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Worku WZ, Azale T, Ayele TA, Mekonnen DK. Women's voices: the lived experience of HIV-positive women in the postpartum period at the University of Gondar comprehensive specialized referral hospital, Ethiopia: a phenomenological study. BMC Womens Health 2023; 23:325. [PMID: 37344854 DOI: 10.1186/s12905-023-02470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Pregnancy and the postpartum period are incredibly challenging for women living with the Human Immune Deficiency Virus (HIV) due to the multidimensional influence of HIV infection. These women experience the challenges of navigating pregnancy and motherhood while living with HIV. It is poorly understood how women living with HIV (WLWH) experience pregnancy and postpartum. Therefore, the current study aimed to explore the lived experience of pregnancy and postpartum among women living with HIV. METHODS A phenomenological qualitative study design was employed. A semi-structured, interview guide was used to conduct in-depth interviews with HIV-positive postpartum women from April to May 2022. All interviews were recorded using a voice recorder and note was taken. The collected data were transcribed and translated into English for analysis. Inductive thematic analysis was applied to analyze the data. RESULTS Six main themes about the lived experience of women living with HIV were identified: (1) Fear and distress related to maternal and child Health, (2) HIV status self-disclosure dilemma, (3) Courage and commitment of HIV-positive women to prevent HIV, (4) Challenges faced and coping mechanisms used by HIV-positive women, (5) Health care providers and HIV-positive women interaction, and (6) Solution from their voices. CONCLUSION HIV infection also has a multidimensional impact on women's life during pregnancy and postpartum. The findings of this study improve our understanding of the lived experience of HIV-positive women while pregnant and in the postpartum period. These women's descriptions showed that they have been experiencing various challenges that are not often addressed in antenatal clinics, such as distress and uncertainties related to vertical transmission of HIV. These women need specialized support and all-encompassing care to have a healthy pregnancy and postpartum period. Moreover, it is essential to understand the circumstances of women's lives, their relationships with others, and their decision-making processes. Healthcare professionals and other responsible bodies working with women living with HIV should encourage and support these mothers to appraise and maintain their commitment to protecting their children from acquiring HIV infection and maintaining their Health to the maximum to raise their children.
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Affiliation(s)
- Workie Zemene Worku
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun Mekonnen
- Department of Gynaecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Vodicka EL, Chung MH, Zimmermann MR, Kosgei RJ, Lee F, Mugo NR, Okech TC, Sakr SR, Stergachis A, Garrison LP, Babigumira JB. Estimating the costs of HIV clinic integrated versus non-integrated treatment of pre-cancerous cervical lesions and costs of cervical cancer treatment in Kenya. PLoS One 2019; 14:e0217331. [PMID: 31170193 PMCID: PMC6553698 DOI: 10.1371/journal.pone.0217331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 05/09/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the modified societal costs of cervical cancer treatment in Kenya; and to compare the modified societal costs of treatment for pre-cancerous cervical lesions integrated into same-day HIV care compared to "non-integrated" treatment when the services are not coordinated on the same day. MATERIALS AND METHODS A micro-costing study was conducted at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital from July 1-October 31, 2014. Interviews were conducted with 54 patients and 23 staff. Direct medical, non-medical (e.g., overhead), and indirect (e.g., time) costs were calculated for colposcopy, cryotherapy, Loop Electrosurgical Excision Procedure (LEEP), and treatment of cancer. All costs are reported in 2017 US dollars. RESULTS Patients had a mean age of 41 and daily earnings of $6; travel time to the facility averaged 2.8 hours. From the modified societal perspective, per-procedure costs of colposcopy were $41 (integrated) vs. $91 (non-integrated). Per-procedure costs of cryotherapy were $22 (integrated) vs. $46 (non-integrated), whereas costs of LEEP were $50 (integrated) and $99 (non-integrated). This represents cost savings of $25 for cryotherapy and $50 for colposcopy and LEEP when provided on the same day as an HIV-care visit. Treatment for cervical cancer cost $1,345-$6,514, depending on stage. Facility-based palliative care cost $59/day. CONCLUSIONS Integrating treatment of pre-cancerous lesions into HIV care is estimated to be cost-saving from a modified societal perspective. These costs can be applied to financial and economic evaluations in Kenya and similar urban settings in other low-income countries.
