Contraceptive Management Research Articles

Human-specific epigenomic states in spermatogenesis

Infertility is becoming increasingly common, affecting one in six people globally. Half of these cases can be attributed to male factors, many driven by abnormalities in the process of sperm development. Emerging evidence from genome-wide association studies, genetic screening of patient cohorts, and animal models highlights an important genetic contribution to spermatogenic defects, but comprehensive identification and characterization of the genes critical for male fertility remain lacking. High divergence of gene regulation in spermatogenic cells across species poses challenges for delineating the genetic pathways required for human spermatogenesis using common model organisms. In this study, we leveraged post-translational histone modification and gene transcription data for 15,491 genes in four mammalian species (human, rhesus macaque, mouse, and opossum), to identify human-specific patterns of gene regulation during spermatogenesis. We combined H3K27me3 ChIP-seq, H3K4me3 ChIP-seq, and RNA-seq data to define epigenetic states for each gene at two stages of spermatogenesis, pachytene spermatocytes and round spermatids, in each species. We identified 239 genes that are uniquely active, poised, or dynamically regulated in human spermatogenic cells distinct from the other three species. While some of these genes have been implicated in reproductive functions, many more have not yet been associated with human infertility and may be candidates for further molecular and epidemiologic studies. Our analysis offers an example of the opportunities provided by evolutionary and epigenomic data for broadly screening candidate genes implicated in reproduction, which might lead to discoveries of novel genetic targets for diagnosis and management of male infertility and male contraception.

Counseling Women About Sexual Health Effects of Contraceptives.

Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.

Sex Hormone Treatment for Female Children and Young Adults with Disorders Affecting Hypothalamic, Pituitary, and Ovarian Function.

Normal hypothalamic-pituitary-ovarian (HPO) endocrine function is essential for female pubertal and psychosocial development and for ongoing adult physical, sexual, and psychosocial health. Girls with hypogonadism, any endocrine disorder causing abnormal uterine bleeding (AUB) or with contraception needs may require sex hormone treatment. Challenges include evolving needs of a young girl through the course of sexual maturation, potential health risks related to the use of sex hormones for pubertal induction, hormone replacement therapy (HRT), menstrual management, and/or contraception. To ensure optimal sex hormone treatment, both a comprehensive understanding of the underlying disorder affecting HPO endocrine function and a professional communication with the patient and physicians involved are warranted. In this narrative mini-review, we discuss pubertal induction and HRT for girls with hypogonadism and the management of AUB and contraception for young women up to age 30 years. Additionally, we provide advice on management of AUB and contraception in young women with common conditions including polycystic ovary syndrome, congenital adrenal hyperplasia and others. A PubMed-literature search including articles published over the last 20 years, together with clinical experience of the authors was integrated to provide treatment recommendations. Sex hormone treatment, where needed, requires comprehensive understanding of a range of available options. When tailored to individual needs, with flexibility to accommodate changing circumstance in young women it is safe, well tolerated and provides both physical and psychosocial health.

Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518

INTRODUCTION: Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs. METHODS: All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test. RESULTS: A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020. CONCLUSION: Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.

Sexual and Reproductive Health Outcomes Among Adolescent Females During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) posed a significant threat to adolescents' sexual and reproductive health. In this study, we examined population-level pregnancy and sexual health-related care utilization among adolescent females in Ontario, Canada during the pandemic and evaluated relationships between these outcomes and key sociodemographic characteristics. This was a population-based, repeated cross-sectional study of >630 000 female adolescents (12-19 years) during the prepandemic (January 1, 2018-February 29, 2020) and COVID-19 pandemic (March 1, 2020-December 31, 2022) periods. Primary outcome was pregnancy; secondary outcomes were contraceptive management visits, contraception prescription uptake, and sexually transmitted infection (STI) management visits. Poisson models with generalized estimating equations for clustered count data were used to model pre-COVID-19 trends and forecast expected rates during the COVID-19 period. Absolute rate differences between observed and expected outcome rates for each pandemic month were calculated overall and by urbanicity, neighborhood income, immigration status, and region. During the pandemic, lower-than-expected population-level rates of adolescent pregnancy (rate ratio 0.87; 95% confidence interval [CI]:0.85-0.88), and encounters for contraceptive (rate ratio 0.82; 95% CI:0.77-0.88) and STI management (rate ratio 0.52; 95% CI:0.51-0.53) were observed. Encounter rates did not return to pre-pandemic rates by study period end, despite health system reopening. Pregnancy rates among adolescent subpopulations with the highest pre-pandemic pregnancy rates changed least during the pandemic. Population-level rates of adolescent pregnancy and sexual health-related care utilization were lower than expected during the COVID-19 pandemic, and below-expected care utilization rates persist. Pregnancy rates among more structurally vulnerable adolescents demonstrated less decline, suggesting exacerbation of preexisting inequities.

