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Showing 1 - 20 of 281 Results for "Africa"

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Active case finding increases TB detection, particularly in sub-Saharan Africa where HIV is driving the epidemic.
Tuberculosis
4 studies Gray IIIb, V TB, counseling, screening, testing India, Lesotho, Malawi, South Africa
Interventions are needed to reduce drug resistance, particularly among those who are treatment naïve. Third line regimens may be needed in some resource limited settings. A systematic review was done on studies published on the spread of drug resistance in resource-limited settings after rollout of ART from 2001 to 2011, which reported on changes in the rate of HIV-1 drug resistance in treatment-naïve HIV-positive patients. The review found that east Africa had the highest rate of increase of drug resistance in treatment-naïve patients at 29% per year since rollout, followed by 14% in southern Africa, and 3% in west and central Africa. No specific analysis was done on gender because many studies did not include sex ratios. In total, 162 reports were included with data from 42 countries and 26,102 patients. In another study of Latin America, it was estimated that at least 6% of patients would need third line regimens within 5 years of ART initiation.
Adherence and Support
1 study
Increased links are needed for women who access treatment to receive counseling concerning desired children and contraception. [See also Meeting the Sexual and Reproductive Health Needs of Women Living with HIV and Safe Motherhood and the Prevention of Vertical Transmission] A study with patients from multiple sites in sub-Saharan Africa found that within four years of follow up for 4,531 women, one-third experienced a pregnancy.
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
Research and interventions are needed to better to support people living with HIV with disclosure and reduce stigma so they can adhere to ART and can continue to have a healthy and safer sex life. In-depth interviews with patients in South Africa who were acutely infected found that patients did not retain the information that they are very likely to transmit HIV and that condom use was particularly important, but were focused on identifying who transmitted HIV to them. In addition, patients were still in shock on learning of their HIV status and did not understand how they could be HIV-positive if they tested negative with a rapid HIV test (Wolpaw et al., 2014). Women who were acutely infected in South Africa faced profound "challenges, immediately after HIV diagnosis" (Tomita et al., 2014b: 1118). Focus groups of women living with HIV found that women were concerned that their access to lifelong treatment when becoming pregnant may discourage their men from condom use, as men know that treatment can decrease the risk of transmission.
Staying Healthy and Reducing Transmission
1 study
Well-functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment. However, adequate clinical results can also be cost-effective and meet patient needs. A study in sub-Saharan Africa found that more than half of test results for viral load were invalid or inaccurate. A review done in low and middle-income countries showed that lack of routine virologic monitoring in resource limited ART programs led to the development of cross-resistance to the NRTI component of second-line treatment. Even where virological monitoring is available and demonstrates virological failure, delayed switching of patients to alternative antiretroviral therapy regimens occurs.
Provision and Access
1 study
Interventions, policies and budgets are needed to reduce sexual coercion and rape of both boys and girls, create awareness in communities that violence against children is unacceptable, strengthen child statutory protection systems, and conceptualize and implement appropriate child protection services in developing countries. Access to post-exposure prophylaxis in case of rape when the perpetrator is HIV-positive is also needed. [See also %{c:21}] In most countries of Eastern and Southern Africa, the age of consent for sex is 16. Despite these restrictions, more than 10% of girls have had sexual debut before age 15. A study found that in a sample of more than 1,000 males and more than 1,000 females, large numbers had experienced high rates of physical punishment, emotional abuse and touching of sexual organs when not wanted or sex due to force or coercion prior to age 18 and that incident HIV infections were more common in women who suffered emotional abuse, sexual abuse and physical punishment. Sexual abuse in men was associated with alcohol abuse and depression. Other studies found high rates of sexual coercion and high-risk behaviors among street children. “Few children disclose abuse, fewer still seek services and report to authorities, virtually no children actually receive services and perpetrators rarely suffer consequences” (Sommarin et al., 2014: S213). Most research does not provide adolescent-specific data on violence, instead listing results for ages 15 to 49. Reviews have not found evidence that preventive responses have had an impact on rates of sexual abuse. Effective programs in the US and Canada have not been assessed for adaptation in other countries.
Mitigating Risk
1 study
Enacting and enforcing laws and policies that respect, protect and fulfill women’s human rights, including those protecting women’s rights to land, property and inheritance and addressing violence against women, can enhance women’s ability to cope with HIV.
Advancing Human Rights and Access to Justice for Women and Girls
3 studies Gray IIIb, V inheritance, property rights, violence against women East Africa, Southern Africa
Voluntary medical male circumcision (VMMC) may be effectively integrated into school programs. [See also %{s:5}]
Mitigating Risk
4 studies Gray IIIb, V adolescents, male circumcision South Africa
Early HIV diagnosis and early HAART for HIV positive infants can drastically reduced infant mortality in resource-limited settings.
Postpartum
1 study Gray II PMTCT, testing, treatment South Africa
Postnatal home visits by trained lay counselors may reduce mixed feeding.
Postpartum
1 study Gray II breastfeeding, counseling, formula feeding South Africa
A wide range of contraceptive method choices are safe and effective for women living with HIV, including hormonal contraception and IUDs. However, further research is awaited on hormonal contraception and HIV. [See Overview for the role of hormonal contraception in HIV acquisition and transmission]
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
4 studies Gray I, IIIb PMTCT, contraception, family planning Africa, Uganda, Zimbabwe
Co-trimoxazole prophylaxis, antiretroviral therapy and ITNs can substantially reduce the incidence of malaria in women living with HIV.
Malaria
4 studies Gray I, II, IIIa, V bednets, malaria, treatment Africa, Rwanda, Thailand, Uganda
Promoting acceptability of condom use by both women and men as the norm in sexual intercourse may decrease national HIV prevalence.
Male and Female Condom Use
4 studies Gray IIIb, V condoms, marriage, pregnancy, sexual partners, stigma Ethiopia, Kenya, South Africa, Sub-Saharan Africa, Tanzania, Uganda, Zambia
Male circumcision reduces HIV acquisition for men and reduces the likelihood of transmission to HIV-negative women.
Voluntary Medical Male Circumcision
6 studies Gray I, II, IIIb, IV Eastern and Southern Africa, condoms, male circumcision Kenya, Rwanda, South Africa, Uganda, Zambia
Promoting condoms for pregnancy prevention may increase condom use for safe sex among young people.
Mitigating Risk
4 studies Gray IIIb, IV, V adolescents, condom use, pregnancy prevention, youth Africa, Brazil, Colombia, South Africa
PMTCT-Plus (family-focused) HIV care can increase the numbers of women and their partners who access treatment and remain adherent. Note: This should not be implemented in any way that prejudices women who do not want to disclose to partners (see overview).
Antenatal Care - Treatment
4 studies Gray IIIa, IIIb PMTCT Plus, PMTCT-Plus, pregnancy, treatment Africa, Botswana, Côte d’Ivoire, South Africa, Tanzania, Uganda, Zambia
Access to ARVs may decrease stigma and improve quality of life. [See also %{s:67}]
Women and Girls
2 studies Gray IIIb Swaziland and Tanzania, stigma, support groups, treatment Lesotho, Malawi, South Africa
Training teachers about gender-based violence can change norms about acceptance of gender-based violence.
Addressing Violence Against Women
2 studies Gray IIIb pregnancy, teachers, training programs, violence Ghana, Malawi, South Africa
Microfinance programs can lead to reduction in gender-based violence when integrated with participatory training on HIV, gender, and violence.
Addressing Violence Against Women
1 study Gray II gender norms, microfinance, self-perception, violence South Africa