Showing 61 - 80 of 106 Results for "and Zambia"

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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
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
Concerted efforts are needed to enable adolescents at risk to test confidentially for HIV and be immediately linked to services, with information on where and how to access services. Access to and update of HIV testing and counseling (HTC) by adolescents is significantly lower than for adults. One study found that adolescents who were tested through provider-initiated testing (the WHO standard) had higher loss to follow up if they tested HIV-positive than adolescents who were tested through voluntary testing and counseling (Lamb et al., 2014). HTC must, according to WHO, include consent, confidentiality, counseling, correct test results and connections to treatment, care and prevention services. A recent report found that no data exists for HTC among ages 10 to 14 (All in to End Adolescent AIDS, 2015c). Access to HTC for adolescents who inject drugs is particularly challenging. HTC clients also need counseling on contraception and referral to services.
Increasing Access to Services
1 study
Additional outreach programs are needed for patients who miss ART clinic visits or fail to initiate treatment. A study showed that issues such as provider to patient ratios; adherence support programs; and needing transport from rural areas were associated with lower CD4 counts at initiation of ART. Other studies showed that patients were lost between initiation and maintenance sites. Another study found that one in five treatment-eligible HIV-positive individuals refused to initiate ART (Katz et al., 2011). Others who dropped out of treatment were using unproven remedies.
Provision and Access
1 study
Monitoring for drug resistance in low- and middle-income countries is needed during Option B+ scale up. Studies are finding drug resistance among women who are initiating cART or who have initiated cART
Antenatal Care - Treatment
1 study
Efforts are needed to effectively implement Option B+ in non-prejudicial ways. Women who were sex workers reported being denied care until delivery. Women who were not accompanied by husbands were denied any health services during pregnancy. A sign on health centers read: “Notice: all pregnant women are supposed to come with their husbands/partners at their first visit. You will not be given services without implementing this” (Beckham et al., 2015: 66).
Antenatal Care - Treatment
1 study
Adolescents living with HIV need information and services through adolescent-friendly HIV services on a number of topics, including disclosure, safer sex, contraception, safe motherhood and gender-based violence. Studies found that health providers were unprepared to discuss HIV and contraception with adolescents who acquired HIV through perinatal transmission, despite the fact that significant numbers of these adolescents were already sexually active. Another study found that these adolescents need skills to disclose their serostatus to sexual partner. WHO recommends that perinatally infected adolescents be advised of their positive serostatus by age 6 (WHO, 2013) but there is little guidance on disclosure for adolescents. Facilitated disclosure by parents and providers to adolescents living with HIV may lead to higher retention in HIV care (Arrive et al., 2012). Parents living with HIV whose adolescents may be living with HIV also need assistance to disclose to their adolescents, as parents fear rejection from their children. Positive health dignity and prevention interventions can help people living with HIV lead healthy lives and reduce HIV transmission, but tailored interventions for adolescents and their parents have not been evaluated for effectiveness, although a trial is currently ongoing (Cunningham, 2015; Mofeson and Cotton, 2013). One study found that 29% of young women aged 16 to 24 living with HIV reported being forced to have sex. No validated curriculum that was shown to be effective for reducing unsafe sex among adolescents living with HIV was found, although some manuals have been developed (Parker et al., 2013c; UNESCO and GNP+, 2012).
Increasing Access to Services
1 study
Laws and practices that obstruct adolescents’ access to services, such as parental consent requirements, age, and marital status requirements, must be aligned with the actual behavior of adolescents. Studies found that legal requirements restricted adolescents from getting tested for HIV even if they were sexually active and at risk for HIV. "There is a strong evidence base that the stigma, discrimination and criminalization affecting adolescent key populations aged 10 to 17 is intensified due to domestic and international legal constructs that rely on law-enforcement based interventions dependent upon arrests, pre-trial detention, incarceration and compulsory ‘rehabilitation’ in institutional placements," particularly among adolescents who sell sex or inject drugs (Conner, 2015: para 1).
Increasing Access to Services
1 study
Barriers such as cost of medications, stigma, long clinic waits, lack of food, and child-care responsibilities, among others, may discourage women living with HIV from accessing antiretroviral therapy. A study found that patients who were living with HIV but did not access antiretroviral therapy were twice as likely as patients on antiretroviral therapy to report not having enough food to take with treatment as a concern, in addition to concerns about cost barriers. Another study found that cost of ARVs, with direct out of pocket payment at point of care delivery decreased access to ARVs. Another study found transport costs and waiting time a barrier to access to treatment. Increased efforts are needed so that those in pre-ART care understand that HIV can be transmitted prior to ART eligibility.
Provision and Access
1 study
Ongoing surveillance is needed to assess the impact of cART on infants (both HIV-negative and HIV-positive) exposed in utero and during breastfeeding. A recent US study had encouraging results that among ARV-exposed uninfected children, no learning issues were noted (Nozyce et al., 2014) and another US-based study found no increased risk for infants exposed to ART (Phiri et al., 2014). A pilot ART registry in Africa has been launched
Antenatal Care - Treatment
1 study
Interventions are needed for male involvement that do not such reinforce harmful gender norms or increase risk for violence, stigma or discrimination. “Evidence for effectiveness of male involvement in PMTCT programs is scant” (Beckham et al., 2015: 67). One study only evaluated male involvement as accompanying their pregnant partner to ANC care with no HIV related outcomes listed and tasking the woman to require her male partner to come to ANC (Nyondo et al., 2015). Most approaches only reach men through their pregnant spouse, with no services for men beyond HIV testing and use men as an instrument solely to increase access to services by women. Men have been denied involvement in antenatal care, birth and delivery even if the couple so chooses.
