First name
Aletha
Middle name
Y
Last name
Akers

Title

Identifying Opportunities to Discuss Pre-Exposure Prophylaxis During Contraceptive Coaching Discussions With Urban Adolescent Women.

Year of Publication

2021

Date Published

2021 Jun 05

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>HIV pre-exposure prophylaxis (PrEP) reduces HIV transmission and is approved for adolescents aged 12-17 years. Adolescent girls and young women (AGYW) have modest PrEP uptake rates, while many receive reproductive health counseling. We sought to identify opportunities for incorporating PrEP education in contraceptive counseling delivered to AGYW.</p>

<p><strong>METHODS: </strong>We performed a secondary analysis of data from the Health Coaching for Contraceptive Continuation pilot study, which supported contraceptive use among AGYW. Participants were 14-22 years old, sexually active with males, and not desiring pregnancy within 12 months. Coaches were sexual health educators with ≥5&nbsp;years' experience providing contraceptive and PrEP counseling to youth. Participants completed a baseline visit within 30 days of contraceptive initiation and completed up to five monthly coaching sessions. Of 33 enrollees, this analysis includes the 21 who completed ≥4 sessions. Two coders deductively coded session transcripts for five themes: opportunities to discuss PrEP; HIV knowledge, risk perception, and testing attitudes; changes in HIV risk status; condom use knowledge and skills; and sexually transmitted infection knowledge and risk perception.</p>

<p><strong>RESULTS: </strong>Of the 111 transcripts coded, 24 contained opportunities to discuss PrEP and were inductively analyzed. Thematic analysis demonstrated three types of opportunities for PrEP discussions: failure to introduce information, and provision of incomplete information or misinformation. Analysis also revealed four opportunity contexts: sexually transmitted infection prevention strategies, HIV risk reduction, avoidance of adverse sexual health outcomes, and disclosures of condom nonprotected sexual behaviors. Only one transcript mentioned PrEP.</p>

<p><strong>CONCLUSIONS: </strong>Multiple opportunities to introduce PrEP counseling exist within contraceptive counseling provided to AGYW.</p>

DOI

10.1016/j.jadohealth.2021.04.031

Alternate Title

J Adolesc Health

PMID

34103237

Title

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

Year of Publication

2021

Date Published

2021 Mar 22

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.</p>

<p><strong>DESIGN: </strong>Cross-sectional mixed methods.</p>

<p><strong>SETTING: </strong>Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>20 sexually active AGYW ages 18-24; 20 health system stakeholders.</p>

<p><strong>INTERVENTIONS: </strong>Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Themes reflecting barriers and facilitators of LARC implementation.</p>

<p><strong>RESULTS: </strong>The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.</p>

<p><strong>CONCLUSIONS: </strong>We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.</p>

DOI

10.1016/j.jpag.2021.03.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33766793

Title

Effect of Prior Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation.

Year of Publication

2021

Date Published

2021 Feb 08

ISSN Number

1873-4332

Abstract

<p><strong>OBJECTIVE: </strong>Nonadherence in sexual risk reduction interventions may be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a prior pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.</p>

<p><strong>DESIGN: </strong>Secondary data analysis from a feasibility study of a health coaching intervention to improve contraceptive continuation.</p>

<p><strong>SETTING: </strong>Three urban pediatric clinics in Philadelphia.</p>

<p><strong>PARTICIPANTS: </strong>Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.</p>

<p><strong>INTERVENTIONS: </strong>At baseline, participants completed a sociodemographic questionnaire and semi-structured interview, followed by five monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Intervention completion was defined as the number of completed coaching sessions.</p>

<p><strong>SECONDARY OUTCOMES: </strong>Qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.</p>

<p><strong>RESULTS: </strong>Participants with a prior adverse outcome (a prior STI and/or a prior pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs. 4, p=0.03). Both groups had low HIV/STI knowledge, negative attitudes towards pregnancy, and low HIV/STI risk perception. Those with a prior adverse reproductive outcome held more negative attitudes towards condoms.</p>

<p><strong>CONCLUSION: </strong>Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome may be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize interventions reach for vulnerable youth.</p>

DOI

10.1016/j.jpag.2021.02.003

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33571659

Title

Evolving the Preconception Health Framework: A Call for Reproductive and Sexual Health Equity.

