Staged introduction of antiretroviral therapy into a family with multiple HIV-infected members

Evaluation of parent-child pairs on antiretroviral therapy in separate adult and pediatric clinics

In Africa, HIV infection is considered a family disease. A retrospective cohort analysis was performed to describe the characteristics and outcome in 35 parent-child pairs taking antiretroviral therapy (ART) in separate adult and pediatric HIV clinics. In 26 pairs, ART was first initiated in children. Baseline median CD4 count was 122/mm(3) in adults and 376/mm(3) in children. World Health Organization stage 3 or 4 disease affected 49% of adults and 83% of children. In all, 3 parents and 1 child died. Hospitalization, poor adherence, missed appointments, or regimen change affected >50% of pairs on ART. Following tuberculosis diagnosis in their parents, 2 of the 5 children were not investigated. By week 104, 29 (83%) pairs remained on ART, and 69% of patients on ART were virologically suppressed. Parent-child pairs with advanced HIV infection had good outcomes when cared for in separate clinics. Establishing lines of communication between clinics is important. Family-centered services may provide more integrated care.

Missed Opportunities for Early HIV diagnosis: Critical Insights from Stories of Kenyan Women Living with HIV

Early HIV testing is critical to prevention and timely treatment. Missed opportunities for HIV diagnosis can result in unnecessary deaths at a time when access to antiretroviral treatment proves life saving. While HIV prevention and treatment research has increased, less research exists on women's experiences with HIV diagnosis, despite the fact that women are most affected. Insights from local women are critical in designing culturally meaningful interventions that thwart missed opportunities for early HIV diagnosis. The purpose of our study was to uncover steps women took to know their HIV diagnosis. Using narrative inquiry methodology informed by post-colonial feminism, we interviewed 40 HIV- positive women in Kenya. Five themes emerged related to uptake of HIV testing for women: (a) spouse's critical illness or death; (b) years of suffering from HIV-related symptoms; (c) sick children; (d) prenatal testing; and (e) personal desire to know one's HIV status. These findings centered on women experiences provide an important basis for health promotion interventions related to HIV prevention, earlier detection, and treatment.

Lessons learned from family-centred models of treatment for children living with HIV: current approaches and future directions

BACKGROUND

Despite strong global interest in family-centred HIV care models, no reviews exist that detail the current approaches to family-centred care and their impact on the health of children with HIV. A systematic review of family-centred HIV care programmes was conducted in order to describe both programme components and paediatric cohort characteristics.

METHODS

We searched online databases, including PubMed and the International AIDS Society abstract database, using systematic criteria. Data were extracted regarding programme setting, staffing, services available and enrolment methods, as well as cohort demographics and paediatric outcomes.

RESULTS

The search yielded 25 publications and abstracts describing 22 separate cohorts. These contained between 43 and 657 children, and varied widely in terms of staffing, services provided, enrolment methods and cohort demographics. Data on clinical outcomes was limited, but generally positive. Excellent adherence, retention in care, and low mortality and/or loss to follow up were documented.

CONCLUSIONS

The family-centred model of care addresses many needs of infected patients and other household members. Major reported obstacles involved recruiting one or more types of family members into care, early diagnosis and treatment of infected children, preventing mortality during children's first six months of highly active antiretroviral therapy, and staffing and infrastructural limitations. Recommendations include: developing interventions to enrol hard-to-reach populations; identifying high-risk patients at treatment initiation and providing specialized care; and designing and implementing evidence-based care packages. Increased research on family-centred care, and better documentation of interventions and outcomes is also critical.