Showing 1 - 14 of 14 Results for "CD4 count"

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Interventions are needed to scale up CD4 count screening, especially for pregnant women. [See %{s:49}]
Structuring Health Services to Meet Women’s Needs
1 study
Pregnant women living with HIV need timely access to CD4 count testing and results to access treatment. [See %{s:45}]
Provision and Access
1 study
Interventions are needed to scale up CD4 count screening, especially for pregnant women. A study found that several barriers limited CD4 cell count screening in rural areas, including “availability of laboratories equipped to perform CD4 cell count enumeration, reagent stockouts, and lack of sample transport systems” (Carter et al., 2010: 408). For mothers with CD4 counts above 500, there may be a low risk of HIV transmission through breastfeeding, though further research is necessary.
Postpartum
1 study
Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services. A study found that record keeping of HIV staging and CD4 counts was inadequate.
Antenatal Care - Testing and Counseling
1 study
Further research is needed to determine the appropriate timing of initiating ART for TB/HIV co-infected patients. Studies conflict with regard to timing of TB therapy and ART for those patients with CD4 counts below 200. Studies also conflict with regard to timing for ART for patients with extra-pulmonary TB.
Tuberculosis
1 study
Major evidence gaps exist on adherence-enhancing interventions for long-term effectiveness and at higher CD4 counts. A rapid systematic review by WHO found that while ART requires life-long therapy, the majority of studies have lasted two years or less.
Adherence and Support
1 study
Specific additional adherence support is needed for those who initiate ARVs at CD4 counts above 250. A review of forty randomized trials found that no consensus exists on how to effectively increase adherence, particularly among those living with HIV with no symptoms. A study found that initiating ARVs at CD4 above 250 was associated with increased odds and number of treatment interruptions and increased odds of persistent increased viral load within the first three months of ARV initiation.
Adherence and Support
1 study
Improved integration is needed between maternal, sexual and reproductive health services and HIV treatment services. A study found that even though 11.6% of 1,369 pregnant women were eligible for ARV treatment based on their low CD4 counts prior to delivery and 6 % were eligible postpartum, these women were not integrated into ARV treatment programs; another study found high rates of HIV in STI patients.
Structuring Health Services to Meet Women’s Needs
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
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
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
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
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