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Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.
[Washington, D.C.], FHI 360, 2017 Nov. 2 p.This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Scaling up HIV / AIDS prevention, treatment and care: a report on WHO support to countries in implementing the “3 by 5” Initiative, 2004-2005.
Geneva, Switzerland, WHO, 2006. 143 p.In September 2003, LEE Jong-wook, Director-General of WHO, and Peter Piot, Executive Director of UNAIDS, declared the lack of access to antiretroviral therapy for HIV/AIDS in low- and middle-income countries to be a global health emergency. Shortly after this declaration, WHO and its partners launched a global initiative to scale up antiretroviral therapy with the objective of having 3 million people receiving antiretroviral therapy - representing half the total number of those globally in need - by the end of 2005 ("3 by 5"). Although the actual target of putting 3 million people on antiretroviral therapy was not reached by the end of 2005, countries have made significant progress in the past two years in expanding treatment coverage, strengthening prevention and building the capacity of health systems to deliver long-term, chronic care. Overall, in the two-year period, antiretroviral therapy coverage in low- and middle-income countries increased from 7% of those in need at the end of 2003 (400 000 people) to 20% of those in need at the end of 2005 (1.3 million people). Eighteen countries managed to increase antiretroviral therapy coverage to half or more of the people who needed it, consistent with the "3 by 5" target. (excerpt)
Washington, D.C., World Bank, Knowledge and Learning Center, 2005 Nov.  p. (Findings Infobriefs No. 118; Good Practice Infobrief)The Mali Multi-sectoral AIDS Project (MAP) began implementation in late 2004 and is in the preliminary phases of the project cycle. This project has been commended by the World Bank's Board for its innovation and the involvement of the private sector to address HIV/AIDS. Mali is one of the poorest countries in the world due to factors such as its limited resource base, land-locked status and poor infrastructure. According to the 2001 Demographic and Health Survey (DHS) published by the Ministry of Health, Mali's HIV/AIDS prevalence rate is estimated at 1.7% in 2001. The project objective is to support the Government of Malis efforts to control the spread of the HIV/AIDS epidemic and provide sustainable access to treatment and care to those infected with or affected by HIV/AIDS. While Mali currently has a low HIV prevalence rate by Sub-Saharan African standards, it runs a high risk of experiencing an increase in prevalence rates. (excerpt)
Lancet. 2007 Jul 21; 370(9583):202-203.After a series of meetings, open internet-based reviews, and consultations over a year, WHO and UNAIDS recently released guidance on HIV testing and counselling initiated by health providers. Those not engaged in this exercise might not fully appreciate the evolution of thinking represented by this final document, nor the role played by active debate between constituencies with diverging views on key issues. Among these issues was whether HIV testing should be included in the panoply of routine tests given in health settings on the initiative of the clinician, unless the patient specifically opted-in by asking to be tested for HIV or opted-out by refusing the test, despite not having been prompted to consent to it. Many found the ideas confusing and questioned the underlying assumption of this approach-ie, that patients who signed off on admission forms when consulting or being admitted to a care facility de-facto agree to any diagnostic test found necessary by the treating doctor. Concerns were raised that, unlike other tests, in view of prevailing stigma, discrimination, and risks of violence attached to an HIV-positive result in many settings, particularly for women, specific individual agreement to the test remained necessary. (excerpt)
Lancet Infectious Diseases. 2007 Jul; 7(7):446.WHO and UNAIDS have issued new guidance on scaling up informed voluntary HIV testing and counselling in health facilities globally. The guidance promotes provider-initiated HIV testing, alongside existing patient-initiated HIV testing, with a view to ensuring earlier diagnosis, reducing transmission, and maximising the benefits of treatment. At a press conference in London, UK, Kevin De Cock (WHO, Geneva, Switzerland) told journalists: "WHO now recommends that in countries with generalised epidemics, all patients - with or without symptoms -who present to health services for whatever reason, should be offered testing". In countries with low-level HIV epidemics, the testing of all patients is now recommended at specific health services catering for at-risk groups. Additionally, all patients presenting to a health service with symptoms suggestive of HIV infection should be encouraged by health professionals to undergo testing. According to WHO, too many opportunities to diagnose HIV infection are being missed. (excerpt)
Geneva, Switzerland, WHO, 2006.  p.Even though children living with HIV/AIDS respond very well to treatment with antiretroviral therapy (ART), to date few children living with HIV/AIDS have access to ART mostly due to a lack of cheap feasible diagnostic tests for infants, lack of affordable child-friendly ARV drugs and lack of trained health personnel. This course aims to address the issue of lack of trained personnel. With an ever increasing burden of HIV and a high percentage of children infected, health workers urgently require accurate, up to date training and information on assessment and management of HIV in children. The IMCI complementary course on HIV is designed to assist health workers to assess, classify, treat and follow up HIV exposed infants and children, to identify the role of family and community in caring for the child with HIV/AIDS and also to enhance health workers' skills in counseling of caretakers around HIV/AIDS. (excerpt)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:42-51.Items from the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001) are analyzed. The Brazilian experience of new methods for testing and counseling among vulnerable populations, preventive methods controlled by women, prevention, psychosocial support for people living with HIV/AIDS, and mother-child transmission, is discussed. These items were put into operation