Reproductive Health Clinics Research Articles

Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro, Tanzania

Background/objectivesLate presentation of congenital cataract in the developing world has led to poor outcomes such that cataract is the leading cause of childhood blindness. Our hypothesis was that, sensitivity of red-reflex testing is greater than sensitivity of torchlight examination. We aimed to compare sensitivity of new red reflex screening tools and assess the feasibility of Arclight red reflex screening in the community.Subject/methodsWe compared the diagnostic accuracy of four different screening tools for cataract and retinoblastoma performed by ophthalmic nurses, using a clinic based enriched sample of 41 positives and 60 negatives. We then conducted a separate feasibility study, training non-specialist community nurses. Following the training, community nurses examined 2827 children <5 years with Arclight who were attending their clinics for growth monitoring and immunisation.FindingsDiagnostic accuracy study: estimated sensitivities were 97.6% for Catcam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight. Estimated specificities were above 90% for Catcam, Arclight and torchlight and 87% for PEEK retina. Feasibility study: twenty-four out of 2728 children screened failed community screening, seven were true positive (six cataract, one retinoblastoma). Prevalence of bilateral cataract was 1.5/1000 (95% CI: 0.40–3.75 per 1000).ConclusionsArclight and CatCam have higher sensitivity than torchlight, are easy to learn and use by primary health care nurses. Red reflex testing should be recommended in the WHO guidelines instead of torchlight examination to help early detection of potential blinding causes including congenital cataract and retinoblastoma.

Deeply Inserted Contraceptive Implants: Where Are They Placed? Experience From a University Hospital Center [12I

INTRODUCTION: We describe our experience in a Family Planning specialty clinic for patients referred for nonpalpable or deep etonogestrel (ENG) implant removal. METHODS: We reviewed the charts of 77 patients evaluated for difficult ENG implant removal from September 2014 through September 2019. In our clinic, we localize implants using high-frequency ultrasound and then proceed with removal under local anesthesia. RESULTS: Most implants were placed in reproductive health clinics (n=26; 34%) and community clinics (n=16; 21%) versus academic medical centers (n=6; 8%) and abroad (n=4; 5%). 25 patients (32%) did not recall where their implant was inserted. We successfully removed 72 implants (94%; 45 suprafascial, 27 subfascial) in the office; one subfascial implant was removed in the OR and four were lost to follow up. Non-obese patients were more likely to have a subfascial implant (36/51) than obese patients (3/24; P=.0014). Nonpalpable subfascial implants were also more likely to be found in individuals with BMI&lt;30 (19/21, P=.0004). Of the patients not desiring immediate pregnancy (n=64), 17% chose another implant (n=11), 16% picked a different LARC method (n=10), 38% chose a combined hormonal contraceptive method (n=24), and 28% opted for condoms or nothing for contraception (n=18). CONCLUSION: In our patient population, most had their implants placed at reproductive health or community clinics. Deeply inserted implants can be successfully removed in the office by experienced providers and many patients choose to continue with the implant for contraception despite complications.

Centring sexual and reproductive health and justice in the global COVID-19 response

Centring sexual and reproductive health and justice in the global COVID-19 response

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial.

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

Right care: Improving timeliness and promoting preventive health in a lower socioeconomic reproductive health clinic.

Missed prevention opportunities are a financial burden to the US health care system and result in excess consumption of resources, reduced quality of life, increased morbidity, and premature death. High staff turnover and inefficient practices at a local health department caused long patient wait times and missed opportunities for preventive health care. The project aim was to improve timeliness through Right Care in a lower socioeconomic reproductive health clinic while decreasing patient cycle time by 10% in 90 days. We used four plan-do-study-act cycles incorporating tests of change that focused on team and patient engagement and two process changes. The interventions included a care coordination huddle, an infant feeding decision aid to better understand patient values, a sexual health screening tool to identify prevention opportunities, and a redesigned patient-centered discharge process to improve efficiency. Over 90 days, the receipt of Right Care increased while patient cycle time decreased by 2.6%. The team improved function with a mean huddle effectiveness score increase from 2 to 4.4 (1-5 Likert scale). Intent to breastfeed increased by 49% (35%-52%), and identification of preventive care needs increased by 320% (15%-63%). Preventive care follow-up remained unchanged at 26% with the new discharge process, identifying weaknesses in the health department referral systems. Standardized tools and processes improved primary prevention opportunities at a local health department while reducing patient cycle time. The tools improved documentation of intent to exclusively breastfeed, increased preventive care identification, and streamlined the discharge process; while demonstrating a systems-level gap for long-term follow-up.