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Affiliation(s)
| | - Michael H. Chung
- University of Washington, Seattle, Washington, United States of America
| | | | - Rose J. Kosgei
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Fan Lee
- University of Washington, Seattle, Washington, United States of America
| | - Nelly R. Mugo
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Samah R. Sakr
- Coptic Hope Center for Infectious Diseases, Nairobi, Kenya
| | - Andy Stergachis
- University of Washington, Seattle, Washington, United States of America
| | - Louis P. Garrison
- University of Washington, Seattle, Washington, United States of America
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Brittain K, Remien RH, Mellins CA, Phillips TK, Zerbe A, Abrams EJ, Myer L. Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa. AIDS Care 2018; 30:1517-1523. [PMID: 30047287 DOI: 10.1080/09540121.2018.1503637] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Across sub-Saharan Africa, prevention of mother-to-child transmission services are encountering increasing numbers of women already established on antiretroviral therapy (ART) when entering antenatal care. However, there are few data examining ART adherence and HIV viral load in this group. We used multivariable logistic regression models to examine self-reported suboptimal adherence (defined as missed ART doses on ≥2 days during the preceding 30 days), elevated viral load (≥1000 copies/mL), and factors associated with each among women entering antenatal care on ART. Participants were recruited from one primary care clinic in Gugulethu, Cape Town, as part of a larger study of HIV-positive pregnant and postpartum women. Among 482 pregnant women established on ART and enrolled between May 2013 and June 2014 (median age: 31 years; median duration of ART use: 3 years), 15% reported suboptimal adherence and 12% had elevated viral load. After adjustment for age, suboptimal adherence was significantly more common among women who were not married/cohabiting and women who reported a higher level of concern about taking ART; a higher level of adherence self-efficacy was associated with a reduced odds of suboptimal adherence. In a multivariable model, elevated viral load was significantly associated with previous discontinuation of ART, a higher level of concern about taking ART, and report of an unintended pregnancy. Suboptimal adherence and elevated viral load are common among women entering antenatal care already on ART. Our findings highlight specific beliefs and concerns about ART use during pregnancy that should be addressed in counselling messaging, and suggest that family planning should be more effectively integrated into HIV care. Including adherence and viral load monitoring as part of pregnancy planning for women on ART may be important to achieve safer conception and promote healthy pregnancies.
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Affiliation(s)
- Kirsty Brittain
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Robert H Remien
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Claude A Mellins
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Tamsin K Phillips
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Allison Zerbe
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA
| | - Elaine J Abrams
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA.,e College of Physicians & Surgeons , Columbia University , New York , NY , USA
| | - Landon Myer
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
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Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia. PLoS One 2018; 13:e0189869. [PMID: 29364895 PMCID: PMC5783339 DOI: 10.1371/journal.pone.0189869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Attempts to conceive and pregnancy may increase HIV transmission to sex partners and infants. Our study evaluated the association between fertility intentions and HIV acquisition among Zambian HIV-serodiscordant couples. Methods We collected demographic, behavioral, clinical exposures, and data on fertility intentions in a cohort of HIV-serodiscordant couples in Lusaka, Zambia from 2005 to 2012. We evaluated factors associated with fertility intentions stratified by gender using multivariable logistic regression. Multivariable Cox proportional hazard models were used to evaluate the associations between fertility intentions and HIV acquisition controlling for a priori confounders and covariates that substantially (>10%) changed the effect estimates in univariate analyses. Results Among 1,029 serodiscordant couples, 311 agreed that they wanted children in the future (30%), 368 agreed they did not want children (36%), and 344 couples disagreed about having children (34%), with men more likely than women to want children. Women wanting child(ren) was associated with increased odds of baseline pregnancy (adjusted odds ratio [aOR] = 4.80 (95% confidence interval [CI] = 2.93, 7.85)), fewer previous pregnancies (aOR = 0.85 per additional pregnancy (95% CI = 0.78, 0.93)), and partner fertility intention (aOR = 2.89 (95% CI = 2.14, 3.91)) adjusting for woman’s age, literacy, years cohabiting and HIV status. Men wanting child(ren) was associated with younger age (aOR = 0.96 per year (95% CI = 0.93, 0.99)), fewer years cohabiting (aOR = 0.95 (95% CI = 0.92, 0.98)), number of previous partners’ pregnancies (aOR = 0.90 (95% CI = 0.82, 0.98)), and partner fertility intention (aOR = 3.00 (95% CI = 2.21, 4.07)) adjusting for partner’s age, literacy, HIV status and partner’s baseline pregnancy. In adjusted survival analyses, HIV-negative women were more likely to seroconvert if they themselves wanted children (aHR = 2.36 (95% CI = 1.41, 3.96)) vs. did not want children, or if their partner wanted children (aHR = 2.34 (95% CI = 1.33, 4.11)) vs. did not want children, or if the couple agreed that they wanted children (aHR = 2.08 (95% CI = 1.01, 4.30)), adjusting for women’s age, women’s literacy, previous pregnancies and time in study. HIV-negative men were more likely to seroconvert if their female partner wanted a child in the next 12-months (aHR = 1.94 (95% CI = 1.02, 3.68)) vs. did not want children, and when both partners wanted children (aHR = 2.02 (CI = 1.09, 3.73)) vs. they did not want children, adjusting for men’s age and literacy, couple income, number of live children, male circumcision status and time in study. Conclusion Women had increased risk of HIV acquisition if they and/or their partner wanted a child, while men had increased risk of HIV acquisition when their partner or if both partners agreed that they wanted children. Safer-conception interventions are needed to protect HIV uninfected women and men from HIV acquisition in HIV-serodiscordant couples who want children.
