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Showing 101 - 120 of 235 Results for "care"

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Young women living with HIV can safely deliver HIV-negative infants with appropriate treatment. [See also %{c:17}]
Increasing Access to Services
1 study Gray IIIb adolescents, health care facilities, pregnancy, transmission Brazil
Further interventions are needed to provide support (physical, psychological, technological, economic) to patients and caregivers. Studies showed that patients and caregivers have many physical, psychological, and economic unmet needs, with high rates of depression and poverty, and in some cases, rely on their young children or relatives to provide care with no outside support. Some studies show that caregivers suffer from stigma attached to caring for someone HIV-positive. [See also %{s:67}] Some studies showed that women have a lower quality of life than men. A study in a high HIV prevalence area showed that for women, lack of control in sexual decision-making was associated with depression, while for men, intergenerational sex was associated with depression.
Women and Girls
1 study
Home- and community-based antiretroviral treatment may be effective, but attention must be paid to potential effects of stigma and discrimination. [See also %{c:21}]
Provision and Access
5 studies Gray II, IIIa, IIIb community-based care, home-based care, treatment Rwanda, South Africa, Uganda
Increased efforts are needed to actively plan for screening and treating HIV-TB co-infection, particularly in antenatal clinics. A study found no planning for HIV-TB co-infection across all levels of the health care system. Other studies found separate services and no information for co-infected patients on the risks of co-infection, plus no screening and treatment of co-infection. [See also %{c:17}]
Tuberculosis
1 study
Interventions are needed to foster the involvement of HIV-positive women and promote cooperation between people living with HIV and AIDS and health care facilities, government and other agencies creating HIV-related programs and policies. Studies found that little cooperation existed between HIV-positive women and health facilities but that efforts have been underway to educate parliamentarians concerning HIV-positive women’s issues.
Promoting Women’s Leadership
1 study
Interventions are needed to scale up and increase access to methadone and buprenorphine—effective agonist therapy for the treatment of drug dependence, as well as needle exchange/distribution programs. Studies found only tiny fractions of those who need maintenance medication had access. A study found that user fees for methadone maintenance programs presented a barrier to access to care. In places where no needle exchange programs are operating, high rates of borrowing of used syringes occur, placing IDUs at high risk of acquiring HIV.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Information systems need better data on distribution of services, effectiveness of services, and how well services are matched to populations and subpopulations in need of HIV treatment and care. A review of PEPFAR data plus site visits to 13 PEPFAR partner countries plus 400 interviews found a lack of data on distribution of services and effectiveness of services for treatment of people living with HIV.
Provision and Access
1 study
Scale up of testing is needed with competent staff and labs in order to assess CD4 counts and link those who test HIV-positive to treatment. Studies are finding that in some countries, those who test HIV-positive are presenting with AIDS and that patients do not initiate ART despite eligibility. Those who test HIV-positive yet not eligible to receive antiretroviral therapy according to their national guidelines often did not remain in care until they were eligible for treatment.
Provision and Access
1 study
Improvements are needed in health services, such as increased or flexible clinic hours, to reduce wait times and to encourage ART initiation. Interviews with people living with HIV eligible for ART who refused ART found that "the problem is…services….The process is so long" (Musheke et al., 2013a: 236). In addition, waiting to access ART jeopardizes livelihoods. Information systems that can track patients across sites can assist in tracking patients who need care.
Provision and Access
1 study
Further operations research is needed on the optimal collaboration between HIV treatment facilities and community-based organizations, including cost-effectiveness data. A review of the global evidence found that more information is needed on which interventions are most effectively provided in communities as compared to HIV treatment facilities, and how a patient's integrated needs can be best met as a continuum of care.
Adherence and Support
1 study
Interventions are needed to ensure that stigma from health care workers does not discourage HIV-positive women from giving birth in safer settings. [See also %{s:67}] Studies found that HIV-positive women experienced discrimination by providers in ANC services or did not attend ANC services due to fear of mistreatment by health providers.
Delivery
1 study
Accurate testing techniques for infants may inform infant feeding. Studies note that rapid scale up of early infant diagnosis is needed in low-resource settings in order to access treatment and care as soon as possible. [For WHO guidance on HIV testing in infants see: www.who.int/hiv/topics/vct/toolkit/additional_resources/children/en/]
Postpartum
1 study
Scaling up PMTCT programs increases the number of women who know their serostatus and improves HIV knowledge.
Structuring Health Services to Meet Women’s Needs
3 studies Gray IV, V HIV testing, PMTCT, antenatal care, treatment Cameroon, Côte d’Ivoire
A combination of infection control strategies is needed to reduce the rate of TB transmission, especially in high-risk, low-resourced health care settings. [See %{c:25}] “Early initiation of ART will significantly reduce TB incidence among people on ART, but additional interventions such as screening for TB using highly sensitive tools, preventative therapy, nutrition interventions, anemia, and poverty reduction may be needed to further reduce the burden of TB among people on ART” (Van Rie et al., 2011: 354). A study found that nutrition supplementation may increase patient survival and decrease the recurrence of TB among people living with HIV.
Tuberculosis
1 study
Women and their sexual partners need access to comprehensive pre-conception care so they can make informed decisions about pregnancy before conception. Studies found that HIV-positive women could not access pre-conception advice on safer pregnancy options, as health providers discouraged pregnancy. Studies found that significant numbers of pregnant women did not know any way to prevent vertical transmission and face dilemmas with balancing the desire for children with fear of risking acquiring HIV or transmitting HIV to their partner or infant. Studies also showed that women did not understand the relationship between high CD4 counts and reducing the risk of HIV transmission.
Pre-Conception
1 study
Interventions are needed to support the autonomous decision-making of HIV-positive women who are caught between the contradictory pressures of family, community and health care providers. Studies found that HIV-positive women and men need information and social support to make decisions that reflect their own preferences in the face of pressure to bear children. A review of the published literature from 1990 to 2008 found that the refusal of health workers to discuss reproductive options in a non-biased way negatively impacts HIV-positive women. Studies also found that HIV-positive men lacked information on pre-conception and felt they could not request this information from health providers.
Pre-Conception
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
Programs that promote the strength of families and offer family-centered integrated economic, health and social support result in improved health and education outcomes for orphans.
Orphans and Vulnerable Children
6 studies Gray IIIb, IV, V OVC, children, community care, community-based care, counseling, family, grandparents, orphans, sexual behavior, support groups Botswana, China, Kenya, Rwanda, South Africa, Zimbabwe
A combination of infection control strategies may significantly reduce the rate of TB transmission, including drug-resistant TB, in high-risk, low-resourced health care settings. A mathematical model was created to simulate TB transmission in high TB/HIV prevalent settings. The model showed that masks alone would prevent 10% of new transmission in an overall epidemic, but could prevent a large proportion of XDR-TB cases among hospital staff. The combination of mask and reduced hospitalization with a shift to outpatient treatment could prevent nearly one-third of XDR-TB cases. Approximately 48% of XDR-TB cases could be averted by the end of 2012, if a combination of mask, reduced hospitalization with shift to outpatient treatment, improved ventilation, rapid drug resistance testing, HIV treatment and TB isolation facilities for highly infectious patients were implemented.
Structuring Health Services to Meet Women’s Needs
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