Linking women who test HIV‐positive in pregnancy‐related services to long‐term HIV care and treatment services: a systematic review |
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Authors: | Laura Ferguson Alison D. Grant Deborah Watson‐Jones Tanya Kahawita John O. Ong’ech David A. Ross |
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Affiliation: | 1. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;2. University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya;3. Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK;4. Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania;5. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK;6. University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya;7. Department of Obstetrics and Gynaecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya;8. Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya |
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Abstract: | Objectives To quantify attrition between women testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV care and treatment services in low‐ or middle‐income countries and to explore the reasons underlying client drop‐out by synthesising current literature on this topic. Methods A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000–2010. Only studies meeting pre‐defined quality criteria were included. Results Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub‐Saharan Africa. The pathway between testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV‐related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38–88% of known‐eligible women. Providing ‘family‐focused care’, and integrating CD4 testing and HAART provision into prevention of mother‐to‐child HIV transmission services appear promising for increasing women’s uptake of HIV‐related services. Individual‐level factors that need to be addressed include financial constraints and fear of stigma. Conclusions Too few women negotiate the many steps between testing HIV‐positive in pregnancy‐related services and accessing HIV‐related services for themselves. Recent efforts to stem patient drop‐out, such as the MTCT‐Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services. |
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Keywords: | antiretroviral therapy female patient dropouts developing countries HIV infections thé rapie antiré trovirale trè s actif fé minin patients dé sistant pays en dé veloppement infections VIH Terapia antirretroviral altamente efectiva mujer abandono de pacientes paí ses en ví as de desarrollo infecció n por VIH |
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