Showing 41 - 48 of 48 Results for "counseling"

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Interventions are needed to enhance counseling to successfully prepare patients for lifelong therapy. Studies have found that patients were not well prepared for life-long therapy; that adherence rates decreased over time and hospital costs increased for those who were less adherent. A study found that patients believed that ART killed other patients, not understanding that initiating ART at high viral loads and low CD4 counts reduces the likelihood of survival.
Adherence and Support
1 study
Providers need training on meeting the contraceptive needs of women and couples with HIV, including providing non-directive, informed choice counseling and reducing stigma and discrimination for women living with HIV. [See also %{s:67}] Studies found that HIV-positive women were required to wait in separate waiting rooms and that because provider bias limited contraceptive options, providers needed additional training on the full range of contraceptive options. Other studies showed that providers have inaccurate knowledge concerning HIV and contraception.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Interventions are needed to address the adherence of patients who fast as part of religious practice. A study found that fasting observed by HIV-positive patients (e.g., Ramadan) did not have a significant effect on adherence, but patients did change when they took their ARVs (Weaver et al., 2014). Another study reported that fasting was a major reason for patients to be non-adherent and to be lost to follow-up (Bezabhe et al., 2014). Counseling should include discussion of fasting when appropriate, and more studies on the impact of rescheduling drug timing on adherence can better illustrate the relationship between fasting and adherence.
Adherence and Support
1 study
Greater efforts are needed to help young people personalize HIV risks. Studies found that knowledge about HIV prevention was superficial and that young people believed that they were not personally at risk of HIV acquisition despite risky behaviors and that condoms were not used because of “trust in partners.” Another study found that one adolescent girl reported she did not need to test for HIV as the only people at risk for acquiring HIV were those “who go to beer halls and pubs – prostitutes” (Ferrand et al., 2011). Married adolescent girls who had not become pregnant were significantly less likely to have had HIV testing and counseling (HTC) yet reported high rates of coerced sex within marriage, associated with acquiring HIV. Adolescents in one study suggested visiting hospices or people who were sick with HIV to understand more about HIV.
Mitigating Risk
1 study
HIV-positive mothers, fathers, grandmothers and the larger community need clear, consistent, non-contradictory and nonjudgmental counseling on infant feeding practices. Health care providers need training based on accurate information. Studies found that health care providers gave HIV-positive women conflicting information and that simplified structured counseling tools are needed. Studies found that women reported that providers accused them of killing their infants if they breastfed. Women lack access to infant formula but have been told by providers that it is the only way for their infant to survive. Women were told that breastfeeding is a mode of HIV transmission and exclusive breastfeeding is a mode of prevention. Women fear HIV more than diarrheal disease, even though more deaths occur from diarrheal disease. Women were not given choices. Women did not give providers accurate information on how they were feeding their infant for fear of being denied health care. Women were told to feed their infants formula yet did not have adequate food support, most mothers could not do so with few having an income and most with no access to safe drinking water. Women lacked autonomy to decide infant feeding, which was decided by male partners or grandmothers. "Despite the current WHO recommendations to use extended infant prophylaxis as long as the infant is breastfed, no data are yet available from a clinical trial to confirm effectiveness and safety of this regimen beyond the first six months postpartum" (Taha, 2011: 919).
Postpartum
1 study
Mandating pregnant women to enroll in ART on the same day they test HIV positive may violate their human rights and may result in loss-to-follow up, increasing the risk of mortality, morbidity and drug resistance. Providing enough counseling and information to pregnant women found positive before being initiated on lifelong treatment helps in reducing cases of loss to follow up. Active tracing of women lost to follow up in a way that does not violate consent, confidentiality and human rights, may be warranted. An analysis of national facilities with over 20,000 women started on cART under Option B+ found that loss to follow up was highest in patients who began cART at large clinics on the day they were diagnosed with HIV. After controlling for age and facility type, Option B+ patients who started on ART on the same day of testing were almost twice as likely to never return to the clinic than other Option B+ patients. Note: WHO September 2015 guidelines do not specify when during pregnancy a woman living with HIV should be initiated on cART
Antenatal Care - Treatment
1 study
Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy and use condoms to reduce the likelihood of HIV transmission upon resumption of sexual activity. [See also %{c:15}] Studies found that women were not given contraceptive counseling or contraceptives postpartum and that transport costs restricted their ability to gain access to their contraceptive method of choice. Studies also found an unmet need for postpartum contraception among women living with HIV. Studies found that sexuality and condom use need to be addressed when sexual activity resumes postpartum. Family planning services are most often not provided postpartum in PMTCT programs. Providers and women did not know that clinically well HIV-positive women can use IUDs. Women lacked the full range of available contraception. No study to date has measured pregnancy intention prospectively in an HIV-discordant couple cohort and measured the effect of desired pregnancy on HIV transmission.
Postpartum
1 study
Interventions are needed to sustain viral suppression and reduce loss to follow up once a woman has initiated Option B+, including affordable means of monitoring virological response and effective adherence counseling. Research is needed on how long is optimal to provide care within maternal health systems or when to transfer cART provision outside of maternal health systems. Compared to people who started cART for their own health, a study found that women who started cART while pregnant were 5 times less likely to return to the clinics after the initial visit. Women who started cART while breastfeeding were twice as likely to miss their first follow up appointment. On average, 17% of pregnant women who started ART under Option B+ dropped out of care in the first six months of ART and 22% dropped out within one year (Tenhathi et al., 2014). Systems are rarely in place to track mothers six weeks post-partum (Psaros et al., 2015; Waiswa, 2016). A survey found that ART retention was greatest in those facilities where newly diagnosed pregnant women living with HIV were referred from ANC to the ART clinic in the same facility for initiation and follow up or were referred to facilities serving as ART referral sites that did not provide ANC (van Lettow et al., 2014). A review noted that women found challenges in accessing cART either through maternal care systems, postpartum or through HIV care. Input from pregnant and postpartum women living with HIV is needed
Antenatal Care - Treatment
1 study