Evaluating the performance of a risk assessment score tool to predict HIV acquisition among pregnant and postpartum women in Kenya.

Background: Clinical risk score tools require validation in diverse settings and populations before they are widely implemented. We aimed to externally validate an HIV risk assessment tool for predicting HIV acquisition among pregnant and postpartum women. In the context of prevention of mother-to-child transmission programs, risk score tools could be used to prioritize retesting efforts and delivery of pre-exposure prophylaxis (PrEP) to pregnant and postpartum women most at risk for HIV acquisition while minimizing unnecessary perinatal exposure.

There's an App for That: Exploring the Market for Contraceptive Fertility Tracking Apps in the Philippines.

For generations, women have relied on fertility awareness methods to plan and prevent pregnancy, for over a decade, many have been aided by digital tools to do so. New contraceptive fertility tracking apps (CFTAs)-that are backed by clinical efficacy trials to support their effectiveness as contraception-have the potential to enhance method choice and offer users a unique contraceptive option, but there is little evidence to inform the decisions around expanding access, particularly in low-and middle-income countries. We conducted a mixed methods study with quantitative online surveys (n = 1600) and qualitative interviews (n = 36) to explore the potential appeal of and demand for a hypothetical CFTA in one such market, the Philippines.

Preference-aligned fertility management among married adolescent girls in Northern Nigeria: assessing a new measure of contraceptive autonomy.

Introduction: Universal access to sexual and reproductive healthcare-including family planning (FP)-is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national or global levels.

Methods: We collected a modified version of preference-aligned fertility management (PFM), a newly proposed rights-based FP outcome measure which we operationalised as concordance between an individual's desired and actual current contraceptive use. We also constructed a modified version (satisfaction-adjusted PFM) that reclassified current contraceptive users who wanted to use contraception but who were dissatisfied with their method as not having PFM.

Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study.

Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot.

Task shifting and community engagement as the keys to increasing access to modern contraception: Findings from mixed methods operational research in coastal Kenya.

Rationale: Kilifi County, Kenya, has a modern contraceptive prevalence of 44%, compared to the national prevalence of 61%. In 2018, the Government of Kenya and Population Services Kenya implemented a pilot project in Kilifi to improve contraceptive awareness and access.

Aims And Objectives: The Riziki Demonstration Project task shifted contraceptive injectable and implant provision to community health extension workers (CHEWs) and supported community engagement led by community health volunteers (CHVs).

Evaluating Counseling for Choice in Malawi: A Client-Centered Approach to Contraceptive Counseling.

Introduction: High-quality contraceptive counseling is critical for supporting full, free, and informed contraceptive decision-making. However, the quality of family planning counseling remains poor globally and is too often not tailored to the individual client. The Counseling for Choice (C4C) approach comprises provider tools and training to structure counseling to center clients' self-identified priorities and to provide relevant information and anticipatory side effects counseling.

Demand Forecasting Approaches for New Contraceptive Technologies: A Landscape Review and Recommendations for Alignment.

Introduction: Market size estimations and demand forecasts use a variety of methodological approaches to inform decision-making around new (and lesser-used) contraceptive methods. For contraceptive products already available at scale in a market, historical procurement and consumption data can help to inform these forecasts. However, little published guidance is available on appropriate approaches to estimating contraceptive demand in the absence of historical data.

Differences in contraceptive prices between and within family planning outlets in urban and semiurban Nigeria: a prospective cohort study.

Background: There is a lack of comprehensive evidence assessing variability and volatility in contraceptive prices. Improved understanding of contraceptive pricing, both between and within public and private service delivery points situated within complex, mixed health systems, may improve understanding of contraceptive access from the perspective of the consumer.

Objective: To describe variability and volatility in contraceptive method prices within localized urban and semiurban markets in Nigeria.

Trajectories of method dissatisfaction among Kenyan women using modern, reversible contraception: A prospective cohort study.

Objectives: Evidence on method dissatisfaction among current contraceptive users is sparse. Group-based trajectory modeling presents a novel approach to describing method dissatisfaction.

Study Design: In a cohort of Kenyan women using modern contraception, we identified group-based trajectories of method dissatisfaction over 24 weeks since clinic visit.