A case study of hospital contraceptive waste management practices in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State

Background: Effective management of hospital waste is a critical component of a hospital’s infection control program and is central to occupational safety for healthcare workers. Thus, this study focused on the assessment of hospital contraceptive waste management practices at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka, Anambra state, Nigeria. Methods: A cross sectional analytical study was carried out among healthcare workers selected using multistage sampling technique in 6 categories of healthcare workers in COOUTH. Data was collected using a pre-tested semi-structured interviewer-administered questionnaire and a World Health Organization (WHO) checklist and analyzed using statistical package for the social sciences (SPSS) version 22. Associations and correlations between variables were tested at the bivariate level using Chi-square and t-test. Results: A total of 86 healthcare workers were surveyed. The majority of the respondents were females, nurses with RN qualification. The mean knowledge score of the respondents was 94.8%. The attitude of healthcare workers towards segregation of hospital contraceptive waste at source point was 71% while the usage of gloves in handling hospital waste was 95.3%. The major factor affecting contraceptive waste management practices in the facility was the respondent’s cultural beliefs. The lack of funds to finance standard waste disposal methods was noted to be a significant barrier to optimum waste management practices. Conclusions: This study showed that despite the high level of knowledge of healthcare workers on hospital contraceptive waste management practice in COOUTH, the hospital contraceptive waste management practice is not functioning optimally in Anambra state. Hence, the need to reform the hospital waste management practice to achieve functional results.

Early removal of the etonogestrel contraceptive implant in Spanish women: a prospective cohort study.

To know the discontinuation rate and characterize predictors and reasons of contraceptive implant removal within 12 months of insertion in our community setting. This prospective cohort study included women receiving the etonogestrel contraceptive implant at sexual and reproductive health centers between September 2019 and September 2020. The variables collected were implanted insertion timing, reproductive and demographic characteristics, medical conditions, sexual activity and counseling. Our primary outcome was implant discontinuation. Kaplan-Meier survival curves were used to show the cumulative discontinuation rate of implants contraceptive within the first year of insertion. We also identified factors that increased the risk of implant removal using the log-rank test and the Cox regression model. Reasons for discontinuation were documented. 199 women were followed up. Implant discontinuation was documented in 17.1% of implant users prior to 12 months. Factors that increase the risk of implant removal are living with a partner, being aged 25-34 years and not receiving comprehensive and structured counseling from the midwife. The main reason for removal was unsatisfactory bleeding (97.1%), but this was combined with other reasons such as cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) or decreased libido (50.0%). The rate of discontinuous implant uses in the first year is relevant in relation to cost-effectiveness, there is room for improvement that should not be overlooked. Comprehensive and structured midwife-led counseling can reduce early implant abandonment removal. The development in different countries of the role of midwives in the management of contraceptives can contribute to the economic benefit of health services and the satisfaction of women.

A contracepção como um valor: histórias de jovens sobre desafios no uso e manejo dos métodos

Abstract This study presents the findings of the social anthropological research project “Jovens da era digital: Sexualidade, reprodução, redes sociais e prevenção às IST/HIV/AIDS” [Young people in the digital age: Sexuality, reproduction, social media, and prevention of STI/HIV/AIDS], which was conducted with interlocutors between the ages of 16 and 24 years old from six Brazilian cities. This study focuses on contraceptive management among heterosexual adolescents and young adults, with particular emphasis on women, given their prominent role in family planning within hierarchical gender contexts. We describe the typical script for youth contraception, which involves the use of condoms at the onset of sexual activity, followed by the incorporation of hormonal methods or the withdrawal method. We also find that adolescents frequently resort to the use of emergency contraception. Women frequently report experiencing side effects from hormonal contraceptives, which results in high rates of discontinuation and an increased interest in copper IUDs, which are scarce resources within the Brazilian National Health System. It can be concluded that, despite gender constraints and social, ethnic, and racial inequalities, the interviewees value contraception, offering insights for the review and improvement of public policies concerning young people.