in the form of keywords, in systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The Brazilian experience relating to testing and counseling strategies has been consolidated through the utilization of algorithms aimed at estimating incidence rates and identifying recently infected individuals, testing and counseling for pregnant women, and application of quick tests. The introduction of alternative methods and new technologies for collecting data from vulnerable populations has been allowing speedy monitoring of the epidemic. Psychosocial support assessments for people living with HIV/AIDS have gained impetus in Brazil, probably as a result of increased survival and quality of life among these individuals. Substantial advances in controlling mother-child transmission have been observed. This is one of the most important victories within the field of HIV/ AIDS in Brazil, but deficiencies in prenatal care still constitute a challenge. With regard to prevention methods for women, Brazil has only shown a shy response. Widespread implementation of new technologies for data gathering and management depends on investments in infrastructure and professional skills acquisition. (author's)
CommonHealth. 2005 Spring; 36-43.As defined by the World Health Organization (WHO):2 Palliative medicine is the study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life. [It is] the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are applicable earlier in the course of the illness, in conjunction with treatment. Palliative care: Affirms life and regards dying as a normal process; Neither hastens, nor postpones, death; Provides relief from pain and other distressing symptoms; Integrates the psychological and spiritual aspects of patient care; Offers a support system to help patients live as actively as possible until death; and Offers a support system to help families cope during a patient's illness and with their own bereavement. In short, palliative care comprehensively addresses the physical, emotional, and spiritual impact a life-threatening illness has on a person, no matter the stage of the illness. It places the sick person and his/her family, however defined, at the center of care and aggressively addresses all of the symptoms and problems experienced by them. Many healthcare providers apply certain elements of the palliative care treatment approach-- such as comprehensive care and aggressive symptom management-- to the care of all of their patients, not only those who are terminally ill, offering the type of care we would all like to receive when we are sick. (excerpt)
Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.
New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
London, England, Christian Aid, 2004 Jul. 17 p.The World Health Organisation (WHO) hopes to treat three million people with antiretroviral drugs by 2005. If ‘3 by 5’, as it is known, is achieved it would represent a ten-fold increase in the number of people in poor countries receiving antiretroviral treatment (ART). This would be a hugely important step – prolonging the lives of the most productive generation and allowing parents to survive long enough to put their children through school. Christian Aid applauds this commitment but warns that this is a highly complex situation. HIV/AIDS is the biggest threat to the developing world. Today’s productive generation is dying and the workforce of tomorrow is being left without parents; the economic future of the developing world is bleak. But, as Drugs alone are not enough shows, without the appropriate infrastructure the drugs themselves may actually become counter-productive. Community organisations and networks must provide recipients of drug treatment with backup. Home-based care and other community-support programmes, the backbone of much of Christian Aid’s HIV work, are ideally placed to provide these services. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2004.  p.While this guide primarily addresses HIV prevention, it also makes the link to other STI’s, since these can increase a pregnant woman’s succeptibility to HIV infection and since both HIV/AIDS and other STI’s can be transmitted to the foetus or newborn child. While preventing HIV infection in pregnant women is a critical element in preventing HIV transmission to the child (vertical transmission), this guide does not attempt to duplicate the many training aides and programme guides that already address prevention of vertical transmission. Prevention of mother-to-child transmission (PMTCT) is more than the provision of antiretroviral drugs to prevent transmission of HIV from an HIV-positive woman to her infant. A comprehensive programme to prevent HIV transmission to pregnant women, mothers, and their children, which has been endorsed by the UN system, includes four elements known as PMTCT, defined as: 1. Prevention of HIV, especially among young people and pregnant women. 2. Prevention of unintended pregnancies among HIV-infected women. 3. Prevention of HIV transmission from HIV-infected women to their infants. 4. Provision of treatment, care, and support to HIV-infected women and their families. This guide focuses primarily on the first of the four elements. (excerpt)
Global AIDSLink. 2002 Jan; (71):11, 17.In many Buddhist countries, people assume that monks would never entertain the prospect of working in HIV/AIDS, an illness associated in many people’s minds with immoral, rather than unsafe, behaviors. In some countries where monks have played more of a ceremonial or purely spiritual role, people wonder how monks will cope with the intense social action HIV/AIDS requires. At this stage someone usually raises the example of Thailand where monks have played a role in development activities for over two decades and have been active at grassroots level on HIV/AIDS for many years. For many countries in the Mekong region, Thailand’s example seems a hard act to follow. And it’s true that monks in Cambodia and Lao PDR, for instance, tend to be less well educated, at least in secular subjects, than their peers in Thailand. It is certainly true that their community temples have less resources. But, as UNICEF has been delighted to discover, there are many, many monks in the Mekong region for whom the realization of the extent of the AIDS problem has been a call to action. (excerpt)
Fighting AIDS. HIV / AIDS prevention and care among armed forces and UN peacekeepers: the case of Eritrea.