Use of a mobile app to capture supplemental health information during pregnancy: Implications for clinical research.

Purpose: Mobile applications ("apps") may be efficient tools for improving the quality of clinical research among pregnant women, but evidence is sparse. We assess the feasibility and generalizability of a mobile app for capturing supplemental data during pregnancy.

Methods: In 2017, we conducted a pilot study of the FDA MyStudies mobile app within a pregnant population identified through Kaiser Permanente Washington (KPWA), an integrated healthcare delivery system.

Incorporating Method Dissatisfaction into Unmet Need for Contraception: Implications for Measurement and Impact.

While unmet need for contraception is commonly used to assess programmatic needs, it inadequately captures the complexity of fertility and contraceptive preferences, including women's satisfaction with their contraceptive method. In their 2019 commentary, Sarah Rominski and Rob Stephenson propose reclassifying dissatisfied current users as having an unmet need for contraception. As revising the current definition based on their proposal would require significant investment to update survey and monitoring systems, understanding the potential impact on current estimates of unmet need is critical.

A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation.

Objective: We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy.

Study Design: Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation ( = 558) and validation ( = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion.

Bypassing high-quality maternity facilities: evidence from pregnant women in peri-urban Nairobi.

Utilization of high-quality maternal care is an important link along the pathway from increased facility-based delivery to improved maternal health outcomes, however women in Nairobi do not all deliver in the highest quality facilities available to them. We explored whether women living in peri-urban Nairobi who live nearby to high-quality facilities bypassed, or travelled farther than, their nearest high technical quality facility using survey data collected before and after delivery from women (n = 358) and from facility assessments (n = 59). We defined the nearest high technical quality facility as the nearest Comprehensive Emergency Obstetric and Newborn Care (CEmONC) capable facility to each woman's neighbourhood.

The Utility of SMS to Report Male Partner HIV Self-testing Outcomes Among Women Seeking Reproductive Health Services in Kenya: Cohort Study.

Background: Use of SMS for data collection is expanding, but coverage, bias, and logistical constraints are poorly described.

Objective: The aim of this study is to assess the use of SMS to capture clinical outcomes that occur at home and identify potential biases in reporting compared to in-person ascertainment.

Methods: In the PrEP Implementation in Young Women and Adolescents program, which integrated pre-exposure prophylaxis (PrEP) into antenatal care, postnatal care, and family planning facilities in Kisumu County, Kenya, HIV-negative women 14 years of age or older were offered oral HIV self-tests (HIVSTs) to take home to male partners.

Free contraception and behavioural nudges in the postpartum period: evidence from a randomised control trial in Nairobi, Kenya.

Background: Short birth intervals are a major risk factor for poor maternal and newborn outcomes. Utilisation of modern contraceptive methods during the postpartum period can reduce risky birth intervals but contraceptive coverage during this critical period remains low.

Methods: We conducted a randomised controlled experiment to test whether vouchers for free contraception, provided with and without behavioural 'nudges', could increase modern contraceptive use in the postpartum period.

Providing support to pregnant women and new mothers through moderated WhatsApp groups: a feasibility study.

Background: Group-based health services can improve maternal and newborn health outcomes. Group antenatal care and participatory learning and action cycles (PLA) with women's groups have been cited by the WHO as health systems interventions that can lead to improvements in adherence to care and health outcomes in pregnancy and the postpartum period.

Methods: We used a mixed-methods approach to assess the feasibility of a light touch group-based support intervention using the WhatsApp text-messaging platform.

Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya.

Background: Since the 2009 WHO and UNICEF recommendation that women receive home-based postnatal care within the first three days after birth, a growing number of low-income countries have explored integrating postnatal home visit interventions into their maternal and newborn health strategies. This randomized trial evaluates a pilot program in which community health workers (CHWs) visit or call new mothers three days after delivery in peri-urban Kiambu County, Kenya.

Methods: Participants were individually randomized to one of three groups: 1) early postnatal care three days after delivery provided in-person with a CHW using a simple checklist, 2) care provided by phone with a CHW using the same checklist, or 3) a standard of care group.