Future of HIV/AIDS Care in Low- and Middle- Income Countries

Hoffmann, Christopher J.; Mills, Lisa; Gallant, Joel E.

doi:10.1007/978-0-387-72711-0_3

Cited by 4 publications

(5 citation statements)

References 107 publications

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“…This is particularly important for later scale-up given the increasing time constraints on professional health staff within HIV programmes. Task shifting is already taking place in many areas of health care in sub-Saharan Africa, with lay counsellors or CHWs taking on roles in infant feeding counselling, HIV counselling, ART adherence, and nutrition counselling [69,70]. Lay counsellors and CHWs have shown ability to conduct psycho-social interventions at the primary health care level, including HIV counselling, testing, and training to initiate HIV treatment [71] and to deliver simplified psychological interventions in poorly resourced settings [72,73].…”

Section: Discussionmentioning

confidence: 99%

Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

2013

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BackgroundAs access to treatment increases, large numbers of HIV-positive parents are raising HIV-negative children. Maternal HIV disclosure has been shown to have benefits for mothers and children, however, disclosure rates remain low with between 30-45% of mothers reporting HIV disclosure to their children in both observational and intervention studies. Disclosure of HIV status by parent to an HIV-uninfected child is a complex and challenging psychological and social process. No intervention studies have been designed and tested in Southern Africa to support HIV-positive parents to disclose their status, despite this region being one of the most heavily affected by the HIV epidemic.MethodThis paper describes the development of a family-centred, structured intervention to support mothers to disclose their HIV status to their HIV-negative school-aged children in rural South Africa, an area with high HIV prevalence. The intervention package includes printed materials, therapeutic tools and child-friendly activities and games to support age-appropriate maternal HIV disclosure, and has three main aims: (1) to benefit family relationships by increasing maternal HIV disclosure; (2) to increase children’s knowledge about HIV and health; (3) to improve the quality of custody planning for children with HIV-positive mothers. We provide the theoretical framework for the intervention design and report the results of a small pilot study undertaken to test its acceptability in the local context.ResultsThe intervention was piloted with 24 Zulu families, all mothers were HIV-positive and had an HIV-negative child aged 6–9 years. Lay counsellors delivered the six session intervention over a six to eight week period. Qualitative data were collected on the acceptability, feasibility and the effectiveness of the intervention in increasing disclosure, health promotion and custody planning. All mothers disclosed something to their children: 11/24 disclosed fully using the words "HIV" while 13/24 disclosed partially using the word "virus".ConclusionThe pilot study found the intervention was feasible and acceptable to mothers and counsellors, and provides preliminary evidence that participation in the intervention encouraged disclosure and health promotion. The pilot methodology and small sample size has limitations and further research is required to test the potential of this intervention. A larger demonstration project with 300 families is currently underway.

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Section: Discussionmentioning

confidence: 99%

Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

2013

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“…In response to the HIV epidemic, antiretroviral treatment (ART) roll out has risen dramatically, with 28.2 million individuals on treatment by 2021 worldwide [1]. Although ART has substantially reduced HIV related morbidity, mortality, and transmission, HIV Drug Resistance (HIVDR) can become a problem, particularly in low-and middle-income countries (LMICs) where genotyping testing is not readily available [2,3]. Among ART naïve individuals, drug resistance may occur through Transmitted Drug Resistance (TDR) or Pretreatment HIV Drug Resistance (PDR) which may compromise the success of future first line regimens [4].…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Trends in HIV-1 Transmitted Drug Resistance in Mozambique 1999–2018

Ismael

Wilkinson

Mahumane

et al. 2022

Viruses

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HIV drug resistance (HIVDR) can become a public health concern, especially in low- and middle-income countries where genotypic testing for people initiating antiretroviral therapy (ART) is not available. For first-line regimens to remain effective, levels of transmitted drug resistance (TDR) need to be monitored over time. To determine the temporal trends of TDR in Mozambique, a search for studies in PubMed and sequences in GenBank was performed. Only studies covering the pol region that described HIVDR and genetic diversity from treatment naïve patients were included. A dataset from seven published studies and one novel unpublished study conducted between 1999 and 2018 were included. The Calibrated Population Resistance tool (CPR) and REGA HIV-1 Subtyping Tool version 3 for sequences pooled by sampling year were used to determine resistance mutations and subtypes, respectively. The prevalence of HIVDR amongst treatment-naïve individuals increased over time, reaching 14.4% in 2018. The increase was most prominent for non-nucleoside reverse transcriptase inhibitors (NNRTIs), reaching 12.7% in 2018. Subtype C was predominant in all regions, but a higher genetic variability (19% non-subtype C) was observed in the north region of Mozambique. These findings confirm a higher diversity of HIV in the north of the country and an increased prevalence of NNRTI resistance among treatment naïve individuals over time.

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“…In addition, from a policy side, there is a need for a systemic view and holistic approach, which consider the connections between different systems, deals with challenges in both origin and destination areas and includes the perspectives of migrants and other stakeholders. Given the multiple linkages and inter‐dependencies, a just policy design needs to foster resilience and sustainability in both origin and destination contexts (Hoffmann & Muttarak, 2021). This requires policymakers and practitioners to look beyond the boundaries of their organizations, incorporate insights and perspectives from other domains and actively collaborate with others.…”

Section: Recommendations: Bridging the Science–policy Gapmentioning

confidence: 99%

“…Also, migration destinations, especially cities in the Global South, are affected by adverse climate impacts. Migrant populations are particularly exposed and vulnerable, creating a novel set of challenges related to climate resilience and human security (Hoffmann & Muttarak, 2021).…”

Section: Introductionmentioning

confidence: 99%

Strengthening the science–policy interface in the climate migration field

Hoffmann

Vinke

Šedová

2023

International Migration

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The question of how climatic changes and hazards affect human mobility has increasingly gained prominence in public debates over the past decade. Despite improvements in the scientific understanding of the subject and advancements in policy, major gaps remain in addressing the humanitarian and socio‐economic challenges related to climate migration. In this perspectives article, we argue for a holistic approach and a closer integration of science and policy involving diverse stakeholders in the process of knowledge generation and implementation. We identify five key challenges characteristic for improving the science–policy interface: (i) conflictual political contexts and the securitization of human migration, (ii) simplistic narratives and framing of the subject, (iii) the uneven production and dissemination of knowledge, (iv) limited data and analytical capacities and (v) a selective topical and methodological focus. To address these diverse challenges, there is a need for more bridging initiatives at the science–policy interface that integrate diverse disciplines, approaches and stakeholders. A closer engagement of researchers and policymakers in the form of multi‐stakeholder exchanges, capacity‐building activities, co‐development and co‐implementation processes and integrative scientific assessments can help bridge the gap to support the inclusive generation of knowledge and the development of comprehensive policies.

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Future of HIV/AIDS Care in Low- and Middle- Income Countries

Cited by 4 publications

References 107 publications

Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

Molecular Epidemiology and Trends in HIV-1 Transmitted Drug Resistance in Mozambique 1999–2018

Strengthening the science–policy interface in the climate migration field

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