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Showing 141 - 160 of 245 Results for "South Africa"

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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
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
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
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
Programs must continue to promote protective behavior such as condom use in addition to male circumcision. Studies found that male circumcision is only partially effective, making protective behavior such as partner reduction and condom use, in addition to circumcision, essential. Men who have been circumcised can still transmit HIV to women if they are HIV-positive. Until healing is complete following circumcision, men are more likely to transmit HIV. A post hoc analysis found the HIV-1 acquisition rate among partners of men who remained uncircumcised was 7.9% during the first 6 months after enrollment compared with 27.8% for partners of men who were circumcised and then resumed sexual activity prior to documented healing of the surgical wound, a substantially increased risk.
Voluntary Medical Male Circumcision
1 study
Multiple strategies are needed to promote male involvement in ways that meet pregnant women’s needs. Studies found that some women found their partners’ involvement controlling and/or violent and other women wanted more autonomy in health decision-making. Studies also found men lacked information on vertical transmission and felt excluded from PMTCT programs. Other studies found that women indicated that they could not discuss their HIV serostatus with their husbands.
Antenatal Care - Testing and Counseling
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
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
Women living with HIV need information and access to services for emergency contraception and post-abortion care (PAC) services. Studies found that women did not have adequate knowledge of emergency contraception, nor access to services for post-abortion care.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
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
Expansion and scaling up of interventions promoting economic opportunities for women are needed to increase their ability to refuse unsafe sex and reduce stigma for women living with HIV. Studies found that lack of income, food and jobs forced women to sell sex to survive, placing them at risk of HIV acquisition.
Promoting Women’s Employment, Income and Livelihood Opportunities
1 study
Provision of ART can reduce stigma, but additional interventions are needed. Studies found that lack of knowledge of ARV treatment increased stigma, but that ARV treatment alone did not eliminate stigma and discrimination.
Reducing Stigma and Discrimination
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
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 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