Why girls get married early in Sarawak, Malaysia - an exploratory qualitative study

BackgroundChild marriage, a marriage that involves someone under the age of 18 years, is a long-standing social issue in Sarawak state, Malaysia. The state has taken several measures to improve situations of inequity for women who get married early; however, the practice is still a common part of the tradition and culture. The aim of this study was to explore the factors leading to child marriage in Sarawak state, Malaysia.MethodsThis was an exploratory qualitative study conducted via semi-structured interviews with twenty-two women who were married when they were younger than 18 years old in Kuching, Sarawak, Malaysia. Participants were recruited through purposive and convenient sampling with the use of data from a reproductive health clinic and recruitment in villages. Thematic analysis was used for data analysis.ResultsFour overarching themes were identified: health risk behaviour, family poverty, early marriage as fate, and family disharmony.ConclusionsIn-depth understanding of the unique factors leading to child marriage locally will facilitate the introduction of new approaches to interventions to eradicate child marriage in Sarawak state, Malaysia.

Teenager, Parent, and Clinician Perspectives on the Electronic Health Record.

* Abbreviation: EHR — : electronic health record Management of adolescent confidentiality and sensitive services has always posed challenges to medical clinicians. State and federal laws, as well as institutional policies, may dictate what information can or cannot be shared by a clinician with a parent or guardian of an adolescent. Clinicians concerned about diagnosis disclosure via insurance notifications may limit their testing or prescription, refer sensitive services to more specialized reproductive health clinics, or appeal to noninsurance funders to cover sensitive testing and confidential prescriptions. All factors may be burdensome to patients, families, and/or clinicians. With the advent of electronic health records (EHRs), clinicians face additional challenges for preserving adolescent confidentiality.1 Clinicians are frequently in the difficult situation of balancing their patient’s need for confidentiality with creating an accurate and complete medical record that enhances coordination of care with families and other clinicians.2 Current EHR systems are often extremely limited in their ability to ensure confidentiality of items such as medications or problem lists across the many interfaces in which these items could be disclosed (such as after-visit summaries, shared or open notes, problem and medication lists within the portal system).3 Whereas some institutions have a practice of using confidential note types or confidential encounters for sensitive information, this practice relies on clinicians to consistently document the appropriate information in the appropriate location. Institutions have also used custom-built functionality for excluding specific laboratory values or medications from being shared within the portal, but this is a labor-intensive undertaking that requires … Address correspondence to Jennifer L. Carlson, MD, Division of Adolescent Medicine, School of Medicine, Stanford University, 770 Welch Rd, Suite 100, Palo Alto, CA 94304. E-mail: carlson2{at}stanford.edu

High Willingness to Participate in Partner Notification among Women Attending Reproductive Health and STI Clinics in Shenzhen, China: A Cross-Sectional Study.

Genital Chlamydia trachomatis (CT) is one of the most common sexually transmitted infections (STI) worldwide. We explored the factors associated with willingness to participate in partner notification (PN) among women attending reproductive health and STI clinics in Shenzhen, China. An anonymous questionnaire was used to collect the sociodemographic characteristics, STI histories, and willingness to participate in routine CT screening and partner notification. In total, 87.31% (n = 10,780) of participants were willing to notify their sex partner(s) if they were diagnosed with a CT infection. Willingness to complete PN was significantly associated with: being married, residing in Shenzhen ≥1 year, having completed junior college or higher, not currently reporting STI-related symptoms, willing to have routine CT screening, and having a correct understanding of the health sequelae of CT infection. Nearly all women surveyed at reproductive health and STI clinics in Shenzhen reported willingness to complete PN. Promoting PN in these settings could help detect a large number of additional CT cases. Our findings provide evidence and implications for public health interventions on PN and suggest that targeted interventions are urgently needed for particular subpopulations including those not currently married, with shorter residency, lower education, and less awareness about the dangers of CT infection.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years; 80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Exploring the institutional sustainability of adolescent reproductive and sexual health program in Tripura