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Akinleye O, Dura G, de Wagt A, Davies A, Chamla D. Integration of HIV Testing into Maternal, Newborn, and Child Health Weeks for Improved Case Finding and Linkage to Prevention of Mother-to-Child Transmission Services in Benue State, Nigeria. Front Public Health 2017; 5:71. [PMID: 28443275 PMCID: PMC5385441 DOI: 10.3389/fpubh.2017.00071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/21/2017] [Indexed: 12/01/2022] Open
Abstract
Background In Nigeria, maternal, newborn, and child health (MNCH) weeks are campaign-like events designed to accelerate progress toward Millennium Development Goals. The authors examined whether integrating HIV testing into MNCH weeks was feasible and could lead to increased case finding and linkage to prevention of mother-to-child transmission (PMTCT) services. Methods Pregnant women attending MNCH week during the first week of December 2014 in 13 local government areas in Benue State were provided with HIV tests and referrals to PMTCT services. Demographic, past antenatal care (ANC), and HIV testing information were collected using a structured questionnaire. We used routine ANC/PMTCT data from national electronic system (DHIS-2) to compare with the results obtained from MNCH week. Results A total of 50,271 pregnant women with a median age of 25 years (IQR: 21–29) were offered HIV testing. About 50,253 (99.96%) agreed to get HIV testing, with 1,063 (2.1%) testing positive. Six hundred forty-four (60.6%) of those with positive results were linked to PMTCT. In multivariate analysis, marital status, gestation age, and those with no ANC visit during this pregnancy were associated with a positive HIV test. Approximately 30% (50,253 versus 39,080) more pregnant women received HIV testing in MNCH week compared to those who received HIV testing in routine ANC services in 2013. Of the 50,253 who accepted testing, 15,611 (31.1%) did not attend ANC during this pregnancy, of which 9,615 (61.6%) had not had any previous HIV tests. Four hundred forty-two (4.6%) of these 9,615 tested HIV-positive. Conclusion Integration of HIV testing into MNCH weeks is feasible and improved uptake of HIV testing and linkage to care. However, the rate of HIV positivity was lower than that reported by previous studies. The findings indicate that MNCH weeks provides opportunity to reach those who do not attend ANC services for HIV care.
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Affiliation(s)
| | - Gideon Dura
- Benue State AIDS Control Agency, Ministry of Health, Makurdi, Nigeria
| | | | | | - Dick Chamla
- Emergency Response Team (ERT) Health Section, UNICEF, New York, NY, USA
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Sztam KA, Liu E, Manji KP, Kupka R, Kisenge R, Aboud S, Fawzi WW, Bosch RJ, Duggan CP. Maternal Antiretroviral Therapy Is Associated with Lower Risk of Diarrhea in Early Childhood. J Pediatr 2016; 175:54-60. [PMID: 27245295 PMCID: PMC4981520 DOI: 10.1016/j.jpeds.2016.04.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify risk factors, including maternal antiretroviral therapy (ART), for diarrhea in Tanzanian children exposed to HIV during the first 2 years of life. STUDY DESIGN Using generalized estimating equations, we analyzed data from a cohort of 2387 Tanzanian children exposed to HIV from age 6 weeks to 2 years, as well as data from their mothers, to determine risk factors for diarrhea in children. Mothers recorded diarrhea in a diary and reported results at visits scheduled every four weeks. RESULTS Body mass index was ≥18.5 in 95.6% of mothers. World Health Organization HIV stage was 1/2 for 1255 (87.8%) mothers. ART was received by 24.3% of mothers, most initiating ART during pregnancy. At baseline (6 weeks of age) 264 (11.3%) children were infected with HIV. In children whose mothers received ART, the relative risk of diarrhea in children was 0.79 (95% CI 0.68-0.92), after we adjusted for multiple factors, including child HIV status and exclusive breastfeeding duration. Exclusive breastfeeding (relative risk 0.67, 95% CI 0.56-0.80) also was protective. CONCLUSION Our results provide additional support to increase ART coverage for all pregnant mothers, to control clinical HIV progression, reduce perinatal HIV infection, but also to reduce the risk of a major cause of death and morbidity in young children worldwide. TRIAL REGISTRATION ClinicalTrials.gov: NCT00197730.
