Asking the right questions: developing evidence-based strategies for treating HIV in women and children

Abstract

In July 2010, the World Health Organization (WHO) issued formal revisions of its guidelines on the use of highly active antiretroviral therapy for HIV. The new guidelines greatly expand eligibility for treatment of adults and children, as well as for pregnant women seeking prophylaxis for vertical HIV transmission. WHO's new recommendations bring the guidelines closer to practices in developed countries, and its shift to earlier treatment alone will increase the number of treatment-eligible people by 50% or more.Scaling up access to HIV treatment is revealing important gaps in our understanding of how best to provide for all those in need. This knowledge gap is especially significant in developing countries, where women and children comprise a majority of those living with HIV infection. Given the magnitude and significance of these populations, the International AIDS Society, through its Industry Liaison Forum, prioritized HIV treatment and prophylaxis of women and children. In March 2010, the International AIDS Society and 15 partners launched a Consensus Statement outlining priority areas in which a relative lack of knowledge impedes delivery of optimal prevention of mother to child transmission (PMTCT) and treatment to women and children.The Consensus Statement, "Asking the Right Questions: Advancing an HIV Research Agenda for Women and Children", makes a special appeal for a more gender-sensitive approach to HIV research at all stages, from conception to design and implementation. It particularly emphasizes research to enhance the understanding of sex-based differences and paediatric needs in treatment uptake and response. In addition to clinical issues, the statement focuses on programmatic research that facilitates access and adherence to antiretroviral regimens. Better coordination of HIV management with sexual and reproductive healthcare delivery is one such approach.We discuss here our knowledge gaps concerning effective, safe PMTCT and treatment for women and children in light of the expansion envisioned by WHO's revised guidelines. The guideline's new goals present an opportunity for advancing the women and children's agenda outlined in the Consensus Statement.

The pregnancy decisions of HIV-positive women: the state of knowledge and way forward

“…Several concerns were expressed regarding how best to operationalize the latest revisions. [130][131][132] Studies have since documented challenges with respect to breastfeeding in South Africa, 133 Uganda 134 and Kenya, 135,136 resulting in mixed feeding and higher transmission of HIV. Nipple shield devices to decrease breastfeeding-related HIV transmission have been shown to be acceptable but are still in effectiveness trials.…”

Prevalence of Drug Resistance and Associated Mutations in a Population of HIV-1+Puerto Ricans: 2006–2010

“…Poverty, low health literacy, lack of family support, limited access to transportation, patient-provider issues, the organizational infrastructure of the health care facility visited, and the perceived HIV stigma within their communities are some of the issues associated with the inequality [ 41 , 42 ]. The aforementioned problems, along with the inclusion of gender-specific issues into management strategies for HIV-infected women, including preconception and reproductive counseling, should be taken into consideration while developing health plans for these patients [ 43 , 44 ]. Research targeted towards the reduction of HIV-related disparities, including the understanding of HIV/AIDS prevalence in women and minority groups, the detection of emerging incidence trajectories in these groups, and obtaining more information on how HIV infection as a chronic disease affects these individuals and their communities remains a high priority for the National Institutes of Health Trans-NIH AIDS research initiatives [ 45 ].…”

Results of an Integrative Analysis: A Call for Contextualizing HIV and AIDS Clinical Practice Guidelines to Support Evidence‐Based Practice

“…At state levels, reasons for this poor uptake have been attributed to insufficient healthcare financing and supply-line failures (Blacklock et al, 2016), restrictive health professional regulations regarding scope of practice (McCarthy et al, 2013), and punitive legislation on homosexuality and illicit drug use (Church et al, 2015;Gruskin et al, 2013). At local levels, barriers to implementation include lack of knowledge about guidelines; and negative attitudes toward implementation resulting from concerns about costs and supplies, excessive demands on healthcare providers, and the cultural inappropriateness of recommendations including gender considerations (Aizire et al, 2013;Blacklock et al, 2016;Gourlay et al, 2013;Granato et al, 2016;Karim et al, 2011;Mwai et al, 2013;Schuster et al, 2016;Shayo et al, 2014).…”