Background: Adolescents are at the peak of growth velocity and warrant special consideration as they undergo enormous psychological, physical as well as cognitive changes. The Government of India implemented friendly adolescent reproductive and sexual health (ARSH) clinics to improve healthcare services all over the country. However, there is lack of information on the sustainability of the programme.Methods: Community workers and public health workers from randomly selected twenty sub centres for intervention from West Tripura district and control from the adjacent Khowai district were selected. Knowledge prior and post intervention at both sites of the health workers was assessed by a self-administered questionnaire on 0 day, at 3, 6 and 12 months. Difference of knowledge score was analysed by paired t-test.Results: The mean knowledge score significantly differed at pre-intervention and immediately post intervention (p&lt;0.01). The knowledge score was sustained even after 12 months of intervention among public (14.63±3.01) and community health workers (12.53±2.91). However, at the control site, a gradual decrease was noted over duration of 12 months. Intervention also considerably increased the utilization of ARSH clinics by both male and females in comparison to previous year’s data.Conclusions: The intervention and increased sustainability of acquired knowledge over 12 months seem to enhance the capacity for the adolescent clinics. Therefore, training the health workers to manage various sexual and reproductive health issues along with creating a friendly environment for adolescents is indispensable in the present setting.

Sexual Activity, Knowledge of Contraceptives Use among Females Choosing Termination of Pregnancy at a Provincial Clinic in South Africa

This study investigated sexual activity, knowledge of contraceptives use among females choosing termination of pregnancy (TOP) at a provincial clinic in South Africa.&#x0D; &#x0D; This was a quantitative and observational study in the form of a cross-sectional survey. A pre-tested self-administered questionnaire was used to collect data from 61 respondents who had terminated their pregnancies. Almost ninety-two (91.8%) percent of the respondents were single women between 18 and 27 years of age. Their level of education showed that 32% had completed high school, 28% were high school learners, 21.1% were tertiary education level learners and 1.8% had tertiary education. The frequency of sexual activity was mostly once a month (40%), followed by once a week (36.5%). Unemployment was high (36%), making the respondents dependent on government grants. Most of the women were aware of contraceptives methods (88.5%). The majority of the respondents (75.4%) have heard about emergency contraceptives (EC), while only 11.5% had never heard of contraceptives in general. The condom was the most popular method (54.1%), followed by the injection (45.9%). However, although 88.5% and 75.4% have heard of emergency contraceptives, their knowledge of contraceptives in general was very low. Contraceptives were used by 78.6% before termination of their pregnancy (TOP) and the most frequently used method was the injection at 36.6%. The respondents were the initiators of TOP. &#x0D; &#x0D; The researchers recommended that awareness of contraceptives should be promoted, and programmes aimed at changing the behaviour of sexually active females should be designed in order for them to make use of reproductive health services and family planning. Continuous education on sexual activities and contraceptives needs to be given to women visiting a reproductive health clinic. Policymakers should facilitate access to modern contraceptives and promote their effectiveness in all disadvantaged communities, thus addressing the root cause of the termination of unplanned pregnancies.

Complications following use of single rod etonogestrel implant (Implanon).