Year of Publication

2021

Number of Pages

234-239

Date Published

2021 Feb 01

ISSN Number

1873-233X

Abstract

<p>Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people. We describe a novel "Reproductive and Sexual Health Equity" framework, defined as an approach to comprehensively meet people's reproductive and sexual health needs, with explicit attention to structural influences on health and health care and grounded in a desire to achieve the highest level of health for all people and address inequities in health outcomes. Principles of the framework include centering the needs of and redistributing power to communities, having clinical and public health systems acknowledge historical and ongoing harms related to reproductive and sexual health, and addressing root causes of inequities. We conclude with a call to action for a multisectoral effort centered in equity to advance reproductive and sexual health across the reproductive life course.</p>

DOI

10.1097/AOG.0000000000004255

Alternate Title

Obstet Gynecol

PMID

33416289

Title

Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens.

Year of Publication

2021

Date Published

2021 Jan 19

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy.</p>

<p><strong>METHODS: </strong>A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18&nbsp;months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth, miscarriage, termination), and continuity with a single clinician. Demographic factors included age, race, ethnicity, primary insurance, and residential zip code. Logistic regression identified factors associated with visits after pregnancy. Separately, for a cohort&nbsp;of 47 parenting teens who received primary care at the same site as their infants, we assessed teen-infant care after birth.</p>

<p><strong>RESULTS: </strong>Teens were predominantly non-Latina black (91%) and Medicaid insured (71%). Before pregnancy, most teens had preventive visits (66%) and reported contraceptive use (65%). After pregnancy, 52% discussed pregnancy decisions within a month, 55% reported contraceptive use, and 64% had any primary care visit. Postpregnancy visits were associated with teen age (&lt;18 vs.&nbsp;≥18&nbsp;years odds ratio 2.84, 95% confidence interval 1.17-6.90) and pregnancy outcome (termination vs. live birth odds ratio 4.02, 95% confidence interval 1.47-11.01). Among parenting teens, there were more infant visits than teen visits, and continuity was higher for infants.</p>

<p><strong>CONCLUSION: </strong>In a primary care cohort of pregnant teens, gaps persisted in pediatric clinical follow-up after pregnancy. Particularly in situations where pregnancy led to a birth, pregnancy frequently prompted a transition away from pediatric care.</p>

DOI

10.1016/j.jadohealth.2020.12.132

Alternate Title

J Adolesc Health

PMID

33483235

Title

What's Known and What's Next: Contraceptive Counseling and Support for Adolescents and Young Adult Women.

Year of Publication

2020

Date Published

2020 Dec 14

ISSN Number

1873-4332

Abstract

<p>The low rates of actual contraceptive failure and high rates of contraceptive use among young women highlights that choice of contraceptive method and patterns of contraceptive use greatly influence unintended pregnancy risk. Promoting contraceptive use among adolescent and young adult women requires supportive health systems and health providers who understand this population's evolving developmental needs. It also requires an awareness of effective tools for counseling patients, while being mindful of the power dynamics operational during clinical encounters to avoid inadvertent, coercive interpersonal dynamics. Missed opportunities to provide such patient centered care can lead to unplanned pregnancies and suboptimal health and social consequences for young women. Unfortunately, health providers often lack the tools and resources to appropriately identify and meet individual young women's contraceptive needs. This paper summarizes the evidence supporting contraceptive counseling strategies linked with contraceptive initiation among young women, and evidence-based approaches for supporting contraceptive adherence and continuation after method initiation. It also orients readers to the unique neurodevelopmental factors that influence the shared-decision making process during contraception counseling sessions with young women. New and emerging approaches for supporting contraceptive initiation, adherence and continuation are reviewed.</p>

DOI

10.1016/j.jpag.2020.12.008

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33333260

Title

Racial/ethnic disparities in female sexual health from adolescence to young adulthood: how adolescent characteristics matter?

Year of Publication

2020

Date Published

2020 Nov 20

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>To describe sexual initiation pattern in female adolescents and examine its association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.</p>

<p><strong>DESIGN: </strong>A prospective, longitudinal, observational study from adolescence to adulthood.</p>

<p><strong>SETTING: </strong>Nationally representative, the National Longitudinal Study of Adolescent to Adult Health data, ranged 24-32 years old at final assessment.</p>

<p><strong>PARTICIPANTS: </strong>43,577 US females in 1994-2008.</p>

<p><strong>INTERVENTIONS AND MAIN OUTCOME MEASURES: </strong>Adolescent sex related characteristics in individual-family-school peer level were accessed, and multiple sex partners, STIs/HIV, and inter-partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and Mixed-effects Poisson regression models.</p>

<p><strong>RESULTS: </strong>The sexual initiation patterns were determined as normative (65.9%), late (24.8%) and early but unempowered (9.3%). The highest rate of early-unempowered group was shown in Hispanics (14.4%); they were more likely to be depressed, unsatisfied with their bodies and on welfare and have less educated/permissive parents to their sexual initiation than others. The late group had a higher BMI and more satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic blacks (NHBs) and Hispanics, respectively. However, NHB females' higher STIs/HIV was shown in late/normative groups, not in early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.</p>

<p><strong>CONCLUSIONS: </strong>NHB females' higher STI/HIV in late/normative groups and Hispanic females' frequent IPV victimization regardless of their sexual initiation patterns may indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.</p>

DOI

10.1016/j.jpag.2020.11.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33227423

Title

Dual-Method Contraception Use Among Young Women Pre- and Post-ACA Implementation.

