Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD&lt;350 cells/μL) in eastern Uganda

Muhamadi, Lubega; Nsabagasani, Xavier; Tumwesigye, Nazarius Mbona; Wâbwire-Mângen, Fred; Ekström, Anna Mia; Peterson, Stefan; Pariyo, George

doi:10.1016/j.healthpol.2010.06.003

Cited by 47 publications

(54 citation statements)

References 31 publications

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“…People with higher CD4 + T cell level and longer time of HIV infection were more likely to reject early ART. The perception that ART is only for sick people and the concern about drug resistance may prevent people with higher CD4 + T cell test results (above 750 cells/μL) from receiving early ART (Muhamadi et al, 2010). Some people with longterm HIV infection never met the standard of ART in our study.…”

Section: Discussionmentioning

confidence: 73%

Acceptability of early anti-retroviral therapy among HIV-infected people in Anhui province in China

et al. 2014

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We investigated the acceptability of early anti-retroviral therapy (ART) among HIV-infected people in Anhui Province, China. A cross-sectional study was conducted in 11 convenience selected cities of Anhui Province from September 2012 to December 2013. Study participants were convenience recruited from local Centers for Disease Control and Prevention when they attended for CD4(+) cell counts testing and HIV counselling. Answers to questionnaires were obtained through face-to-face structured interviews. Factors influencing the acceptability of early ART were identified by multiple logistic regression analysis. A total of 287 HIV-infected people met the criteria and completed the survey. The acceptability of early ART was 65.2%. The results of multiple logistic regression analysis indicated that the acceptability of early ART was associated with the following factors: CD4(+) T cell count (above 750 cells/µL vs. 350 cells/µL to 550 cells/µL: OR = 0.144, P < 0.001), years of HIV diagnosis confirmation (1 year to 5 years vs. <1 year: OR = 0.418, P = 0.005; above 5 years vs. <1 year: OR = 0.160, P < 0.001), whether had sexual behaviour after HIV diagnosis confirmation (yes vs. no: OR = 2.342, P = 0.005) and the awareness of two early ART-related questions (OR = 4.101, P = 0.015; OR = 3.294, P < 0.001). In summary, the present study showed that most HIV-infected people can accept early ART. Early ART interest in Anhui HIV-infected population was high. The awareness of early ART-related knowledge in HIV-infected population was low and should be improved to achieve higher acceptability and keep adherence to early ART for HIV prevention.

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Section: Discussionmentioning

confidence: 73%

Acceptability of early anti-retroviral therapy among HIV-infected people in Anhui province in China

et al. 2014

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“…These factors explain why only about one-half of the pregnant women who tested positive for HIV in low-and middle-income countries were assessed for ART eligibility (133). Stock-outs or expiration of ARV drugs may be other impediments to timely initiation of the prophylactic or therapeutic ARV regimen (136,137).…”

Section: Next Stepsmentioning

confidence: 99%

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives

Young

Mbuya

Chantry

et al. 2011

Advances in Nutrition

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In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world. Adv. Nutr. 2: 225-243, 2011.

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“…This is an area that requires improvement, as ARV drug stock-outs have been shown to be associated with non-adherence to ART and unplanned treatment interruption, 22,23 and may also be a barrier to timely initiation of ART. 24 In comparison with the PLHIV who attended review visits on time, those who had previously been lost to follow-up had higher odds of IPT non-completion. This underscores the need for health workers to provide enhanced adherence counselling on the benefits of IPT and ART for those PLHIV who have a history of interrupting treatment, to ensure IPT completion.…”

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confidence: 98%

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

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Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03-0.28) and receiving a 2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10-13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies. Public Health Action IPT in Zimbabwe 56the WHO-recommended four-symptom TB screening checklist. 11 If PLHIV present with any of the four symptoms, they are considered to be presumptive TB cases and sputum specimens are collected for smear microscopy or Xpert ® MTB/RIF (Cepheid, Sunnyvale, CA, USA) testing. Those patients negative on Xpert or smear microscopy and who have no other symptoms or signs of extra-pulmonary or smear-negative pulmonary TB, including chest radiography if necessary, are not recorded as having active TB. During the pilot phase, PLHIV who were not diagnosed with active TB were offered adherence counselling and were started on a daily oral dose of isoniazid (INH, 5 mg/kg body weight for adults or 10 mg/kg body weight for children) plus a daily low dose of pyridoxine (25 mg/day) for a 6-month period, regardless of their ART status. It was recommended that patients receive regular supplies of INH every month until completion of their prophylactic treatment. 10 During clinic visits, patients were assessed through self-reporting and pill counts for adherence and screened for TB. Patients found to have active TB were taken off IPT and treated according to the national TB guidelines. 11 Data on TB status (screened with no TB signs/not screened/ presumptive TB case/active TB), IPT status (yes/no), IPT quantity dispensed and reasons for starting or stopping IPT were integrated into the individual patient opportunistic infection (OI) ART care booklets and the pre-ART or ART registers, depending on the patients' ART status. This information was updated during each clinical review visit. For easier tracing of all clients enrolled on IPT, ...

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Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda

Cited by 47 publications

References 31 publications

Acceptability of early anti-retroviral therapy among HIV-infected people in Anhui province in China

Acceptability of early anti-retroviral therapy among HIV-infected people in Anhui province in China

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

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