Objectives: To determine the frequency of complications and side effects of single rod etonogestrel implant (implanon). Study Design: Descriptive case series. Setting: At Contraceptive clinic, (Reproductive Health Clinic (Contraception), antenatal clinic of the Department of Obstetrics &amp; Gynaecology, Nishtar Hospital Multan. Period: From November 2014 to November 2016. Material &amp; Methods: The sample included 72 healthy active women. The final outcome in this study was efficacy. Results: Client mean age was 28.07±4.88 years. Usually clients 57 (79.2%) were 1-4 para. 5 (6.9%) clients complain of pain, out of which only 4 had pain at insertion site and 1 had pain at insertion site and also in stomach. No side effects were observed 55 clients (67.4%) main complains about menstrual disturbance like 26 (36.1%) having amenorrhea. Continuous bleeding was the main complain in 9 clients (12.5%), heavy menstruation was found in 7 (9.7%), 10 (13.9%) had irregular bleeding. Prolonged bleeding was present in 2 clients (2.8%), 7 (9.7%) complain of spotting, 10 (13.9%) had no menstruation problem. Conclusion: The results of this study showed that majority of the clients had amenorrhea.

Sexual health services in the Arab region: Availability, access, and utilisation

ABSTRACTSexual health is shaped by cultural, economic, and social norms in society. In the Arab region, cultural sensitivities and taboos surrounding sexuality are prominent and may prevent individuals from accessing and utilising sexual health services. It is important to map out available sexual health services to identify the challenges in availability, access, and treatment, and determine opportunities for improvement. We collected data on sexual health services through (1) relevant published and unpublished literature, (2) Arab media which included forums, websites, blogs and posts, and online surveys conducted in the Arab region, (3) a questionnaire emailed to sexual and reproductive health experts, organisations, clinics, and non-governmental organisations (NGOs), (4) phone and in-person formal and informal interviews with sexual health experts in the field, and (5) advice and recommendations from sexual health experts attending a World Health Organization (WHO) consultation meeting in Dubai related to sexual health in the Arab region. Although there is significant progress when it comes to the availability and provision of sexual health services in Arab countries, there is still a lot to be done to ensure that appropriate needs are met. This study discusses the implication of findings to inform programme and policy implementation in the region.

Reasons for requesting removal of the hormonal implant, Implanon NXT, at an urban reproductive health clinic in KwaZulu-Natal, South Africa.

The contraceptive implant, Implanon NXT, was introduced in South Africa (SA) in 2014 and, although it offers multiple advantages, users may request to have it removed early for several reasons. The number of insertions of Implanon NXT has declined in SA and there have been concerns about early removals. To gain an understanding of patterns of Implanon NXT use, reasons for requesting removal and duration of use at the time of requesting removal. This was a cross-sectional study conducted at an urban public-sector reproductive health clinic in the eThekwini District of KwaZulu-Natal, SA. A total of 120 women ≥18 years of age requesting removal of Implanon NXT completed an interviewer-administered questionnaire that probed experiences of use and reasons for removal. Data were collected electronically on Wits REDCap (Research Electronic Data Capture) and analysed using Stata 14 (StataCorp, USA). The study was conducted from 2017 to 2018. A total of 120 women were interviewed. Their mean age was 28 (range 19 - 44) years and most women (n=103; 85.8%) had completed secondary school. The majority were black (n=115; 95.8%) and unmarried (n=102; 85%). Implants had been inserted primarily by nurses (n=110; 91.7%) at public-sector clinics (n=91; 75.8%). Three-quarters of the women (n=91; 75.8%) requested removal of Implanon NXT because it had reached the intended 3-year duration. Reasons for early removal were mainly due to side-effects, e.g. bleeding problems (n=19; 15.8%), weight gain (n=7; 5.8%), loss of libido (n=2; 1.7%), headaches (n=5; 4.2%), dizziness (n=4; 3.3%) and pain/numbness in the arm (n=2; 1.7%). Just more than half (57.1%) of the women who had received the implant for the intended 3-year duration had requested reinsertion of Implanon NXT. The main reason for requesting removal was that Implanon NXT had reached its intended 3-year duration, and more than half of the women requested reinsertion of the device following removal. Implanon NXT is a highly effective, safe, acceptable, long-acting contraceptive and important in the SA contraceptive method mix.