Utilizing Community Procedure Clinics to Enhance Resident Procedural Education.

Procedure training in family medicine residency is important for future full-spectrum practice. Some residency programs have cited difficulty providing adequate procedure education. Residency collaboration with nonfaculty attending physicians working at community nonresidency clinics may help programs increase resident exposure to procedures. We assessed the feasibility of such an educational model by establishing recurring procedure clinics in a nonresidency family medicine site supervised by nonfaculty physicians. Twice monthly, half-day procedure clinics were conducted at a community site, where family medicine residents were supervised by nonfaculty community family physicians. After participation, we surveyed residents about their perceptions of the clinics. Using retrospective chart review, we determined quantity and type of procedures performed. Fifteen residents participated in 21 procedure clinics, featuring 18 procedure types and 268 procedures. Skin lesion excision, nail removal, punch and shave procedures, joint injection, newborn circumcision, and implantable contraception management were most consistently performed. Residents rated clinics highly and were satisfied with procedure number and variety, opportunity to learn new procedures and techniques, and feedback received. Over 80% of residents noted experiences in procedures that were less commonly encountered in their residency. Procedure clinics at a nonresidency site hosted by nonfaculty attending physicians provided additional training in a variety of primary care procedures. The clinics were favorable to residents and may help programs address training gaps.

Role of Menstrual Bleeding Assessments in Sickle Cell Clinics in Improving Quality of Care for Women- a Multicenter Approach

Introduction: Reproductive health education is lacking among individuals with sickle cell disease (SCD) despite many females reporting increased pain during menstruation. Research suggests that SCD-related pain associated with menstruation may be regulated with the use of hormonal therapy. Yet, education about safe and available contraceptive therapies is often lacking during routine sickle cell visits, leading to increased pain-related healthcare utilization and suboptimal management of menses and contraception. In this prospective cross-sectional study, we hypothesized that menstrual bleeding assessments, in the form of surveys conducted during sickle cell clinic visits would prompt timely identification and management of menstruation complications in females with SCD. Methods: The study was primarily conducted by members of the Foundation for Women & Girls with Blood Disorders' Women & Girls SCD Learning Action Network (WGSCD LAN) and Pacific Sickle Cell Regional Collaborative (PSCRC). The menstrual bleeding assessment consisted of 4 surveys; a patient survey and provider survey both created by the WGSCD LAN, a validated menstrual bleeding questionnaire (MBQ) and a validated measure of global health from the Patient Reported Outcomes Measurement Information System (PROMIS). The patient survey included questions about the patients' experience with sickle cell pain in relation to menstruation, medications being used, their education, access to, and utilization of reproductive health services. The provider survey was completed after the provider reviewed the patient MBQ and surveys and included questions about the providers' access to reproductive health services, the patients' medical data, and the providers' plans of care for that patient. Sickle cell centers across the U.S. were recruited to participate through the WGSCD LAN and the PSCRC. Consented females who reached menarche for >12 months, had menses in the past 12 months, and were not pregnant or breastfeeding were requested to complete the patient, MBQ and PROMIS surveys by their sickle cell providers. For every patient survey filled, provider surveys were encouraged but not required. Results: After IRB approval at 9 U.S. sickle cell centers, 6 institutions enrolled 56 females with SCD for the MBQs and patient surveys, with 45 (80%) provider surveys and 32 (57%) short PROMIS surveys completed. Most patients had hemoglobin SS disease (71%). Thirty-six (64%) females were ≥ 18 years old (range 18-48 years), and 20 (36%) were 13-17 years old. Mean MBQ score for adults with SCD was 17.3 (SD 9.6) (mean validated score 10.8,SD 8.8) and for adolescents with SCD was 16.1 (SD 7.5) (mean validated score 19.6, SD 7.6). Thirty-five (63%) females reported sickle cell pain with menstrual cycles. Despite this, only 7 females (12.5%) reported using one or more hormonal therapies in the 3 months prior, including oral contraceptives (n= 4), Depo injections (n =5), and/or an intrauterine device (IUD) (n =1). Only one female reported using condoms. Most sickle cell providers (38/45) were not prescribing hormonal therapies to their patients, however, all providers reported having access to reproductive health specialists in their institutions. Seven females reported not having heard of hormonal therapy, including 3 females >18 years of age. NSAID use of ≥5 days in a 2-week period was reported by 22% of females (12/54). In the PROMIS survey, only 28% females reported very good to excellent physical health and only 47% reported very good to excellent mental health. After review of MBQ, PROMIS and patient surveys, provider surveys (n = 32) noted intent to or provision of one or more of these services: verbal education about hormonal therapy by 25 (66%) providers, referral to a reproductive health specialist by 14 providers (37%), work-up for iron deficiency by 6 providers (22.2%), and work up for bleeding disorders by 4 providers (14.8%). Conclusion: Patient reportedsickle cell pain with menstruation is quite prevalent, but hormonal therapy use is minimal despite availability of reproductive health specialists in most U.S. sickle cell centers. Menstrual bleeding assessments in the sickle cell clinic can facilitate a dialogue and recognition of reproductive health concerns among females with SCD and enhance medical attention and care from hematologists and reproductive health specialists in collaborative models of care.

