Patients' readiness to start highly active antiretroviral treatment for HIV

Gebrekristos, Hirut T.; Mlisana, Koleka; Karim, Quarraisha Abdool

doi:10.1136/bmj.331.7519.772

Cited by 40 publications

(32 citation statements)

References 15 publications

(8 reference statements)

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“…Some early dropouts may never have started ART, or have stopped after the first dose in the health facility. It is also possible that Option B+ women may have been less well-prepared for ART, and thus less likely to adhere to treatment and to attend follow-up visits [25, 26]. Our findings of better retention in care in patients who did not start ART on the day of diagnosis, and in those who received additional counselling may support this idea.…”

Section: Discussionmentioning

confidence: 69%

“…This may have lowered the former’s risk of LTF. Women who start ART immediately do not have the chance to disclose their HIV status to spouses or relatives, and prior disclosure may improve ART adherence [25]. On the other hand, non-disclosure was frequent among pregnant women who feared stigmatisation, divorce and physical violence even before Option B+ was implemented [27, 28]; and there is limited empirical evidence to document the advantages of systematically delayed ART [29].…”

Section: Discussionmentioning

confidence: 99%

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Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi

Tenthani

Haas

Tweya

et al. 2014

Aids

335

361

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OBJECTIVE To explore the levels and determinants of loss to follow-up (LTF) under universal lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (“Option B+”) in Malawi. DESIGN, SETTING, and PARTICIPANTS We examined retention in care, beginning at date of ART initiation and up to six months, for women in the Option B+ program. We analysed nation-wide facility-level data on women who started ART at 540 facilities (n=21 939). The study included individual-level data on patients who started ART at 19 large facilities (n=11 534). RESULTS Of the women who started ART under Option B+ (n=21 939), 17% appeared to be LTF six months after start. Most losses occurred in the first 3 months of therapy. Option B+ patients who started therapy during pregnancy were five times more likely than women who started ART in WHO stage 3/4 or with a CD4 cell count ≤350 cells/μl, to never return after their initial clinic visit (odds ratio 5.0, 95% CI 4.2-6.1). Option B+ patients who started therapy while breastfeeding were twice as likely to miss their first follow-up visit (odds ratio 2.2, 95% CI 1.8-2.8). LTF was highest in pregnant Option B+ patients who began ART at large clinics on the day they were diagnosed with HIV. LTF varied considerably between facilities, ranging from 0% to 58%. CONCLUSION Decreasing LTF will improve the effectiveness of the Option B+ approach. Tailored interventions, like community- or family-based PMTCT models could improve its effectiveness.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi

Tenthani

Haas

Tweya

et al. 2014

Aids

335

361

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“…Because HAART is an expensive therapy, very few drug users in resource-constrained settings and even in resource-rich settings receive HAART (Celentano et al, 1998). Additionally, the factors associated with the readiness of HIV-seropositive individuals, including HIV-seropositive drug users in resource-constrained settings to receive HAART are not fully explored (Gebrekristos et al, 2005). However, recent evidence indicates that drug users are no less likely than other risk groups to adhere to HAART therapy (Amico et al, 2006;Ware et al, 2005).…”

Section: Haart and Sexual Transmission Of Hiv Among Idusmentioning

confidence: 99%

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Semaan

Jarlais

Malow

2006

Substance Use & Misuse

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Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resourceconstrained settings and to address relevant contextual factors.RESUMEN-Il est important de prévenir la transmission hétérosexuelle du VIH à partir des usagers de drogue pour contrôler l'épidémie hétérosexuelle locale et mondiale de VIH. Des interventions ciblant à la fois la réduction de risque sexuel et la santé des usagers de drogue sont nécessaires. Les interventions de réduction de risque sexuel prennent en compte le niveau individuel, le niveau des pairs et celui des déterminants structurels de la réduction des risques. Les interventions visant l'amélioration de la santé comprennent le conseil et le dépistage du VIH, la prévention et le traitement des infections sexuellement transmissibles et la prescription d'antirétroviraux. Il est important d'adapter les interventions efficaces mises en place dans les pays riches aux réalités des contextes de pays à ressources limitées et de tenir compte des facteurs contextuels pertinents. Keywords global research; HIV; injection drug use; research interventions; sexual risk HIV Infection and Injection Drug UsersInjection drug use continues to complicate the control of the global HIV epidemic (UNAIDS, 2004). In 2003, 136 countries reported injecting drug use and 93 countries reported HIV infection among injection drug users (IDUs) (World Health Organization, 2003). IDUs are at risk for infection with HIV through both multiperson use ("sharing") of drug injection equipment and through unsafe sex behaviors (Aceijas et al., 2004). Although the scope and effectiveness of interventions aimed at reducing HIV infection through drug injection equipment has been well documented in the literature (Des Jarlais et al., 2005;Quan et This review describes sex risk reduction interventions with drug users and their effectiveness in reducing sexual risk behaviors of IDUs and other drug users. We highlight the needs and opportunities for these interventions, discuss the generalizability of the results to resourceconstrained settings, and outline the implications for global research efforts and public health practice. Although our literature review is not comprehensive, it highlights many areas that affect sexual transmission of HIV to and from drug users in both resource-rich and resourceconstrained settings. Efforts to reduce substance abuse and HIV risk associated with injection behav...

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“…Gebrekristos et al (2005b) found that B10% of patients consulted in a Durban, SA, TB clinic were aware of their HIV status, expressing fear of HIV infection as a barrier to testing. Olley et al (2004), examined post-VCT behaviours in a Cape Town, SA, study, finding that 78% of participants had not disclosed their status to sexual partners, and that 48% had no knowledge of their partner's status.…”

Section: Introductionmentioning

confidence: 97%

Wellness programmes for persons living with HIV/AIDS: Experiences from Eastern Cape province, South Africa

Worley

Didiza²,

Nomatshila

et al. 2009

Global Public Health

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Columbia University's International Centre for AIDS Care and Treatment Programmes (ICAP) supports the establishment of HIV prevention, care and treatment programmes, in resource-limited countries, through the President's Emergency Plan for AIDS Relief. In South Africa (SA), ICAP has collaborated with the Eastern Cape Department of Health since 2004, to support HIV treatment and care programmes at public healthcare facilities in rural and urban areas. Adherence, psychosocial and other supportive services have been combined into Wellness Programmes that have been situated within hospital-based Wellness Centres in two rural regions, and integrated within primary healthcare facilities in a third. This paper reviews components of wellness services for people living with HIV/AIDS including: voluntary counselling and testing, disclosure and prevention, ongoing counselling, health literacy and peer education, community- and home-based care, adherence support, and associated comprehensive care continuums. It also describes local context in which the Wellness Programmes were established. Finally it describes processes, successes and challenges, with programme development, and useful indicators monitored, lessons learned and strategies to strengthen and expand such programmes. Insights provided may inform other efforts to create sustainable systems of interdisciplinary care and accessible psychosocial support for HIV-infected persons within public facilities in resource-constrained settings.

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Patients' readiness to start highly active antiretroviral treatment for HIV

Cited by 40 publications

References 15 publications

Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi

Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Wellness programmes for persons living with HIV/AIDS: Experiences from Eastern Cape province, South Africa

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