteristics of women with knowledge of recommended abortion methods, and MA specifically, and how it is influenced by close female friendships may help identify women most at risk of relying on unsafe abortion.

Methods: We used survey data from Performance Monitoring for Action from 11,106 women of reproductive age in Nigeria (April-May 2018) and 3,697 women in Kinshasa and Kongo Central, DRC, (December 2021-April 2022) to produce representative estimates of knowledge of abortion methods at the national and province levels, respectively. We performed bivariate and multivariate logistic regression to determine which characteristics were independently associated with knowing a recommended abortion method, with knowing of MA pills specifically, and to assess our hypothesis that having at least one female confidante would increase one's odds of knowing about these methods.

Results: A minority (26.9%) of women in Nigeria and the majority in Kinshasa (76.7%) and Kongo Central (58.1%) reported having knowledge of at least one recommended abortion method, while knowledge of MA pills was low in all sites. Having at least one close female confidante was associated with increased odds of knowing a recommend abortion method in Nigeria (aOR = 1.50, 95% CI 1.25-1.79) and in Kongo Central (aOR = 2.66, 95% CI 1.40-5.40), and with increased odds of knowing about MA specifically in Kinshasa (aOR = 1.44, 95% CI 1.08-1.93) and Kongo Central (aOR = 3.61, 95% CI 1.28-10.22), but not Nigeria.

Discussion: In legally restrictive contexts where knowledge of recommended abortion methods (particularly medication abortion) is low, having close female friends is related to increased knowledge of recommended abortion methods.

Introduction: Pregnant and breastfeeding women at substantial risk for HIV infection in sub-Saharan Africa can benefit from biomedical interventions such as pre-exposure prophylaxis (PrEP). We estimated the benefit that pregnant and breastfeeding women may derive from PrEP service delivery in order to guide PrEP roll-out in the target population in Zambia.

Methods: Between September and December 2021, we conducted a discrete choice experiment (DCE) among a convenient sample of 389 pregnant and breastfeeding women not living with HIV in Lusaka, Zambia. Women aged 18 years or older, with a documented negative HIV result in their antenatal card responded to a structured questionnaire containing 12 choice sets on service delivery attributes of PrEP: waiting time at the facility, travel time to the facility dispensing PrEP, location for PrEP pick-up, health care provider attitude and PrEP supply at each refill. Mixed logit regression analysis was used to determine the participant's willingness to trade off one attribute of PrEP for the other at a 5% significance level. Willingness to wait (WTW) was used to determine the relative utility derived from each attribute against waiting time.

Results: Waiting time at the facility, travel time to the facility, health care provider attitude and amount of PrEP supply at each refill were important attributes of PrEP service delivery (all p < 0.01). Participants preferred less waiting time at the facility (β = -0.27, p < 0.01). Women demonstrated a strong preference for a 3-months' supply of PrEP (β = 1.69, p < 0.01). They were willing to wait for 5 h at the facility, walk for more than an hour to a facility dispensing PrEP, encounter a health care provider with a negative attitude in order to receive PrEP enough for 3 months.

Conclusion: Patient-centered approaches can help to inform the design and implementation of PrEP services among pregnant and breastfeeding women. In this study, we found that a reduction in clinic visits-including through multi-month dispensing of PrEP-could improve uptake of services in antenatal and postnatal settings.