Out of focus: tailoring the cascade of care to the needs of women living with HIV

Abstract

Around half of the global adult HIV-positive population are women, yet historically women have been under-represented in clinical studies of antiretroviral therapy (ART) and there has been minimal exploration of gender-specific factors related to the response to and appropriateness of treatment choices in women living with HIV (WLWH). There are several key issues pertaining to the cascade of HIV care that make it important to differentiate WLWH from men living with HIV. Factors that are gender specific may impact on the status of WLWH, affecting access to diagnosis and treatment, optimal clinical management, ART outcomes, retention in care, and the overall long-term wellbeing of WLWH. In this review, we discuss the results of recently reported women-only clinical trials and highlight the key unmet needs of WLWH as they pertain to the cascade of HIV care across World Health Organization European Region countries. As significant knowledge gaps remain, the review identifies key areas where further research is required, in order to support improved management of WLWH and guide informed clinical decision-making, including addressing psychosocial factors as part of comprehensive care.

Implementing a Comprehensive Hepatitis C Virus (HCV) Clinic Within a Human Immunodeficiency Virus Clinic: A Model of Care for HCV Microelimination

“…It has been speculated that women tend to prioritize their families or are preoccupied with other responsibilities and delay their HCV treatment. Additional help can be provided by the clinic to female patients through support services such as medical case management and counseling [35]. In general, the younger patient population (<30 years old) has been a challenging group to retain in HIV care as noted by Griffith et al [36].…”

Sex Differences in HIV Infection

“…From the perspective of the investigator, the cyclic variation in hormone levels and/or exogenous hormone administration and potential for pregnancy introduce variables and safety concerns that can require larger sample sizes and more intensive monitoring of interventions. These concerns notwithstanding, the global burden of HIV infection in women and the population of women and girls at risk obligates that research specifically address the optimal treatment, prevention, and curative interventions for women [ 137 ]. From the view of the potential study participants, engagement with research, education about risks and benefits, and addressing logistical challenges to enrollment are all feasible [ 138 ].…”

Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care

“…Women represent over 50% of the population living with HIV worldwide and face unique challenges and barriers to HIV care. 33 Clearly, strategies for improving retention in care and ART adherence are essential to achieve the goal of controlling the HIV epidemic, and there is a need to understand barriers to care among the vulnerable population of women of reproductive age. 33 Despite the importance of our findings and the need to address depressive symptoms in this population, this study had several limitations.…”

“…33 Clearly, strategies for improving retention in care and ART adherence are essential to achieve the goal of controlling the HIV epidemic, and there is a need to understand barriers to care among the vulnerable population of women of reproductive age. 33 Despite the importance of our findings and the need to address depressive symptoms in this population, this study had several limitations. The primary limitation was the small sample size and the use of a cross-sectional analysis.…”