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Affiliation(s)
- Kevin A Sztam
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
| | - Enju Liu
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roland Kupka
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Nutrition Section, UNICEF Headquarters, New York, NY
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ronald J Bosch
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christopher P Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Rahmalia A, Wisaksana R, Meijerink H, Indrati AR, Alisjahbana B, Roeleveld N, van der Ven AJAM, Laga M, van Crevel R. Women with HIV in Indonesia: are they bridging a concentrated epidemic to the wider community? BMC Res Notes 2015; 8:757. [PMID: 26645634 PMCID: PMC4673839 DOI: 10.1186/s13104-015-1748-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
Abstract
Background Male injecting drug users drove the onset of the HIV epidemic in Indonesia but over time more women have been diagnosed. We examined the relative proportion of female patients in an HIV cohort and characterized their probable transmission route and reproductive profile. Designs Prospective cohort study in a referral hospital in West Java. Methods Interviews with standardized questionnaires, physical and laboratory examinations were done for 2622 individuals enrolled in HIV care between 2007 and 2012. The proportion of women in this cohort was compared with national estimates. The general characteristics of HIV-infected women and men as well as the sexual and reproductive health of HIV-infected women were described. Results The proportion of female patients enrolled in HIV care increased from 22.2 % in 2007 to 38.3 % in 2012, in line with national estimates. Women were younger than men, fewer reported a history of IDU (16.1 vs. 73.8 %, p < 0.001) and more were tested for HIV because of a positive partner (25.5 vs. 4.0 %, p < 0.001). The majority of women were in their reproductive age, had children, and were not using contraceptives at the time of enrolment. Conclusion HIV-infected women in Indonesia have specific characteristics that differ them from women in the general population. Further research to elucidate the characteristics of women exposed to HIV, their access to testing and care and sexual and reproductive needs can help reduce transmission to women and children in the context of concentrated HIV epidemic in Indonesia.
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Affiliation(s)
- Annisa Rahmalia
- Tuberculosis and HIV Research Centre, Faculty of Medicine Universitas Padjadjaran, Jl. Dr. Eijkman No. 38, Bandung, 40161, Indonesia. .,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Rudi Wisaksana
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Hinta Meijerink
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Agnes R Indrati
- Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Bachti Alisjahbana
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands. .,Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Andre J A M van der Ven
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Integration of HIV in child survival platforms: a novel programmatic pathway towards the 90-90-90 targets. J Int AIDS Soc 2015; 18:20250. [PMID: 26639111 PMCID: PMC4670840 DOI: 10.7448/ias.18.7.20250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/09/2015] [Accepted: 09/25/2015] [Indexed: 11/07/2022] Open
Abstract
Introduction Integration of HIV into child survival platforms is an evolving territory with multiple connotations. Most literature on integration of HIV into other health services focuses on adults; however promising practices for children are emerging. These include the Double Dividend (DD) framework, a new programming approach with dual goal of improving paediatric HIV care and child survival. In this commentary, the authors discuss why integrating HIV testing, treatment and care into child survival platforms is important, as well as its potential to advance progress towards global targets that call for, by 2020, 90% of children living with HIV to know their status, 90% of those diagnosed to be on treatment and 90% of those on treatment to be virally suppressed (90–90–90). Discussion Integration is critical in improving health outcomes and efficiency gains. In children, integration of HIV in programmes such as immunization and nutrition has been associated with an increased uptake of HIV infant testing. Integration is increasingly recognized as a case-finding strategy for children missed from prevention of mother-to-child transmission programmes and as a platform for diffusing emerging technologies such as point-of-care diagnostics. These support progress towards the 90–90–90 targets by providing a pathway for early identification of HIV-infected children with co-morbidities, prompt initiation of treatment and improved survival. There are various promising practices that have demonstrated HIV outcomes; however, few have documented the benefits of integration on child survival interventions. The DD framework is well positioned to address the bidirectional impacts for both programmes. Conclusions Integration provides an important programmatic pathway for accelerated progress towards the 90–90–90 targets. Despite this encouraging information, there are still challenges to be addressed in order to maximize the benefits of integration.
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Narasimhan M, Loutfy M, Khosla R, Bras M. Sexual and reproductive health and human rights of women living with HIV. J Int AIDS Soc 2015; 18:20834. [PMID: 28326129 PMCID: PMC4813610 DOI: 10.7448/ias.18.6.20834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. J Int AIDS Soc 2015; 18:20302. [PMID: 26643464 PMCID: PMC4672401 DOI: 10.7448/ias.18.6.20302] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. DISCUSSION There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. CONCLUSIONS Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support.
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