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Antenatal Care - Treatment Gap
Interventions are needed to provide pregnant and breastfeeding women with more food security in order to increase viral suppression. A study found that food insecurity was associated with lower odds of sustained virological suppression.
Antenatal Care - Treatment
1 study
Strategies, including legal strategies, are needed to empower pregnant women living with HIV to ask questions, be properly informed and to challenge stigma, disrespect and abuse. [See also %{s:67}] Consequences for violating patient confidentiality, redress for women with HIV facing discrimination in facilities, and stigma reduction efforts are needed to increase adherence to cART, prior to, during and post pregnancy, including training for providers.
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 sustain viral suppression and reduce loss to follow up once a woman has initiated Option B+, including affordable means of monitoring virological response and effective adherence counseling. Research is needed on how long is optimal to provide care within maternal health systems or when to transfer cART provision outside of maternal health systems. Compared to people who started cART for their own health, a study found that women who started cART while pregnant were 5 times less likely to return to the clinics after the initial visit. Women who started cART while breastfeeding were twice as likely to miss their first follow up appointment. On average, 17% of pregnant women who started ART under Option B+ dropped out of care in the first six months of ART and 22% dropped out within one year (Tenhathi et al., 2014). Systems are rarely in place to track mothers six weeks post-partum (Psaros et al., 2015; Waiswa, 2016). A survey found that ART retention was greatest in those facilities where newly diagnosed pregnant women living with HIV were referred from ANC to the ART clinic in the same facility for initiation and follow up or were referred to facilities serving as ART referral sites that did not provide ANC (van Lettow et al., 2014). A review noted that women found challenges in accessing cART either through maternal care systems, postpartum or through HIV care. Input from pregnant and postpartum women living with HIV is needed
Antenatal Care - Treatment
1 study
Mandating pregnant women to enroll in ART on the same day they test HIV positive may violate their human rights and may result in loss-to-follow up, increasing the risk of mortality, morbidity and drug resistance. Providing enough counseling and information to pregnant women found positive before being initiated on lifelong treatment helps in reducing cases of loss to follow up. Active tracing of women lost to follow up in a way that does not violate consent, confidentiality and human rights, may be warranted. An analysis of national facilities with over 20,000 women started on cART under Option B+ found that loss to follow up was highest in patients who began cART at large clinics on the day they were diagnosed with HIV. After controlling for age and facility type, Option B+ patients who started on ART on the same day of testing were almost twice as likely to never return to the clinic than other Option B+ patients. Note: WHO September 2015 guidelines do not specify when during pregnancy a woman living with HIV should be initiated on cART
Antenatal Care - Treatment
1 study