{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T10:19:26Z","timestamp":1769941166434,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,5,31]],"date-time":"2013-05-31T00:00:00Z","timestamp":1369958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,10]]},"abstract":"Objective<\/jats:title>To analyse the current provision of long\u2010acting reversible contraception (LARC<\/jats:styled-content>) and clinician training needs in HIV<\/jats:styled-content>\u2010prevalent settings.<\/jats:p><\/jats:sec>Design<\/jats:title>Nationally representative survey of clinicians.<\/jats:p><\/jats:sec>Setting<\/jats:title>HIV<\/jats:styled-content>\u2010prevalent settings in S<\/jats:styled-content>outh A<\/jats:styled-content>frica and Z<\/jats:styled-content>imbabwe.<\/jats:p><\/jats:sec>Population<\/jats:title>Clinicians in S<\/jats:styled-content>outh A<\/jats:styled-content>frica and Z<\/jats:styled-content>imbabwe.<\/jats:p><\/jats:sec>Methods<\/jats:title>Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n<\/jats:italic>\u00a0=\u00a01444) to assess current clinical practice in the provision of LARC<\/jats:styled-content> in HIV<\/jats:styled-content>\u2010prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs.<\/jats:p><\/jats:sec>Main outcome measure<\/jats:title>Multivariable logistic regression of contraceptive provision and clinician training needs.<\/jats:p><\/jats:sec>Results<\/jats:title>Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUD<\/jats:styled-content>s), 4% levonorgestrel\u2010releasing IUD<\/jats:styled-content>s and 16% contraceptive implants. Clinicians\u2019 perceptions of patient eligibility for IUD<\/jats:styled-content> use were overly restrictive, especially related to HIV<\/jats:styled-content> risks. Less than 5% reported that IUD<\/jats:styled-content>s were appropriate for women at high risk of HIV<\/jats:styled-content> or for HIV<\/jats:styled-content>\u2010positive women, contrary to evidence\u2010based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV<\/jats:styled-content>. Most clinicians (82%), however, felt that IUD<\/jats:styled-content>s were underused by patients, and over half desired additional training on LARC<\/jats:styled-content> methods. Logistic regression analysis showed that LARC<\/jats:styled-content> provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Clinician competency in LARC<\/jats:styled-content> provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV<\/jats:styled-content>\u2010positive and at\u2010risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence\u2010based training in LARC<\/jats:styled-content> to reduce unintended pregnancy and associated morbidities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12290","type":"journal-article","created":{"date-parts":[[2013,5,31]],"date-time":"2013-05-31T09:46:47Z","timestamp":1369993607000},"page":"1386-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Provision of long\u2010acting reversible contraception in HIV<\/scp>\u2010prevalent countries: results from nationally representative surveys in southern Africa"],"prefix":"10.1111","volume":"120","author":[{"given":"J","family":"Morse","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Duke University Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Chipato","sequence":"additional","affiliation":[{"name":"UZ\u2010UCSF Collaborative Programme on Women's Health Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Blanchard","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health Cambridge MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Nhemachena","sequence":"additional","affiliation":[{"name":"South African Medical Research Council HIV Prevention Research Unit Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Ramjee","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Blum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of California Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Saleeby","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CC","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of California Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,31]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"SedghG JussainR BankoleA SinghS.Women with an unmet need for contraception in developing countries and their reasons for not using a method. 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New York: Guttmacher Institute; 2007."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(03)00078-7"},{"key":"e_1_2_6_4_1","volume-title":"Medical Eligibility Criteria for Contraceptive Use","author":"World Health Organization (WHO)","year":"2010"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.12.1376"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.030049"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1783\/147118904322701956"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1783\/147118904322995474"},{"key":"e_1_2_6_9_1","unstructured":"Centers for Disease Control and Prevention.U.S. Medical Eligibility Criteria for Contraceptive Use 2010; Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use 4th edn.MMWR Early Release2010;59:May 28."},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.15.1969"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-011-0109-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31824f9eaf"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.13.1715"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318173fd83"},{"key":"e_1_2_6_15_1","first-page":"564","article-title":"Evidence\u2010based IUD practice: family physicians and obstetrician\u2013gynecologists","volume":"44","author":"Harper CC","year":"2012","journal-title":"Fam Med"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000363778.58203.b6"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01726-4"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.10.010"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.2307\/3583464"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006675226663"}],"container-title":["BJOG: An International Journal of Obstetrics & Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.12290","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.12290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T08:20:32Z","timestamp":1696321232000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.12290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,31]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2013,10]]}},"alternative-id":["10.1111\/1471-0528.12290"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.12290","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,31]]},"assertion":[{"value":"2013-03-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-05-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}