Preconception Care for Individuals with Diabetes

The incidence of diabetes has been increasing and, in parallel, so has the incidence of females in their childbearing years with diabetes. Preconception care is important in females with diabetes due many factors related to fertility, blood glucose control, and complications. For example, many individuals with Type 2 diabetes are obese, which can affect contraceptive efficacy, fertility, and fetal growth. Additionally, patients with all types of diabetes are at risk for disordered eating, which can be harmful to a developing fetus. Both hypoglycaemia and hyperglycaemia are known to increase the risk of adverse maternal and neonatal outcomes, including during the first trimester, when many females are not aware of pregnancy. Additionally, individuals with diabetes are at risk for complications, such as atherosclerotic cardiovascular disease, nephropathy, retinopathy, and neuropathy, that can lead to complicated pregnancies. Importantly, several of the medications used to control blood glucose, and manage diabetes complications, are not recommended for use during pregnancy due to potential fetal harm. For these reasons, females with diabetes in their childbearing years are encouraged to utilise reliable contraception, so that pregnancies can be planned, or should be treated with medications with low teratogenicity potential. Thus, the preconception care of females with diabetes is complex, and the increasing prevalence of this patient population warrants greater awareness among clinicians. This narrative review summarises the current standard of preconception care for individuals with diabetes, including the management of contraception, weight, blood glucose, hypertension, and dyslipidaemia.

Continuation rates of hormonal intrauterine devices in adolescents and young adults when placed for contraceptive and non-contraceptive indications

ObjectiveThis study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. Study DesignWe conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least 1-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded. ResultsA total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p = 0.74). The mean age at insertion was 18.9 years (SD = 2.4 years), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those without follow-up, the overall continuation rates were 77% at 1 year, 66% at 2 years, and 54% at 3 years. While continuation rates did not differ by indication at 1 year, at 3 years, continuation was highest among those who sought the device for menstrual management only (contraception = 53%, menstrual = 57%, both = 53%, p < 0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication. ConclusionIUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. ImplicationsAdolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at 1 year regardless of the indication for utilization.

Connecting Coding to Clinical Policy: Contraception

There are distinct diagnosis and procedure codes for the counseling and/or contraceptive management services personally provided by physicians and other qualified health care professionals (QHPs). This article reviews reporting options for the following services: Contraception counseling as part of a comprehensive preventive medicine service Contraception counseling on a separate date from a comprehensive preventive medicine service Initiation of contraception Surveillance of contraception Diagnosis codes for contraception services and procedure codes for some related services are also reviewed.

Pathways to medical abortion self-use (MASU): results from a cross-sectional survey of women’s experiences in Kenya and Uganda

BackgroundIn Kenya and Uganda, unsafe abortions are a leading cause of maternal mortality. The new WHO policy guidelines on the safe termination of pregnancies up to 9 weeks lack information on women’s experiences with self-administered medical abortion (MA), impeding the development of interventions to increase MA use. This study aimed to comprehend women’s experiences with MA in Kenyan and Ugandan pharmacies.MethodsA cross-sectional mixed-methods survey utilized data from medical registers in 71 purposefully identified pharmacies and clinics dispensing MA drugs between September and October 2021. Forty women who were MA users participated in focus group discussions. The main outcome variables were: sources of MA information, costs of MA services, complications from MA, pain management, follow-up rates, and use of post-MA contraception. Quantitative data were analyzed using Stata 15, while qualitative thematic analysis was conducted using Dedoose qualitative analysis software.Results73.6% of 2,366 women got an MA, both in Kenya (79%) and Uganda (21%). Most (59.1%) were walk-in clients. Kenya had significantly more women referred for MA (49.9%) than Uganda (10.1%) (p 0.05). Friends and family members were the main sources of MA information. The median cost of MA was USD 18 (IQR 10–60.5) in Kenya and USD 4.2 (IQR 2–12) in Uganda. Most MA clients received pain management (89.6%), were followed up (81%), and received post-MA contraception (97.6%). Qualitative results indicated a lack of medicines, high costs of MA, complications, stigma, and inadequate training of providers as barriers to MA use.Conclusions and recommendationsCommunities are a valuable information resource for MA, but only if they have access to the right information. A relatively weak health referral system in Uganda highlights the importance of pharmacies and clinicians collaborating to support clients’ abortion needs and contraceptive use after medical abortion (MA). Low client follow-up rates show how important it is to make sure pharmacy technicians know how to give MA correctly. Finally, it is crucial to strengthen the supply chain for MA products in order to eliminate cost barriers to access.