Antenatal Care - Treatment
1 study
Strategies, including legal strategies, are needed to empower pregnant women living with HIV to ask questions, be properly informed and to challenge stigma, disrespect and abuse. [See also %{s:67}] Consequences for violating patient confidentiality, redress for women with HIV facing discrimination in facilities, and stigma reduction efforts are needed to increase adherence to cART, prior to, during and post pregnancy, including training for providers.
Antenatal Care - Treatment
1 study
Stigma reduction interventions are needed so that women with HIV can choose replacement feeding, breastfeeding and weaning schedules. Studies found that HIV-positive women feared that if they used infant formula or abruptly weaned, they would be stigmatized for their HIV-positive serostatus.
Postpartum
1 study
Evaluated interventions are urgently needed to reduce multiple and concurrent partnerships – particularly for both men and women where perceived HIV risk is low and the woman is subjected to gender norms of faithfulness while the man is subjected to gender norms of having multiple sexual partners. [See also %{s:57}] Studies found that married women were at risk of HIV acquisition, but were either unaware of the risk or did not believe they were at risk. Studies found that extra-relational sex on the part of the husband was common. Other studies found that a significant portion of women have had high rates of multiple partners. Other studies found that serial monogamous relationships led to a high risk of HIV acquisition.
Partner Reduction
1 study
Effective programs (as described here) must be expanded to reach many more young people, especially young people who are most neglected such as very young adolescents, out-of-school youth, young people living with HIV, homeless and rural youth, as well as lesbian, MSM and transgender adolescents and other key populations. [See also %{s:73}] Studies found adolescent girls did not know that anal sex increased the risk of HIV acquisition, did not use condoms, and did not know that oral sex carries a low risk of HIV acquisition. Out-of school-youth were at high risk of early sexual debut. A scan of sex education curricula found that information on key aspects of sex such as information on condoms in addition to negative, fear-based curriculum were prevalent and that less than half of out of school youth were reached. In some countries, pornography was the principal source of information about sex and pornography often depicts condom-free sex and gender inequality, with men in domineering roles (Day, 2014).
Mitigating Risk
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
Strategies need to be identified to empower women to create demand for improved maternal health services and challenge violations of their rights in facility-based childbirth. This is a particularly acute need for women living with HIV. Studies show that HIV-related stigma may reduce the likelihood of delivering in a health facility
Antenatal Care - Treatment
1 study
Women and men need accurate information on vertical transmission, treatment adherence strategies, the importance of their viral load and the low risk of vertical transmission if virally suppressed. Adherence has been challenging for women living with HIV postpartum, even for those initiating ART during pregnancy at CD4 counts under 350, with adequate adherence dropping from 75.7% during pregnancy to 53% postpartum globally (Nachega et al., 2012 cited in Coutsoudis et al., 2013). Knowledge of HIV and vertical transmission has shown to be correlated with increased initiation, adherence and retention for pregnant women living with HIV.
Antenatal Care - Treatment
1 study
Initiatives that provide for early diagnosis and appropriate longitudinal care prior to treatment eligibility are needed to reduce mortality rates and costs among adults accessing treatment. A review found that early mortality among adults accessing antiretroviral therapy can be attributed to late diagnosis of HIV. Despite multiple interactions with parts of the healthcare system, a study of women in Uganda found that late presentation for HIV care resulted largely from the, “inability of the medical system to link women to appropriate care,” (McGrath et al., 2012: 1095). Women entered care only when symptomatic. Another study found that more than a quarter of HIV patients in care prior to ART initiation did not start ART according to national guideline criteria. Another study found that women did not know where to go to access treatment. A review found that a process is needed to optimize transfers of care without treatment interruption and with appropriate medical documentation. Another study found that over half of patients who were not yet known to be eligible for ART at enrollment but who had tested HIV-positive, including a quarter who had CD4 counts taken, were lost to follow up. Another review found that asymptomatic patients perceived little need to initiate ART. Another study found that those with higher CD4 counts who were not yet eligible for ART lacked social support and social capital, yet needed this support.
Provision and Access
1 study
Interventions are needed to reduce barriers to treatment adherence and to understand how these differ by sex. Increased research is needed to understand the most effective strategies to increase adherence. Studies found that a number of barriers that impact treatment adherence, such as violence, stigma, transport costs, childcare, forced migration, the need for food, the need to hide their medication from their male partners and changes in body image. Screening and treatment for depression may improve adherence, although some studies have shown mixed results. A review found that adherence differs by sex, but with little disaggregation for which factors affect women. Data collection should be more nuanced and not assume that women fall into static groups. A study of people living with HIV who disengaged from ART found that harsh and disrespectful treatment by providers, as well as competing work and livelihood demands, lack of funds for transport, etc. made attendance at ART clinics challenging.
Adherence and Support
1 study