Showing 61 - 80 of 80 Results for "treatment"

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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
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
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
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
Alternate efficacious drugs for intermittent preventive treatment are needed due to resistance to SP. In Tanzania, a country with high rates of SP resistance, SP during pregnancy increased the risk of fetal anemia and decreased cord hemoglobin levels. IPTp did not decrease the risk of placental malaria, maternal anemia, or low birth weight. (Harrington et al., 2011).
Malaria
1 study
While treatment of all STIs can improve everyone’s health and well-being, further interventions are needed to screen and treat ulcerative STIs, which have the most impact on HIV susceptibility and transmission. Studies have found however, that, to date, regimens to suppress genital herpes and other STIs have not been effective in reducing HSV transmission.
Treating Sexually Transmitted Infections (STIs)
1 study
Interventions are needed to inform women who use drugs of harm reduction early in pregnancy and to ensure systematic access to opioid agonist treatment during pregnancy and in hospitals for birth and postpartum. Some studies have shown increased risk adverse health impacts as well as of vertical transmission among women who use drugs which may be mitigated by harm reduction [See %{s:45}]
Women Who Use Drugs and Female Partners of Men Who Use Drugs
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
Further efforts are needed to ensure optimal counseling strategies and topics, with detailed information about accessing treatment and risk reduction. Studies found that women who went for an HIV test prior to marriage felt they did not need another HIV test for the duration of the marriage and that pre-test counseling was important. Providers do not feel comfortable asking about sexual practices. Studies have found that those who test HIV-negative engage in a high frequency of sexual risk behaviors.
HIV Testing and Counseling for Women
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
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
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
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
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
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
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
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
Adequate supply planning and secure funding are needed to avoid ARV stock-outs and use of obsolete medications. "As ART cannot be interrupted without risk of development of drug resistance – and hence worse survival – people on ART need an uninterrupted supply…" (WHO, 2014a: 32). The Coordinated Procurement Planning Initiative, which monitors the supply of ARVs in 22 countries, found that at any point half of these countries were at high risk of stock out (WHO, 2014a).  Between 30% and 45% of low- and middle-income countries have annually reported stock outs in recent years (WHO, 2014a).  Studies in multiple sub-Saharan African countries report stock shortages and stock outs as major risk factors for treatment interruption. "….Models of supply chain management need to be directly tied to health outcomes to ensure that the priority is improving health rather then reducing costs" (Ying et al., 2014, para 17).
Provision and Access
1 study
Additional efforts are needed to improve information and counseling about HIV during ANC to ensure that pregnant women and their sexual partners have adequate information. Studies found significant numbers of pregnant women received HIV tests with no counseling and reported that HIV testing was a mandatory part of their antenatal care. Studies also found that HIV-positive women feared transmitting HIV to their babies through casual contact. Studies found some providers assured women that treatment guaranteed that there would be no vertical transmission. In addition, studies found that some couples erroneously believed that sex during pregnancy causes miscarriages. Studies have also found that women who have tested HIV-negative at their first antenatal visit had seroconverted to HIV-positive by 12 months following delivery.
Antenatal Care - Testing and Counseling
1 study
Successful strategies are needed to increase adherence to ART among adolescents and reduce loss to follow up. A study found that adolescents and young adults aged 15 to 24 living with HIV were more likely, following treatment initiation, to have higher viral loads, higher rates of virological failure and greater low to follow up from services. Another study found that adolescents (ages 9 to 19) had poorer virological outcomes compared to young adults (ages 20 to 28). A review found few estimates on viral suppression among ages 10 to 19 (All in End Adolescent AIDS, 2015c). A specialized HIV management program could not retain a substantial proportion of those who tested positive for HIV in care. A review of studies of adherence among adolescents and children in Lower and Middle Income countries found that most studies were cross-sectional with age data ranging from six months to 21, limiting the ability to define which strategies are key to increasing adherence among ages 10 to 19. Cognitive behavioral therapy can be further explored as a strategy to increase adherence in adolescent populations.
Increasing Access to Services
1 study