Long-acting reversible contraception in gender-diverse adolescents and young adults: Outcomes from a multisite collaborative

ObjectivesThis study aimed to describe the clinical experience of gender-diverse adolescents and young adults receiving long-acting reversible contraception (LARC). Study designThis was a secondary analysis of prospectively collected quality improvement data among gender-diverse adolescents and young adults receiving LARC in four adolescent medicine clinics. ResultsMost attempted insertions (59/63) were successful. A majority (54%) chose LARC for both contraception and menstrual management. Pelvic pain/cramping and unsatisfactory bleeding were reported side effects. One known expulsion and six known LARC removals occurred. ConclusionsGender-diverse adolescents and young adults had high rates of successful LARC insertion and demonstrated a side effect profile similar to a broader adolescent and young adult population seeking LARC care. ImplicationsLARC is an important and well-tolerated method of menstrual management and contracention in gender-diverse adolescents and young adults, although more investigation is needed to understand how gender-affirming testosterone therapy may impact the LARC experience in this population.

552-P: Disparities in Preventive Reproductive Health Services in Women with Type 1 and Type 2 Diabetes

About 50% of (~13 million) reproductive aged women with Type I or II diabetes receive any preconception care. Even fewer receive contraceptive counseling, or other vital reproductive health services. This scoping review aimed to explore if reproductive aged women with diabetes receive adequate preventative reproductive health services compared to women without diabetes. A systematic search strategy of the published literature was built and applied in multiple databases (PubMed, Web of Science, Cochrane). Interventional and observational studies describing access to reproductive health services among reproductive-aged women with compared to those without diabetes were included. The Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search strategy identified 6785 unique records. A two reviewer method was used to screen abstracts, with 41 studies identified to be relevant. These studies were separated into the domains of contraception counseling (N=20), cervical cancer screening (N=12), counseling/screening for sexually transmitted infections (N=3), and preconception counseling (N=12). We did not include studies focusing on prenatal care, pregnancy, menstrual irregularities, sexual dysfunction, or breast cancer screening. While a vast amount of literature exists related to diabetes and pregnancy, this scoping review draws attention to the lack of research focused on the reproductive health of women with diabetes prior to pregnancy. The majority of available literature focuses on contraception and preconception management, consistently demonstrating that women with diabetes lack adequate preventative reproductive healthcare compared to their nondiabetic counterparts. Far less evidence exists for sexually transmitted infection risk assessment and screening. It is imperative that future research focus on ways to mitigate disparities in access to reproductive health services for women with diabetes. Disclosure M.Treasure: None. P.S.Nourbakhsh: None. A.Osuna-garcia: None. S.C.Esteves: None. L.N.Kransdorf: None. L.E.Wisk: None.

Perceptions of HIV risk screening strategies among patients seeking abortion, contraception, and pregnancy loss management in the United States