Copenhagen, Denmark, UNAIDS, Office on AIDS, Security and Humanitarian Response, 2003 Aug. 40 p. (UNAIDS Series: Engaging Uniformed Services in the Fight against AIDS. Case Study No. 1; UNAIDS/03.44E)Uniformed services, including peacekeepers, frequently rank among the population groups most affected by sexually transmitted infections (STIs), including HIV. Military personnel are two-to-five times more likely to contract STIs than the civilian population and, during conflict, this factor can increase significantly. However, soldiers may also become important agents for behavioural change in reversing the spread of HIV within the army and beyond. If equipped with the right information, knowledge and tools, the military can achieve lower HIV prevalence rates than the national average, as can be seen from the experiences among the armed forces of Ethiopia and Uganda. HIV/AIDS poses a particular threat to peacekeeping, which is a pillar of the international security system. Conflict and post-conflict situations represent high-risk environments for the spread of HIV/AIDS. One-third of the officers and soldiers under UN command are stationed in Africa, which is home to 70% of people living with HIV. As early as 1995, the US State Department noted, “worldwide peacekeeping operations may pose a danger of spreading HIV… peacekeepers could both be a source of HIV infection to local populations and be infected by them, thus becoming a source of the infection when they return home”. For example, the HIV infection rate was 11% among Nigerian peacekeepers who returned home from duty in Sierra Leone and Liberia in 2000, when the rate in the civilian adult population in Nigeria was5%. (excerpt)
Geneva, Switzerland, UNAIDS, 2003 Dec.  p. (UNAIDS/03.39E)The global response has expanded significantly in the past two-to-three years. Spending (domestic and external) on HIV/AIDS programmes in low- and middle-income countries increased again in 2003, notably in sub-Saharan Africa. Dozens of national AIDS coordinating bodies are now in operation, and a growing number of countries (many of them in Africa) have begun extending antiretroviral and other AIDS-related medications to their citizens. But, at the moment, these developments do not match the region’s epidemics in scale or pace. Antiretroviral treatment coverage remains dismal in sub-Saharan Africa overall, despite recent efforts in countries such as Botswana, Cameroon, Nigeria and Uganda. WHO—the convening agency for HIV care in the Joint United Nations Programme for HIV/AIDS (UNAIDS)—and partners are developing a comprehensive global strategy to bring antiretroviral treatment to 3 million people by 2005. Dramatic and sustained increases in resources and political commitment—including from hard-hit countries themselves—are needed in order to reach that goal. The policies and practices used to achieve that goal must ensure that treatment access is equitable and that it benefits the poor and marginalized sections of societies, especially women. Alongside that huge challenge stands the urgent need to boost prevention programmes. More effective prevention and much wider treatment access should go hand in hand. Prevention efforts can slow the spread of HIV, and antiretroviral treatment blunts the impact of AIDS. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1850-1853.Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (author's)
Geneva, Switzerland, UNAIDS, 2003 Sep. 74 p. (UNAIDS/03.44E)This report provides a snapshot of the action being taken across the African continent in response to the challenge of AIDS. It highlights governments working with all their ministries to deliver a full-scale response. It demonstrates progress in closing the gaps in the provision of HIV prevention and treatment. It shows the value of partnership between government, communities and businesses. It showcases the determination of African women to throw off the disproportionate burden that AIDS represents for them. And it makes manifest the voice of hope, in the many successful responses by young people in fighting the epidemic. (author's)
HIV-infected women and their families: psychosocial support and related issues. A literature review.
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2003. vi, 57 p. (Occasional Paper; WHO/RHR/03.07; WHO/HIV/2003.07)This review is divided into three sections. Section one provides a synthesis of the reviewed literature on prevention of mother-to-child transmission (PMTCT) of HIV, voluntary HIV testing and counselling (VCT), and other issues that impact on the care, psychosocial support and counselling needs of HIV-infected women and their families in the perinatal period. Section two provides examples from around the world of projects that focus on the care and support of women and families, with a focus on MTCT. The fi nal section contains recommendations on psychosocial support and counselling for HIV-infected women and families. (excerpt)