Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV

2021 ◽  
pp. 095646242199995
Author(s):  
Farai Nyatsanza ◽  
Jessica Gubbin ◽  
Thomas Gubbin ◽  
Paula Seery ◽  
Pippa Farrugia ◽  
...  
Keyword(s):  
Post Partum ◽  
World Health Organisation ◽  
Formula Feeding ◽  
World Health ◽  
Community Members ◽  
Hiv Viral Load ◽  
Middle Income ◽  
Black African ◽  
Women Living With Hiv ◽  
Living With Hiv

Background. The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. Methods. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Results. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Conclusion. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

scholarly journals Outcomes of retained and disengaged pregnant women living with HIV in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251413
Author(s):  
Agnes N. Kiragga ◽  
Ellon Twinomuhwezi ◽  
Grace Banturaki ◽  
Marion Achieng ◽  
Juliet Nampala ◽  
...  
Keyword(s):  
Post Partum ◽  
Urban Environments ◽  
Hiv Viral Load ◽  
Viral Loads ◽  
Women Living With Hiv ◽  
Resource Limited ◽  
Increased Risk ◽  
Exposed Infant ◽  
Public Clinics ◽  
Living With Hiv

Introduction Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.

scholarly journals A pilot to investigate the use of the icf in documenting levels of function and disability in people living with hiv

2006 ◽  
Vol 62 (1) ◽  
Author(s):  
J. Jelsma ◽  
N. Brauer ◽  
C. Hahn ◽  
A. Snoek ◽  
I. Sykes
Keyword(s):  
World Health Organisation ◽  
World Health ◽  
International Classification Of Functioning ◽  
Resource Poor Setting ◽  
People Living With Hiv ◽  
Community Members ◽  
Health Related ◽  
Increased Sensitivity ◽  
Living With Hiv

Objective: The study was a pilot study aimed at investigating the use of the International Classification of Functioning, Disability and Health (ICF) checklist developed by the World Health Organisation in determining the function of individuals living with HIV in a township near Cape Town.Methods: Twelve participants attending the HIV clinic were examinedusing the ICF checklist.Findings: Areas of the ICF in which problems were noted included emotional functioning and energy and drive. Four participants complained of increased sensitivity to sound. Several respondents (three) reported difficulties in relationships with community members, with less having problems in family and intimate relationships. Conclusion: The ICFwas found to be time consuming and many codes were not relevant. Some of the concepts were not well understood by the participants. However, despite limitations, the use of the ICF in a resource poor setting formed a useful framework within which to examine the functional problems of HIV infected individuals. In the absence of any equivalent unifying framework within which to classify health and health related states, the use of the ICF merits further investigation.

scholarly journals Relating CYP2B6 Genotype and EFV Resistance Among Women Living With HIV With High Viremia in Uganda: A Nested Cross-Sectional Study.

2021 ◽  
Author(s):  
ALLAN BUZIBYE ◽  
Kara Wools-Kaloustian ◽  
Adeniyi Olagunju ◽  
Ellon Twinomuhwezi ◽  
Constantin Yiannoutsos ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Post Partum ◽  
Cross Sectional Study ◽  
World Health ◽  
Sectional Study ◽  
Cross Sectional ◽  
Women Living With Hiv ◽  
Living With Hiv

Abstract BackgroundWe investigated the association between CYP2B6 polymorphisms and efavirenz drug resistance among women living with HIV started on anti-retroviral therapy during pregnancy and with high viremia during post-partum.MethodsThis was a cross sectional study. Women between 6-12 weeks post-partum with viral load >1000 copies/ml were eligible. Sanger sequencing to detect resistant mutations and host genotyping were performed. We categorized efavirenz metabolizer genotype according to the AIDS clinical trials group algorithm as slow, intermediate and extensive; and compared efavirenz resistance among the metabolizer genotypes.Results Over a one-year period (July 2017-July 2018), three hundred and thirty two women were screened of whom 112 (34.8%) had viral load ≥1000 copies/ml of whom 62 had whole blood available for genotyping. Fifty-nine of these women had both viral resistance and human host genotypic results. We observed a higher frequency of efavirenz resistance among slow metabolizers (47% versus 34% in extensive and 28% in intermediate, metabolizers) but due to low numbers, this was not statistically significant. ConclusionsOur findings raise the possibility that CYP2B6 polymorphism may contribute to efavirenz drug resistance in women started on antiretroviral therapy during pregnancy and with high viremia in the post-partum period. If confirmed in a larger study, this would have important implications for all patients in sub-Saharan Africa receiving efavirenz and add further support to the changes in World Health Organization policy to switch away from efavirenz as first line antiretroviral therapy in countries with a high prevalence of CYP2B6 polymorphisms.

