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Showing 181 - 200 of 281 Results for "Africa"

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Research is needed on treating anemia, malnutrition and other dietary conditions as well as on optimum micronutrients for patients accessing HAART and for patients prior to accessing treatment. [See also %{c:13}] Increased clarity is needed for providers, caregivers and patients on nutritional needs in settings of marked food insecurity. A Cochrane review which included 16 studies with weak methodologies found that “the evidence-base for the specific effect of micronutrient supplements in children and adults with HIV is limited, but sufficient to make some recommendations for practice. In the absence of population-specific adverse effects, there is no reason to decline similar recommendations for HIV-infected populations” (Irlam et al., 2010: 16).
Women and Girls
1 study
Additional efforts are needed to reduce the risk of TB transmission in high risk, low resource settings. Studies found that significant TB transmission occurs in health care settings, particularly among nurses.
Structuring Health Services to Meet Women’s Needs
1 study
Interventions are needed to provide sex workers with greater control and access over money and resources, which can have a positive impact on HIV-related risk reduction. Studies found that if sex workers had access to resources under their control, women were more likely to negotiate condom use and that female sex workers in debt were less likely to report condom use.
Female Sex Workers
1 study
Women who use drugs need access to services for violence against women, dual method use, effective contraception and reproductive health. Studies found high rates of violence, including rape, and lack of access to reproductive health services among women who use drugs. One study found high rates of unintended pregnancies.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Sex and age disaggregated data is critical to assess which ages are falling through the cracks in data collection. Current HIV data collection masks critically needed data on adolescents ages 10 to 19. For example, a study that disaggregated ages found that loss to follow up for patients aged 10 to 24 was twice as high for ages 15 to 19 than for ages 10 to 14 (Koech et al., 2014).
Increasing Access to Services
1 study
Interventions are needed to counter gender norms that discourage men from attending health services until they are extremely sick. Studies have shown that norms of masculinity prevent men from accessing ART until severely symptomatic.
Provision and Access
1 study
HIV surveillance systems do not count those over age fifty, particularly women, and treatment guidelines are missing for this age group. Currently, 4.2 million people live with HIV globally with increasing numbers of people over the age of 50 living with HIV. Few studies assess prevalence among women above age 50. Integration of treatments for common chronic diseases of old age will need to be integrated into HIV services.
Provision and Access
1 study
Improved support systems for lay or basic health workers are needed to facilitate effective care in areas where lay health care workers provide a significant proportion of HIV care. Systems need to be developed specifically for remuneration, retention, and adequate supervision.
Provision and Access
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 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
Interventions are needed to mitigate adverse events such as stigma or violence when women disclose their serostatus to their partners. [See also %{c:21}] A study found that women who disclosed their positive serostatus to their sexual partners feared abandonment; fear that the relationship would end; and fear of stigma. Of women who disclosed their positive serostatus to their partner, 59.3% experienced a negative reaction, such as violence, break-up of the relationship, being blamed, stigma and abandonment.
Staying Healthy and Reducing Transmission
1 study
Increased detection of acute infection, along with immediate, effective counseling and support is needed. A trial is underway in Botswana to identify those with high viral loads to initiate treatment (Novitsky et al., 2010 cited in Delva and Abdool Karim, 2014).
Staying Healthy and Reducing Transmission
1 study
Providers need training on meeting the contraceptive needs of women and couples with HIV, including providing non-directive, informed choice counseling and reducing stigma and discrimination for women living with HIV. [See also %{s:67}] Studies found that HIV-positive women were required to wait in separate waiting rooms and that because provider bias limited contraceptive options, providers needed additional training on the full range of contraceptive options. Other studies showed that providers have inaccurate knowledge concerning HIV and contraception.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
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
Further interventions are needed to incorporate violence prevention, screening and counseling services into PMTCT testing and counseling. [See also %{s:59}] Studies found high rates of violence, sexual coercion and abuse among HIV-positive pregnant women, particularly when accessing HIV testing or during disclosure.
Antenatal Care - Testing and Counseling
1 study
Additional efforts are needed to ensure confidentiality in testing. Studies found that women were tested without their consent and that providers did not protect women’s confidentiality.
Antenatal Care - Testing and Counseling
1 study
Promoting HIV testing for male and female adolescents prior to pregnancy or fatherhood may increase those on cART prior to pregnancy, thus decreasing viral load prior to pregnancy and increasing the likelihood of reduced risk of vertical transmission
Antenatal Care - Treatment
1 study
Interventions are needed to reduce the higher attrition rate among pregnant adolescents living with HIV, including those perinatally infected, and provide needed support by parents and others. [See also %{c:9}] Additional research may also be needed on how to best care for perinatally-infected pregnant women who have decreased virological suppression, increased risk of vertical transmission and increased challenges in remaining adherent. While currently noted in the United States, it is anticipated to be relevant to low- and middle-income countries as more perinatally-infected women give birth.
Antenatal Care - Treatment
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
Changing laws and policies, ending police violence, and other mechanisms are needed to protect sex workers from violence and rape. Studies found sex workers experienced high rates of violence and rape from clients and police, and that fear of arrest was a barrier to accessing health services. Studies also found that violence was associated with inconsistent condom use and HIV incidence. Studies also found high rates of violence from intimate partners and clients, but inability to press charges.
Female Sex Workers
1 study