Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward

Mullick, Saiqa; Chersich, Matthew; Pillay, Yogan; Rees, Helen

doi:10.7196/samj.2017.v107i10.12849

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…8,9,11 Challenges described in this study with inadequate training and overburdened clinics have been similarly described in other reports on health care system-level barriers in South Africa. [27][28][29] Given the pronounced differences in contraceptive implant uptake in South Africa relative to other countries in sub-Saharan Africa, it will be essential to solicit perspectives from HCPs in other sub-Saharan African countries on PrEP implant design and implementation who likely have varied patient experiences. In planning for a PrEP implant targeted for use across much of sub-Saharan Africa, a broad array of opinions from other HCPs, not just South Africa specifically, will be crucial in guiding development.…”

Section: Discussionmentioning

confidence: 99%

Design of an Implant for Long-Acting HIV Pre-Exposure Prophylaxis: Input from South African Health Care Providers

Krogstad

Montgomery

Atujuna

et al. 2019

AIDS Patient Care and STDs

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Implants are in the pre-clinical stage for long-acting HIV pre-exposure prophylaxis (PrEP), with an opportunity to solicit end-users' feedback early in development. Health care providers (HCPs) have been key gatekeepers for contraceptive implant uptake, and uniquely understand both technical considerations and the social context of use. Given their influential role, we gathered South African HCP perspectives on contraceptive implant implementation and features of PrEP implant prototypes that may influence future provider and patient acceptability. We conducted in-depth interviews with 30 HCPs (20 nurses and 10 doctors) in Cape Town and Soshanguve, South Africa. Interviews were conducted by a bioengineer and later transcribed, coded, and analyzed for key themes. HCPs described health system barriers such as understaffed clinics and inadequate training on contraceptive implant removal as major influences to their PrEP implant design preferences. They preferred a PrEP implant that is long lasting (>6 months) to minimize patient-clinic interactions, biodegradable to avoid need for removal, and flexible (but still palpable in case of removal). Commenting on negative experiences with contraceptive implant rollout, they recommended prioritizing both HCP and community education on the PrEP implant, with emphasis on expected side effects, and planning ahead for adequate training of HCPs before rollout. Challenges experienced with past contraceptive implant rollout may taint perspectives on future PrEP implants and must be carefully considered during product development and planning for clinical studies. Particular consideration should be given to the health system context of future distribution, including staff who would be providing and monitoring implants.

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Section: Discussionmentioning

confidence: 99%

Design of an Implant for Long-Acting HIV Pre-Exposure Prophylaxis: Input from South African Health Care Providers

Krogstad

Montgomery

Atujuna

et al. 2019

AIDS Patient Care and STDs

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“…We conducted a targeted desk and literature review of existing documents, including WHO guidelines on ART and oral PrEP, 1 the WHO implementation guidance for oral PrEP delivery, 13 monitoring and evaluation 1 (M&E), literature on treatment and prevention cascades, 7–12 literature on indicators of uptake for family planning 5,6,14–16 and available programmatic and country-level data on oral PrEP service delivery among AGYW in Kenya and South Africa, and other DREAMS countries. 17,18 We discussed as a group the variety of ways uptake and coverage are being defined and the key challenges to measuring these indicators.…”

Section: Methodsmentioning

confidence: 99%

“…Addressing barriers early may affect long-term success in product uptake, while delays in detecting and rectifying problems may result in methods being discarded prematurely. 6…”

Section: Introductionmentioning

confidence: 99%

Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa

et al. 2018

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In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably. Furthermore, operationalising these measures in real-world settings is challenged by the difficulties in defining the denominator for measuring uptake and coverage among AGYW, due to the lack of data and experience required to identify the subset of AGYW at substantial risk of HIV infection. This paper proposes an intervention-centric cascade as a framework for developing a common lexicon of metrics for uptake and coverage of oral PrEP among AGYW. In codifying these indicators, approaches to clearly define metrics for uptake and coverage are outlined, and the discussion on ‘low’ uptake is reframed to focus on achieving the highest possible proportion of AGYW using oral PrEP when they need and want it Recommendations are also provided for making increased investments in implementation research to better quantify the sub-group of AGYW in potential need of oral PrEP.and for improving monitoring systems to more efficiently address bottlenecks in the service delivery of oral PrEP to AGYW so that implementation can be taken to scale.

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“…The term ‘hormonal contraception’ is used here to refer to either injectable or oral contraception. The model does not consider hormonal implants, as these were introduced only in 2014 and uptake has not yet reached high levels [26, 27].…”

Section: Demographic and Socio-economic Variablesmentioning

confidence: 99%

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

Johnson

Kubjane

Moolla

2018

Preprint

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Executive summary Background and objectives South Africa has one of the highest HIV incidence rates in the world. Although much research has focused on developing biomedical strategies to reduce HIV incidence, there has been less investment in prevention strategies that address the social drivers of HIV spread. Understanding the social determinants of HIV is closely related to understanding high-risk populations (‘key populations’), since many of the factors that place these key populations at high HIV risk are social and behavioural rather than biological. Mathematical models have an important role to play in evaluating the potential impact of new HIV prevention and treatment strategies. However, most of the mathematical modelling studies that have been published to date have evaluated biomedical HIV prevention strategies, and relatively few models have been developed to understand the role of social determinants or interventions that address these social drivers. In addition, many of the mathematical models that have been developed are relatively simple deterministic models, which are not well suited to simulating the complex causal pathways that link many of the social drivers to HIV incidence. The frequency-dependent assumption implicit in most deterministic models also leads to under-estimation of the contribution of high-risk groups to the incidence of HIV. Agent-based models (ABMs) overcome many of the limitations of deterministic models, although at the expense of greater computational burden. This study presents an ABM of HIV in South Africa, developed to characterize the key social drivers of HIV in South Africa and the groups that are at the highest risk of HIV. The objective of this report is to provide a technical description of the model and to explain how the model has been calibrated to South African data sources; future publications will assess the drivers of HIV transmission in South Africa in more detail. Methods The model is an extension of a previously-published ABM of HIV and other sexually transmitted infections (STIs) in South Africa. This model simulates a representative sample of the South African population, starting from 1985, with an initial sample size of 20 000. The population changes in size as a result of births and deaths. Each individual is assigned a date of birth, sex and race (demographic characteristics). This in turn affects the assignment of socio-economic variables. Each individual is assigned a level of educational attainment, which is dynamically updated as youth progress through school and tertiary education, with rates of progression and drop-out depending on the individual’s demographic characteristics. Each individual is also assigned to an urban or rural location, with rates of movement between urban and rural areas depending on demographic characteristics and educational attainment. The model assigns to each individual a number of healthcare access variables that determine their HIV and pregnancy risk. These include their ‘condom preference’ (a measure of the e...

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Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward

Cited by 13 publications

References 20 publications

Design of an Implant for Long-Acting HIV Pre-Exposure Prophylaxis: Input from South African Health Care Providers

Design of an Implant for Long-Acting HIV Pre-Exposure Prophylaxis: Input from South African Health Care Providers

Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

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