Sexual and reproductive health problems among women with mental illness attending tertiary care psychiatric outpatient clinic in India: A cross-sectional study.

Objectives: Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. Materials and Methods: This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Results: Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Conclusion: Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.

A Qualitative Study to Identify the Perceptions of Adherence to Antiretroviral Therapy among People Living with HIV.

BACKGROUND: Primary health care for marginalized population group such as people living with HIV (PLHIV) is challenging as evidenced by the alarming magnitude of nonadherence to freely available antiretroviral therapy (ART). Successful viral suppression depends on optimum adherence to ART which in turn depends on the client's perceptions toward adherence and ART. OBJECTIVES: This study aims at identifying the prevailing perceptions of PLHIV toward adherence to ART. MATERIALS AND METHODS: A qualitative research was conducted through 7 focused group interviews and 5 in-depth interviews among 44 PLHIV across 3 ART centers of different organizational characteristics. Interviews were transcribed and analyzed through a thematic content analysis approach. Unique perceptions and thoughts identified from each interview were listed and regrouped according to related themes. Data were triangulated across different sources of information such as key informant interview and review of the literature. RESULTS: The median age of PLHIV was 36 years, and the mean duration of ART was 3.53 years. A qualitative analysis of transcribed data yielded stigma, cost, distance, type of health-care setting, and desire for living longer as dominant themes in perceptions of PLHIV toward ART. CONCLUSION: Overall 70% of perceptual expressions and 15 themes out of 30 themes were related to person related factors that determine the adherence to ART.

Predictors of adherence to antiretroviral therapy among PLHIV.

Adherence to antiretroviral therapy (ART) is of paramount importance to achieve the optimum control of viral load and progression of disease among people living with HIV (PLHIV). An overview of systematic reviews to summarize the factors influencing adherence to ART was not found in the literature; hence, the systematic review of systematic reviews was conducted to provide global view of factors influencing adherence to ART. Systematic reviews ever published till May 2018 were searched and retrieved between May 2015 and May 2018 from Cochrane and PubMed databases. Among 88 studies initially chosen based on inclusion and exclusion criteria, 22 were selected for further analysis. Qualitative analysis of included reviews was made through narrative synthesis approach. Results of the study show that among the 60 factors enlisted, 5 were most highly significant, 7 were highly significant, 19 were moderately significant, and 29 were emerged as significant factors. Substance abuse, financial constraints, social support, HIV stigma, and depressive symptoms were the most highly significant factors influencing the adherence, whereas age, employment status, long distance, side effects of drugs, pill burden, education, and mental health were regarded as highly significant factors influencing ART. Fatigue, away from home, being too busy in other things, simply forgot, and beliefs about the necessity of ART emerged as significant factors. The study concludes that findings from the overview give global insight into the factors determining adherence to ART which would further influence the innovations, program, and policy-making to mitigate the problem of nonadherence.