Showing 1 - 16 of 16 Results for "antiretrovirals"

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Improved and timely access to antiretrovirals is needed for orphans. A study found that orphans were more likely to be at WHO clinical stage 4, and need timely treatment initiation.
Orphans and Vulnerable Children
1 study
PWID need equitable access to antiretroviral therapy. PWID have successfully started antiretroviral therapy in at least 50 countries but PWID are disproportionally less likely than other patients with HIV to receive antiretroviral therapy, even in the countries where PWID represent most of the HIV-positive population. In 2008, PWID were 67% of HIV cases in five countries with the largest HIV epidemics concentrated in PWID yet only 25% of those receiving ART (Wolfe et al., 2010). [See also %{c:13}]
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Interventions are needed to increase adherence for adolescents. Multiple studies from developed and developing countries reported young age as a risk factor for treatment interruption and that adolescents were less adherent to antiretroviral therapy than adults.
Adherence and Support
1 study
Access to antiretroviral treatment (and minimization of treatment interruption for those with access) is needed in prisons. Screening and treatment for TB is needed in prison settings as well. A study found that while one in three participants in HIV services has been in prison, officials report that antiretroviral therapy was available to fewer than one in ten of over 6,000 people with HIV incarcerated in 2009.
Women Prisoners and Female Partners of Male Prisoners
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
While mobile phones have been shown to be effective in increasing adherence for adults on antiretroviral therapy, more implementation science research is needed on how to effectively employ mobile phones and websites for adolescent HIV prevention, treatment and care and whether adolescents have adequate access via mobile phones.
Mitigating Risk
1 study
Additional programming, including access to antiretroviral therapy, is needed to reduce sexual transmission within stable heterosexual serodiscordant couples. Despite the majority of infections in some countries attributable to HIV transmissions between stable heterosexual serodiscordant couples, little programming had been directed toward this population.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Services to provide sex workers with access to antiretroviral therapy in the same clinics that provide them with condoms, contraceptives, HIV testing and STI services are needed. A study found that sex workers, particularly HIV positive sex workers, wanted integrated comprehensive care to meet all their needs if they tested positive for HIV.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Further studies are needed to determine whether standard intermittent preventive treatment and antiretroviral therapy regimens are medically and operationally compatible in pregnancy and to determine safe and effective protocols for management of concurrent HIV and malarial infections in pregnant and non-pregnant women living with HIV. A study found that alternative malarial drug regimens should be considered for HIV/malaria co-infected patients receiving nevirapine.
Malaria
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
Efforts are needed to reform laws that criminalize drug use and/or drug possession for personal use and to eliminate compulsory drug detention and instead, provide people who use drugs with access to HIV and health services, including harm reduction, and voluntary, effective evidence-based drug dependency treatment. Detention centers are administered by police, military or other national government public security authorities and operate outside the formal criminal justice system with detainees held without trial or right of appeal; those detained are not allowed to leave voluntarily (Wolfe, 2012). Studies found that female IDU were not given reproductive health services, including PMTCT services in compulsory detention and/or prison settings. Detoxification programs were substandard and ineffective. Despite high rates of HIV, antiretroviral treatment is largely unavailable in compulsory drug detention centers. IDUs who have started antiretroviral treatment should be able to continue treatment in prison with access to medical supervision. [See also %{s:11}]
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Efforts are needed to eliminate compulsory drug detention and instead, provide PWID with HIV prevention and testing services and effective drug dependency treatment by medical professionals. Detention centers are administered by police, military or other national government public security authorities and operate outside the form criminal justice system with detainees held without trial or right of appeal and those detained do not allow people to leave voluntarily (Wolfe, 2012). Studies found that women who use drugs were not given reproductive health services, including PMTCT services in compulsory detention and/or prison settings. Detoxification programs were substandard and ineffective. Despite high rates of HIV, antiretroviral treatment is largely unavailable in compulsory drug detention centers. One study found high rates of injecting drug use within prison and high rates of syringe sharing within prisons plus incarceration was not associated with reduction in drug use, with over a quarter of these female drug users. PWID in and out of prison who have started antiretroviral treatment should be able to continue treatment with access to medical supervision. Treatment in compulsory drug detention takes the form of sanction rather than therapy, with high relapse rates.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
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
Programs must adhere to the longstanding international agreement to voluntarism, informed consent, and ensuring the right of individuals and couples to decide freely and responsibly the number and spacing of their children. Studies found that women living with HIV had been sterilized against their will, were pressured by providers to terminate a pregnancy, or were stigmatized for becoming pregnant. Studies also found that provision of antiretroviral therapy was conditional on using certain types of contraception. Litigation is currently being undertaken. A study found that HIV-positive women who accessed contraceptive services were not informed of the benefits of PMTCT programs in reducing vertical transmission.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Intensified efforts are needed to increase male and female condom use and reduce multiple partnerships by people who know their HIV-positive status and are not virally suppressed, including young people. Studies found that consistent condom use between discordant couples (or with partners whose serostatus was unknown) was low and, among those on treatment, decreased over time. Lack of condom use was associated with fear of disclosure. People living with HIV as well as couples also believed that treatment with antiretroviral therapy meant that they were either cured of HIV or could no longer transmit the virus and were less likely to disclose their positive serostatus. In some studies, men are more likely to report condom use than women, "given the limited control that women have over the use of the male condom" (Walusaga et al., 2012: 698). Particular attention is also needed to provide condoms to men living with HIV who frequent sex workers, as well as for sex workers themselves to protect themselves (Paz-Bailey et al., 2012). [See %{s:9}]
Staying Healthy and Reducing Transmission
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