scholarly journals Practical Pharmacist-Led Interventions to Improve Antimicrobial Stewardship in Ghana, Tanzania, Uganda and Zambia

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 124
Author(s):  
Frances Kerr ◽  
Israel Sefah ◽  
Darius Essah ◽  
Alison Cockburn ◽  
Daniel Afriyie ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
International Health ◽  
World Health Organisation ◽  
Mobile App ◽  
World Health ◽  
Infection Prevention And Control ◽  
Middle Income ◽  
Train The Trainer ◽  
Partnership Model ◽  
Health Partnership

The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR.

scholarly journals Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi

2021 ◽  
Vol 11 ◽  
Author(s):  
Obadia Yator ◽  
Muthoni Mathai ◽  
Tele Albert ◽  
Manasi Kumar
Keyword(s):  
Postpartum Depression ◽  
Post Partum ◽  
Internalized Stigma ◽  
Child Transmission ◽  
National Hospital ◽  
Cross Sectional ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv ◽  
Mother To Child

Background: We look at how various HIV-related stigma subtypes, especially internalizing types, interact with postpartum depression (PPD) among women living with HIV. Additionally, we identify key psychosocial risk factors that influence stigma and PPD among women attending Prevention of Mother-to-Child Transmission (PMTCT) clinics.Methods: In this cross-sectional design, 123 women living with HIV were recruited. Participants ages between 18 and 50, who were at least 8 weeks postpartum seeking PMTCT services at Kenyatta National Hospital (KNH), between June and September 2014 participated in the study. HIV/AIDS Stigma Instrument—PLWHA (HASI–P) was used to assesses stigma and Postpartum depression was assessed by Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV-related stigma Scale. Post survey a few in-depth-interviews were conducted to explore individuals' stigma and depression experiences.Results: The mean age was 31.2 years (SD = 5.2). Fifty-nine (48%) women screened positive for significant depressive symptoms. Post-partum depression was a significant predictor of internalized stigma, enacted, and total stigma (P &lt; 0.05). Older age was associated with less internalized stigma. Living with a partner was associated with more internalized stigma. Having an income above 100 USD per month was protective against stigma. Having good family social support was protective against internalized stigma. A higher educational level was protective against enacted stigma. Being treated for STIs was a risk factor for both enacted and overall stigma.Conclusions: HIV-related stigma needs to be addressed through integrated mental health care programs in PMTCT. Postpartum depression requires comprehensive management to improve short- and long-term outcomes of women living with HIV.

scholarly journals Simple and adaptable R implementation of WHO/ISH cardiovascular risk charts for all epidemiological subregions of the world

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2522 ◽  
Author(s):  
Dylan Collins ◽  
Joseph Lee ◽  
Niklas Bobrovitz ◽  
Constantinos Koshiaris ◽  
Alison Ward ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Communicable Disease ◽  
World Health Organisation ◽  
World Health ◽  
Cvd Risk ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Risk Charts ◽  
Free Open Source

The World Health Organisation and International Society of Hypertension (WHO/ISH) cardiovascular disease (CVD) risk assessment charts have been implemented in many low- and middle-income countries as part of the WHO Package of Essential Non-Communicable Disease (PEN) Interventions for Primary Health Care in Low-Resource settings. Evaluation of the WHO/ISH cardiovascular risk charts and their use is a key priority and since they only exist in paper or PDF formats, we developed a simple R implementation of the charts for all epidemiological subregions of the world. The main strengths of this implementation are that it is built in a free, open-source, coding language with simple syntax, can be modified by the user, and can be used with a standard computer.

scholarly journals Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Grace Sum ◽  
Gerald Choon-Huat Koh ◽  
Stewart W. Mercer ◽  
Lim Yee Wei ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
World Health Organisation ◽  
World Health ◽  
Uncontrolled Hypertension ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Increased Risk ◽  
And Control

Abstract Background The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Methods Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007–10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). Results A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Conclusion Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.

scholarly journals Drivers of the Adoption and Exclusive Use of Clean Fuel for Cooking in Sub-Saharan Africa: Learnings and Policy Considerations from Cameroon