Year of Publication

2020

Number of Pages

1527154420923747

Date Published

2020 May 12

ISSN Number

1552-7468

Abstract

<p>The 2012 implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive coverage mandate removed financial barriers to contraception access for many insured women. Since that time, increases in sexually transmitted disease (STD) rates have been noted, particularly among Black adolescent and young adult women aged 15 to 24 years. It is unclear whether changes in dual-method contraception use (simultaneous use of nonbarrier contraceptive methods and condoms) are associated with the increase in STD rates. A repeated cross-sectional analysis was conducted among adolescent and young adult women to compare pre-ACA data from the 2006-2010 cohort and post-ACA data from the 2013-2015 cohort of the National Survey for Family Growth. A significant decrease in short-acting reversible contraception use (SARC; 78.2% vs. 67.5%; &lt;.01) and a significant increase in long-acting reversible contraception use (LARC; 8.9% vs. 21.8%; &lt;.01) were found, but no significant change in dual-method contraception use was found among pre- versus post-ACA SARC users and SARC nonusers (odds ratio [OR]: 1.88, 95% confidence interval [CI]: 0.64-5.46, =.25), LARC users and LARC nonusers (adjusted odds ratio [AOR]: 1.62, 95% CI: 0.42-6.18, =.48), or White and Black women (AOR: 1.45, 95% CI: 0.66-3.18, =.35). There was no direct association between changes in contraception use and decreased condom use and therefore no indirect association between changes in contraception use and increased STD rates. Health care providers should continue promoting consistent condom use. Additional research is needed to understand recent increases in STD rates among Black women in the post-ACA era.</p>

DOI

10.1177/1527154420923747

Alternate Title

Policy Polit Nurs Pract

PMID

32397804

Title

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Year of Publication

2020

Date Published

2020 Mar 16

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing.</p>

<p><strong>METHODS: </strong>Retrospective study of STI episodes (gonorrhea, <em>Chlamydia,</em>&nbsp;trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis.</p>

<p><strong>RESULTS: </strong>The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.</p>

<p><strong>CONCLUSIONS: </strong>HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.</p>

DOI

10.1542/peds.2019-2265

Alternate Title

Pediatrics

PMID

32179661

Title

Follow-Up Care and 6-month Continuation Rates for Long-Acting Reversible Contraceptives in Adolescents and Young Adults: A Retrospective Chart Review.

Year of Publication

2019

Date Published

2019 Sep 09

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Describe follow-up care patterns and continuation rates during the first 6-months after initiating a long-acting reversible contraceptive device (LARC) among adolescent and young adult (AYA) women.</p>

<p><strong>DESIGN: </strong>Retrospective chart review among patients who had an intrauterine device (IUD) or subdermal implant placed between January 2015 and December 2016.</p>

<p><strong>SETTING: </strong>Urban adolescent specialty care clinic.</p>

<p><strong>PARTICIPANTS: </strong>Women ages 13-23 years.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Follow up encounters were defined as scheduled and unscheduled phone calls, outpatient clinic visits, or emergency department visits during the 6-months after device placement. Continuation was defined as not having the device removed or expelled during the 6-months following initiation. Frequencies were calculated, and logistic regression was used to determine predictors of follow-up encounters and continuation.</p>

<p><strong>RESULTS: </strong>Among the 177 patients, 180 LARC devices were placed. Most were 13-17 years (56%), non-Hispanic Black (64%), publicly insured (57%), and had an IUD placed (57%). The majority (86%) had &gt;1 clinical encounter during the 6-months: 70% attended a scheduled encounter and 53% had an unscheduled encounter. Half (45%) attended the scheduled 2-week office visit; only 6% attended the 6-month office visit. The 6-month LARC continuation rate was 92% (n=166), with most discontinuations among IUD users (n=12; 7%).</p>

<p><strong>CONCLUSIONS: </strong>LARC continuation rates were high in our study population. Most AYA women have at least one follow-up encounter in the 6-months following LARC placement. Clinical practices should be prepared to address issues that arise during follow-up encounters, whether in-person or by phone.</p>

DOI

10.1016/j.jpag.2019.09.003

Alternate Title

J Pediatr Adolesc Gynecol

PMID

31513921

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