Acceptability and performance of a nonwoven device for vaginal drug delivery among women and their male partners in KwaZulu-Natal, South Africa

Background: Multipurpose prevention technologies are needed to provide protection against HIV and sexually transmitted infections. Gel-based vaginal microbicides inserted via an applicator are prone to leakage. A novel device for vaginal drug delivery was developed to contain gel-based formulations, aiming to improve gel retention and reduce leakage. The objectives of this study were to assess acceptability and performance of a nonwoven vaginal delivery device.Methods: A nonwoven vaginal delivery device was prepared, pre-saturated with a commercially available water-based lubricant, with a finger pocket for insertion and string for removal. Quantitative and qualitative methods were used to collect data from interviews with 40 women and 10 male partners recruited from a sexual and reproductive health clinic in Durban, KwaZulu-Natal, South Africa. Women wore one device in the clinic and one device overnight or with their partner during intercourse. The primary endpoint was acceptability including comfort, ease of insertion and removal, and opinions on device attributes.Results: Most women said the device was ‘easy’ to insert and remove. Six women reported leakage after insertion and 34 reported having sexual intercourse while wearing the device. One woman was lost-to-follow-up and five women only wore the device overnight because their partners did not agree to intercourse with the inserted device. The best-liked attribute was the device’s lubrication (22 women, 7 men); the least-liked was the removal string (9 women, 8 men).Conclusions: Data are promising for further development of this nonwoven device for vaginal drug delivery.Plain English summaryMultipurpose prevention technologies (MPTs) that protect against HIV and sexually transmitted infections (STIs) are urgently needed. A variety of vaginal gel-based products are actively being researched; however, these products can often have challenges with vaginal leakage and retention. This research investigates the acceptability and performance of a nonwoven device to deliver vaginal gel formulations. The gel used in this study was a currently available marketed personal lubricant. In South Africa, 40 women (and 10 male partners) were recruited and given the opportunity to comment on various device attributes after insertion, overnight wear and sexual intercourse with their male partners. Generally, participants found the device easy to use and acceptable, where many factors possibly contributed to the device’s acceptability (i.e., similarity to tampons, saturation with lubricant, minimal leakage, ease of insertion, comfort during intercourse and the male partners’ willingness to have vaginal intercourse with the device in place). Further studies of the vaginal delivery device for acceptability, safety and efficacy using a gel-based formulation with an active ingredient are warranted.

In-depth examination of issues surrounding the reasons for child marriage in Kelantan, Malaysia: a qualitative study

ObjectiveTo examine individual, familial, community and societal issues surrounding the reasons for child marriage in Kelantan, Malaysia.DesignQualitative study by means of semistructured interviews with women and key informants, using social-ecological...

Characteristics and contraceptive outcomes of women seeking medical or surgical abortion in reproductive health clinics in Cambodia

BackgroundSince the approval of medical abortion in Cambodia in 2010, the proportion of women reporting an abortion has increased. We describe the characteristics and contraceptive outcomes of women seeking medical abortion compared to surgical abortion at four reproductive health clinics in Cambodia.MethodsSecondary data analysis using data collected in the MObile Technology for Improved Family Planning (MOTIF) trial, a single blind, randomized trial of a personalized, mobile phone-based intervention designed to support post-abortion family planning in Cambodia. Baseline interviews were conducted after women had received post-abortion family planning counselling at the clinic, and follow-up interviews were conducted at 4 and 12 months. We used multivariable logistic regression to assess associations between abortion type and baseline characteristics, contraceptive uptake, repeat pregnancy and repeat abortion. We conducted an exploratory analysis to compare the timing of initiation of long-acting (LA) contraception between women having medical versus surgical abortion over the four-month post-abortion period.ResultsOf the 500 women who participated in the trial, 41% had a medical abortion. In multivariate analyses, women undergoing medical abortion were more likely to be urban residents, have a higher level of education, be undecided or not intending to use family planning, and be undecided or intending to have another child. There was no association between type of abortion and contraceptive uptake, repeat pregnancy or repeat abortion. Women who had medical abortion initiated LA contraception post abortion later than women who had surgical abortion.ConclusionsOur results suggest women having a medical abortion in Cambodia have different baseline characteristics and had delayed uptake of contraception compared to women having a surgical abortion. However, we cannot draw conclusions on the direction of associations and causality. Further research is recommended to explore reasons for the observed findings with view to increasing access to abortion and post-abortion contraception.

