What are the essential components of HIV treatment and care services in low and middle-income countries

Munderi, Paula; Grosskurth, Heiner; Droti, Benson; Ross, David A.

doi:10.1097/qad.0b013e32835bdde6

Cited by 21 publications

(26 citation statements)

References 21 publications

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“…These countries have greatly expanded access to ARV treatment in recent years [34], which stresses the valuable contribution of the present study.…”

Section: Discussionmentioning

confidence: 97%

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Tancredi¹,

Waldman

2014

BMC Infect Dis

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BackgroundBrazil was the first middle-income country to provide free and universal access to AIDS treatment. Understanding the impact of this policy is key to promote ongoing improvement of current intervention strategies. The aim of this study was to compare mortality rates and survival in a cohort of AIDS patients before and after the introduction of antiretrovirals (ARV) and to investigate predictors of survival.MethodsA retrospective cohort study of AIDS patients aged 13 years or more living in the city of Sao Paulo was conducted. All patients were recruited from an STD/HIV outpatient clinic between 1988 and 2003 and followed up until 2005. We estimated AIDS mortality rates in person-years (py) and carried out a survival analysis using the Kaplan-Meier method. The Cox proportional hazards model was used to assess predictors of survival in AIDS patients.ResultsThe study cohort comprised 6,594 patients. The yearly mean mortality rates were 17.6, 23.2, and 7.8 per 1,000 py for the study periods 1988-1993, 1994-1996, and 1997-2003, respectively. Median survival time was 13.4 and 22.3 months for patients entering the study in the first and second study periods and survival time was 108 months or more in 72% of those entering the study during 1997-2003. Factors independently associated with shorter survival included: AIDS diagnosis during the 1994-1996 (HR 2.0) and 1988-1993 (HR 3.2) periods; 50 years of age or more (HR 2.0); exposure category of injection drug users (IDU) (HR 1.5); 8 years of schooling or less (HR 1.4); no schooling (HR 2.1); and CD4+ counts between 350 and 500 cells/mm3 (HR 1.2) and less than 350 cells/mm3 at AIDS diagnosis (HR 1.3).ConclusionsThe study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART. However, some groups of patients were less likely to benefit from the new drug regimens. Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0599-8) contains supplementary material, which is available to authorized users.

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“…These countries have greatly expanded access to ARV treatment in recent years [34], which stresses the valuable contribution of the present study.…”

Section: Discussionmentioning

confidence: 97%

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Tancredi¹,

Waldman

2014

BMC Infect Dis

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“…By strengthening the family, the child and adolescent will have a better opportunity to develop necessary psychological resilience factors and become less vulnerable. Besides a detected need of screening and treatment for mental disorders in HIV service provision [42] the preventive efforts consequently should target the strengthening of AIDS affected families: «The capacities of families to protect children and to compensate for their loss of caregivers, security, possessions and the like, is highly dependent on the social context, most especially, pervasive and enduring poverty and labour migration [43]. Consequently, an effective response to the challenge is to work for a basic income security as well as access to health and education services for AIDS affected families.…”

Section: Discussionmentioning

confidence: 99%

Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study

et al. 2017

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Background This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: ‘Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA) ’. Method The study is constructed of both quantitative and qualitative components. In this article we report a qualitative study on the experiences of 21 adolescents (twelve to seventeen years) living with HIV in Uganda. The purpose of the study was to investigate both the protective and the risk factors in HIV-infected adolescents’ care environment in order to understand what might contribute to negative outcomes and what might provide a protective buffer against harmful life events. Semi-structured interviews with vignettes about mental disorders were employed and a phenomenological analysis was done. Results The findings uncovered that the adolescents’ families were mostly characterized by instability and diffuse relationships that provided an insecure basis for secure attachment and emotional support. Even in stable and secure family environments, there was no guarantee for getting sufficient emotional support in order to develop a positive self-concept due to the fate being the only infected child in the family. Both secure attachment and positive self-concept are known psychological protective mechanisms that provide the individual with resilience. The adolescents in this study seemed hampered in the development of protective mechanisms and consequently seemed psychologically vulnerable and badly equipped for coping with challenges, which paves the way for the possible development of mental disorders. Conclusion To change the focus towards strengthening the children and adolescents’ development of psychological protective mechanisms implicates a change in focus from illness to health and has consequences for both treatment and prevention. Psychological health promotion must be systemic and aim at strengthening the family environment, but also to establish peer group support.

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“…Clinical training of healthcare workers for NCD screening and treatment is necessary, 167,182 as is further training of students and health professionals in epidemiology and implementation science. 183 As new programmatic initiatives are developed for NCDs in LMICs, formal training in costing methodology, CEA, and budget impact analysis will offer opportunities for capacity building to assist policymakers at local, regional, and national levels.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

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What are the essential components of HIV treatment and care services in low and middle-income countries

Cited by 21 publications

References 21 publications

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study

HIV, Tuberculosis, and Noncommunicable Diseases

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