A Systematic Review of Health System Barriers and Enablers for Antiretroviral Therapy (ART) for HIV-Infected Pregnant and Postpartum Women
| Autor: | Jennifer Albertini, Christopher J. Colvin, Konopka S, Karen P. Fogg, Edna Jonas, John Chalker, Anouk Amzel |
|---|---|
| Přispěvatelé: | Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Service delivery framework
Epidemiology Maternal Health Psychological intervention lcsh:Medicine HIV Infections Antenatal care Immunodeficiency Viruses Pregnancy Pregnancy Complications Infectious lcsh:Science education.field_of_study Multidisciplinary Postpartum Period HIV diagnosis and management Research Assessment Vaccination and Immunization Government Programs Anti-Retroviral Agents Medical Microbiology HIV epidemiology Viral Pathogens Infectious diseases Female Health Services Research Research Article medicine.medical_specialty Drug Adherence Systematic Reviews Population Immunology MEDLINE Antiretroviral Therapy Viral diseases Research and Analysis Methods Microbiology Nursing Intervention (counseling) medicine Humans education Health systems strengthening Microbial Pathogens Medicine and health sciences Pharmacology business.industry lcsh:R Health Services Administration and Management Biology and Life Sciences HIV medicine.disease Diagnostic medicine Health Care Family medicine Women's Health lcsh:Q business Delivery of Health Care Postpartum period Qualitative research |
| Zdroj: | PLoS ONE PLoS One PLoS ONE, Vol 9, Iss 10, p e108150 (2014) |
| ISSN: | 1932-6203 |
| Popis: | BACKGROUND: Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes--ART initiation, retention in care, and long-term ART adherence--remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. METHODS: Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. RESULTS: Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. CONCLUSIONS: There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade. |
| Databáze: | OpenAIRE |
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