ObjectivesWomen make up nearly a fifth of new human immunodeficiency virus (HIV) infections yearly in the United States, more than half of which could have been prevented with broader use of HIV pre-exposure prophylaxis (PrEP). We aimed to qualitatively assess (1) acceptability of an HIV risk screening strategy and PrEP provision in a family planning setting, and (2) the influence of family planning visit type (abortion, pregnancy loss management, or contraception) on HIV risk screening acceptability. Study designGuided by the P3 (practice-, provider-, and patient-level) model for preventive care interventions, we conducted three focus group discussions including patients who had experienced induced abortion, early pregnancy loss (EPL), or contraception care. We developed a codebook of a priori and inductive concepts, and categorized themes by practice, provider, and patient considerations. ResultsWe included 24 participants. Practice-level considerations included overall positive feelings about being screened for PrEP eligibility during family planning visits, though some expressed reservations about screening during EPL visits. Provider-level themes included the concept of screening tools as entry points into conversation and education, and the importance of nonjudgment in discussing sexually transmitted infection (STI) prevention. Participants often had to initiate STI prevention discussions and felt that contraception was overemphasized by their providers compared with STI prevention and PrEP care. Patient-level themes included the stigma of STIs and oral PrEP, and the dynamic nature of STI risk. ConclusionsParticipants in our research had genuine interest in learning about PrEP during family planning visits. Findings from our research support the consistent inclusion of STI prevention education into family planning clinical practice using patient-centered STI screening methods. ImplicationsFamily planning encounters, including visits for contraception and abortion, are generally appropriate times to discuss HIV PrEP. Patient-centered conversations are an important adjunct to HIV risk screening tools.

Intervening on women's health for rural young breast cancer survivors: A study protocol

IntroductionFrom diagnosis to post-treatment, many young breast cancer survivors (YBCS) experience infertility, limited contraception choices, concern about pregnancy safety, and menopausal symptoms. Clinical guidelines recommend oncofertility care (counseling and/or clinical services that meet fertility, contraception, pregnancy health and/or menopausal symptom management needs) throughout the cancer care continuum. However, significant oncofertility care gaps exist in rural, community oncology settings. Materials and methodsWe describe the design of an interrupted time series, effectiveness-implementation hybrid clinical trial that evaluates a multi-component intervention to improve YBCS engagement in oncofertility care. The intervention is comprised of 1) oncology clinic-based oncofertility needs screen; 2) a women's health survivorship care plan in Spanish and English; 3) remote patient navigation; and 4) telehealth oncofertility consultation. During the pre-intervention period (12 months), usual care will be delivered. During the intervention period (15 months), the multi-component intervention will be implemented at two rural oncology clinics with largely Latina, Spanish-speaking populations. The primary outcome of YBCS (n = 135) engagement in oncofertility care will be collected from medical record review. We will also collect validated patient-reported outcomes. Informed by the Exploration Preparation Implementation Sustainment (EPIS) implementation science framework, we will integrate qualitative and quantitative data to explore whether and how the intervention was effective, acceptable, appropriate, and delivered with fidelity. DiscussionOur overall goal is to speed implementation of a scalable oncofertility care intervention for YBCS in underserved areas to reduce disparities and improve reproductive health and quality of life. Trial registrationClinicaltrials.gov Identifier: NCT05414812

Adolescent Contraception Management: A Review of Medical Options

Disparity in access to family planning and contraceptive services remains disproportional within underserved communities. The United States ranks highest among developed countries for rates of adolescent unplanned pregnancies. This coupled with legal implications including confidentiality further contribute to a lack of access to medically appropriate, safe, and reversible contraceptive options. The nurse practitioner is a key partner in the implementation of the evidence-based recommendations by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. This article reviews medical options for the management of adolescent contraception.

Population-level use of gynecological health services by female youth with intellectual/developmental disabilities in British Columbia Canada

BackgroundThere is evidence that female youth with intellectual/developmental disabilities (IDD) experience poorer gynecological care compared to female youth without disabilities. ObjectiveThe objective of this study was to obtain baseline data on visits to a health care provider for a gynecological issue for females with IDD and compare that information to the experiences of female youth without IDD. MethodsThis study is a retrospective cohort study using population-level administrative health data from 2010 to 2019 for females aged 15–24 years, with and without IDD. Results6452 female youth with IDD and 637,627 female youth without IDD were identified in the data. Over the ten-year period, 53.77% of youth with IDD and 53.68% of youth without IDD had a visit to a physician for a gynecological issue. However, as females with IDD aged, the number of people seeing a physician for a gynecological issue decreased. In the group aged 20–24 years, 15.25% of females with IDD and 24.47% of females without IDD (p < 0.0001) had a Pap test done at any time; 25.94% of females with IDD had a visit for contraception management and 28.38% of females (p < 0.0001) without IDD had a visit for contraception management. Gynecological care also varied by type of IDD. ConclusionsFemales with IDD had a similar number of visits for a gynecological issue as female youth without IDD. However, the reasons for visits and the age at which visits occurred differed between youth with and without IDD. As females with IDD transition into adulthood, gynecological care must be maintained and improved.