Assessment of an electronic and clinician-delivered brief intervention on cigarette, alcohol and illicit drug use among women in a reproductive healthcare clinic

BackgroundWomen are at highest risk for development of a substance use disorder during their reproductive years. We recently evaluated the efficacy of an electronic screening, brief intervention and referral to treatment (e-SBIRT) and a clinician-delivered SBIRT (SBIRT) compared with enhanced usual care (EUC) for reducing overall substance use among women recruited from reproductive health clinics. The present study assessed the impact of the SBIRT interventions within three primary substance subgroups: cigarettes, illicit drugs, and alcohol. MethodsThis is a secondary analysis from a 3-group randomized trial comparing e-SBIRT and SBIRT to EUC. For the present study, participants (N = 439) were grouped according to their primary substance: cigarettes, alcohol, or illicit drugs. Differences in days per month of primary substance use over time between treatment groups were examined using generalized estimating equations, modelling linear as well as quadratic effects of time. ResultsCigarettes were the most frequently reported primary substance (n = 251), followed by illicit drugs (n = 137) and alcohol (n = 51). For primary cigarette use the interaction between the linear effect of time and treatment was significant for SBIRT (β (SE) = −0.067 (0.029), p = .020), but not e-SBIRT, suggesting greater reductions in cigarette use over the first 3 months following treatment with SBIRT compared to EUC. However, the significant interaction of SBIRT with time-squared (β (SE) = 0.009 (0.004), p = .049) showed that reductions in cigarette use attenuated over time, such that after month 3, monthly reductions in cigarette use were similar between groups. Results followed a similar pattern for primary illicit drug use among the e-SBIRT group in which the interaction of e-SBIRT treatment with linear time (β (SE) = −0.181 (0.085), p = .033) and quadratic time (β (SE) = 0.028 (0.012), p = .018) were statistically significant suggesting greater reductions in illicit drug use with e-SBIRT versus EUC, which attenuated with time. Neither SBIRT nor e-SBIRT was associated with a significant reduction in days of alcohol use per month, as compared to EUC. ConclusionsReproductive-age women appear to respond differently to electronic- and clinician-delivered interventions, depending on their primary substance. SBIRT reduced use of cigarettes, and e-SBIRT reduced illicit drug use. Although neither intervention reduced primary alcohol use, the sample size was small (n = 51), suggesting a need for further testing in a larger sample.

Can youth get the contraception they want? Results of a pilot study in the province of Quebec.

Canadian contraceptive providers report many barriers to access to contraception, and perceive youth as particularly vulnerable to these barriers. This study explores Quebec youth's experience of obtaining contraception. A convenience sample of Quebec youth (aged 14 to 21 years) participated in an online anonymous survey of their experiences obtaining contraception. Data were collected between June 1, 2016 and December 31, 2016. One hundred and five youth were eligible to participate. Of these, 95 had used at least one form of contraception. Twelve (13%) reported not being able to obtain their preferred method of contraception, with cost being the most common barrier (N=10). Eleven participants (12%) stopped using their preferred contraceptive method: cost was a factor in four cases, and difficulty with access to the clinic/prescription in seven. Youth who required confidential access experienced more difficulty obtaining contraception (P<0.01). Despite benefitting from universal pharmacare and a network of youth sexual and reproductive health clinics, Quebec youth still experience barriers to obtaining and continuing their preferred contraceptive. Youth who desire confidential care are more likely to experience difficulty obtaining contraception.

28. Acceptance of Expedited Partner Therapy Among Adolescents in an Urban Reproductive Health Clinic

28. Acceptance of Expedited Partner Therapy Among Adolescents in an Urban Reproductive Health Clinic