Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review

Background: The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC) is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting: The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal.Aim: The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics.Methods: A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization’s guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities.Results: None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure.Conclusion: HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics.

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Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13072221 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2221

Author(s):

Hugo G. Quezada-Pinedo ◽

Florian Cassel ◽

Liesbeth Duijts ◽

Martina U. Muckenthaler ◽

Max Gassmann ◽

...

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Child Health ◽

Methodological Quality ◽

Iron Status ◽

Meta Analysis ◽

Child Health Outcomes ◽

Maternal Iron ◽

In Pregnancy

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.

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Integration of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Postpartum Services with Other HIV Care and Treatment Services within the Maternal and Child Health Setting in Zimbabwe, 2012

PLoS ONE ◽

10.1371/journal.pone.0098236 ◽

2014 ◽

Vol 9 (6) ◽

pp. e98236 ◽

Cited By ~ 21

Author(s):

Katherine Wiegert ◽

Thu-Ha Dinh ◽

Angela Mushavi ◽

Owen Mugurungi ◽

Peter H. Kilmarx

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Hiv Care ◽

Mother To Child Transmission ◽

Child Transmission ◽

Treatment Services ◽

Care And Treatment ◽

Mother To Child ◽

And Child Health

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Factors Associated with the Failure to Seek HIV Care and Treatment Among HIV-Positive Women in a Northern Province of Vietnam

AIDS Patient Care and STDs ◽

10.1089/apc.2009.0285 ◽

2010 ◽

Vol 24 (5) ◽

pp. 325-332 ◽

Cited By ~ 7

Author(s):

Nguyen T. Nam ◽

Ib C. Bygbjerg ◽

Hanne O. Mogensen ◽

Vibeke Rasch

Keyword(s):

Hiv Care ◽

Hiv Positive ◽

Northern Province ◽

Factors Associated ◽

Hiv Positive Women ◽

Care And Treatment

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Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

10.21203/rs.3.rs-711025/v1 ◽

2021 ◽

Author(s):

Daniel Kasozi ◽

Philip Govule ◽

Simon Peter Katongole ◽

Bismark Sarfo

Keyword(s):

Health Workers ◽

Screen Test ◽

Hiv Care ◽

People Living With Hiv ◽

Presumptive Diagnosis ◽

Treatment Services ◽

Care And Treatment ◽

Living With Hiv ◽

Greater Accra Region ◽

General Appearance

Abstract BackgroundTuberculosis (TB) remains a significant public health concern, and a leading cause of ill-health and death globally. More so, People living with HIV have been shown to carry an increased risk of developing TB with an estimated one-third of deaths in this population. The World Health Organization recommends systematic and routine screening of PLHIV for TB on every clinic visit and further testing using sputum for those with a positive TB screen test. Not all PLHIV with a positive TB screen test in Ghana are further tested for TB using sputum and the factors for this are not well understood. This study assessed factors associated with sputum ordering for TB diagnosis in PLHIV who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.MethodsMixed method study performed at three purposively selected hospitals providing HIV care and treatment services in the Greater Accra region. The study involved a cross sectional review of patients’ charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Quantitative data was analyzed using STATA version 15. Chi square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. P≤ 0.05 was considered statistically significant. Inductive thematic analysis was used to determine emerging themes from the interviews. The major themes were represented with representative quotations.ResultsFour hundred (400) patient charts were reviewed of which 67.7% were female with median age of 39 (IQR 31-49). TB screening was recorded in 78% (95% CI 73.6, 82.0) of the patients of whom ninety-two (92) patients had a positive TB screen test. Only 53 (57.6%) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, patient general appearance described as abnormal (OR=3.05, p=0.036), having more than one TB symptom (OR=3.42, p=0.028) and presence of an alternative presumptive diagnosis (OR=0.34, p=0.023) were associated with having a sputum test ordered. High patient numbers, inability to produce sputum, unwillingness of the not so sick patients to provide sputum and the costs associated with chest X-ray were perceived as the challenges to further testing for TB.ConclusionTB screening in PLHIV is still lower than recommended and almost half of PLHIV with a positive TB screen test did not have a sputum test documented. Sputum testing was likely to be done in patients with an abnormal general appearance and more than one TB symptom and unlikely in those with an alternative presumptive diagnosis. High workload, costs of TB tests, lack of training for health workers and inability to produce sputum by patients were the barriers to sputum testing highlighted by the health workers.

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