2020 ◽  
Vol 17 (16) ◽  
pp. 5874 ◽  
Author(s):  
Alison Pye ◽  
Sara Ronzi ◽  
Bertrand Hugo Mbatchou Ngahane ◽  
Elisa Puzzolo ◽  
Atongno Humphrey Ashu ◽  
...  
Keyword(s):  
Economic Status ◽  
World Health Organisation ◽  
Household Wealth ◽  
Sub Saharan Africa ◽  
World Health ◽  
Solid Fuels ◽  
Liquefied Petroleum Gas ◽  
Financial Barriers ◽  
Middle Income ◽  
Sub Saharan

Household air pollution (HAP) caused by the combustion of solid fuels for cooking and heating is responsible for almost 5% of the global burden of disease. In response, the World Health Organisation (WHO) has recommended the urgent need to scale the adoption of clean fuels, such as liquefied petroleum gas (LPG), in low and middle-income countries (LMICs). To understand the drivers of the adoption and exclusive use of LPG for cooking, we analysed representative survey data from 3343 peri-urban and rural households in Southwest Cameroon. Surveys used standardised tools to collect information on fuel use, socio-demographic and household characteristics and use of LPG for clean cooking. Most households reported LPG to be clean (95%) and efficient (88%), but many also perceived it to be expensive (69%) and unsafe (64%). Positive perceptions about LPG’s safety (OR = 2.49, 95% CI = 2.04, 3.05), cooking speed (OR = 4.31, 95% CI = 2.62, 7.10), affordability (OR = 1.7, 95% CI = 1.38, 2.09), availability (OR = 2.17, 95% CI = 1.72, 2.73), and its ability to cook most dishes (OR = 3.79, 95% CI = 2.87, 5.01), were significantly associated with exclusive LPG use. Socio-economic status (higher education) and household wealth (higher income) were also associated with a greater likelihood of LPG adoption. Effective strategies to raise awareness around safe use of LPG and interventions to address financial barriers are needed to scale wider adoption and sustained use of LPG for clean cooking, displacing reliance on polluting solid fuels.

scholarly journals Support for Lowering Cervical Cancer Screening Age To 25 for Women Living With HIV: Retrospective Cross-Sectional Programmatic Data From Botswana

2021 ◽  
Author(s):  
Doreen Ramogola-Masire ◽  
Surbhi Grover ◽  
Anikie Mathoma ◽  
Barati Monare ◽  
Lesego Gabaitiri ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Age Groups ◽  
Cervical Cancer Prevention ◽  
World Health ◽  
Hiv Status ◽  
Cross Sectional ◽  
Cancer Risk Factors ◽  
Women Living With Hiv ◽  
Younger Age ◽  
Living With Hiv

Abstract Background: Women living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than HIV-negative women. The World Health Organization’s (WHO) new guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intra-epithelial neoplasia grade two or higher (CIN2+) in Botswana. Methods: A retrospective cross-sectional study of 5,714 participants aged 25 through 49 years who underwent VIA screening. VIA-positive women received cryotherapy if indicated or were referred for colposcopy. Known cervical cancer risk factors, screening, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status.Results: Median age was 35 years [IQR 31-39], and 18% of the women were aged 25-29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150-428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25-29 years versus age 30-49 years ), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was associated with HIV positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (12.1% versus 10.8%).Conclusions: Younger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.

scholarly journals ECONOMIC DISPARITY IN CHILDHOOD GROWTH IN BIHAR

2020 ◽  
pp. 35-40
Author(s):  
Sumela Ajmer
Keyword(s):  
Child Survival ◽  
Family Health ◽  
World Health Organisation ◽  
World Health ◽  
Middle Income ◽  
Childhood Growth ◽  
Children Under Five ◽  
Economic Disparity ◽  
Under Five ◽  
Socioeconomic And Demographic Factors

Stunted childhood growth is a major child health problem in most of the developing nations. It is a proxy indicator for determining the general health status of the population and is one of the main predictors of child survival. World Health Organisation reported that around 45% of deaths are related to undernutrition in children under five years of age. These deaths fare mainly from low- and middle-income countries. The economic disparity across the socioeconomic and demographic factors among children under-five in Bihar is carried out in this study using the data from the National Family Health Survey conducted during 2015-16. The bivariate analyses were used to achieve the objectives of the analysis. The prevalence of stunting in Bihar (48%) is 10% higher than the national average. The findings show that the children with higher educated mothers, higher birth order, higher age at birth, Magadh region, have a significantly higher economic disparity in stunting among children under-five in Bihar as compared to their counterparts. Therefore, it is recommended that socioeconomically, demographically, and regionally backward sections should get focussed on policy modification and program interventions.

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