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1.
J Acquir Immune Defic Syndr ; 66 Suppl 2: S228-35, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24918600

RESUMO

BACKGROUND: Globally, a staggering number of adolescents, approximately 2.1 million, were estimated to be living with HIV in 2012. Unique developmental, psychosocial, and environmental considerations make them particularly vulnerable to HIV acquisition and argue for a comprehensive response to address this burgeoning problem. METHODS: This article explores the current state of the science of HIV prevention, treatment, and care for adolescents and identifies opportunities to address knowledge gaps and improve health outcomes for this age group. RESULTS: Over the past decade, several important milestones have been achieved in HIV prevention and care among adults, and despite evidence that adherence to care and medications among affected adolescents is significantly compromised, critical research among adolescents and young adults substantially lags behind. Operational research, in particular, is crucial to understanding how to use effective services and interventions for HIV prevention and care safely and effectively for adolescents who are in dire need. CONCLUSIONS: Operational research among adolescent populations affected by HIV is critically needed to close the knowledge and investment gaps, and scale-up efforts for HIV prevention, treatment, care, and support for this vulnerable age group.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/organização & administração , Infecções por HIV/prevenção & controle , Adolescente , Comportamento do Adolescente , Criança , Aconselhamento , Acesso aos Serviços de Saúde , Humanos , Prevenção Primária , Projetos de Pesquisa , Adulto Jovem
2.
Curr HIV/AIDS Rep ; 10(2): 159-68, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23563990

RESUMO

Adolescents are critical to efforts to end the AIDS epidemic. Few national AIDS strategies explicitly program for children in their second decade of life. Adolescents (aged 10-19 years) are therefore largely invisible in global, regional, and country HIV and AIDS reports making it difficult to assess progress in this population. We have unprecedented knowledge to guide investment towards greater impact on HIV prevention, treatment, and care in adolescents, but it has not been applied to reach those most vulnerable and optimize efficiency and scale. The cost of this is increasing AIDS-related deaths and largely unchanged levels of new HIV infections in adolescents. An AIDS-free generation will remain out of reach if the global community does not prioritize adolescents. National AIDS responses must be accountable to adolescents, invest in strengthening and monitoring protective and supportive laws and policies and access for adolescents to high impact HIV interventions.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Serviços de Saúde do Adolescente/organização & administração , Soropositividade para HIV/transmissão , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Comportamento do Adolescente , Serviços de Saúde do Adolescente/tendências , Criança , Aconselhamento Diretivo/organização & administração , Feminino , Soropositividade para HIV/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Vigilância da População , Assunção de Riscos , Estados Unidos/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
3.
Health Policy Plan ; 28(4): 367-74, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22826516

RESUMO

In 2005, due to slow global progress in the scale-up of prevention of mother-to-child transmission (PMTCT) and paediatric HIV programmes, the Inter-agency Task Team (IATT) on the Prevention of HIV infection among Pregnant Women, Mothers, and their Children initiated joint technical missions (JTMs) to countries of high HIV disease burden. The JTMs were intended to galvanize country actions for a more comprehensive response to PMTCT and paediatric HIV by bringing national and global stakeholders together to review national policies and programmes and develop country-specific recommendations for accelerating scale-up. Between 2005 and 2010, the IATT conducted JTMs in 18 low- and middle-income countries. In 2007, to assess the role played by the missions, a review in the first eight countries (Burkina Faso, Cameroon, Côte d'Ivoire, India, Malawi, Rwanda, Tanzania and Zambia) that hosted JTMs was undertaken. Country progress was assessed through desk review and key informant interviews. For each country, documents reviewed included JTM reports, baseline data for PMTCT and paediatric HIV care and treatment, and 2004 to 2007 trend data on key PMTCT and paediatric HIV indicators. Drawing upon the findings, this paper posits that JTMs contributed to national scale-up of PMTCT and paediatric HIV programmes through strengthening governance and co-ordination mechanisms for the programmes, promoting enabling policy environments, and supporting the development of national scale-up plans, which have been critical for leveraging additional financial resources for scale-up. Although the impact of the JTMs could be enhanced through greater follow-up and continued targeted assistance in technical areas such as infant and young child feeding, community-based programming and supply chain management, findings indicate that the JTMs are a useful mechanism for informing policy and programme decisions necessary for scaling up PMTCT and paediatric HIV responses. Moreover, by bringing stakeholders together around unified action plans, the JTMs created a platform for common action-a key tenet of the 'Three Ones' principles for effective HIV/AIDS responses.


Assuntos
Comportamento Cooperativo , Tomada de Decisões , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Formulação de Políticas , Complicações Infecciosas na Gravidez , Países em Desenvolvimento , Feminino , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Humanos , Gravidez , Pesquisa Qualitativa
4.
AIDS Care ; 22(9): 1066-85, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20824560

RESUMO

Over the past decade, there has been increasing global attention to mitigating the impacts of the HIV/AIDS epidemic on children's lives. Within this context, developing and tracking global child vulnerability indicators in relation to HIV and AIDS has been critical in terms of assessing need and monitoring progress. Although orphanhood and adult household illness (co-residence with a chronically ill or HIV-positive adult) are frequently used as markers, or definitions, of vulnerability for children affected by HIV and AIDS, evidence supporting their effectiveness has been equivocal. Data from 60 nationally representative household surveys (36 countries) were analyzed using bivariate and multivariate methods to establish if these markers consistently identified children with worse outcomes and also to identify other factors associated with adverse outcomes for children. Outcome measures utilized were wasting among children aged 0-4 years, school attendance among children aged 10-14 years, and early sexual debut among adolescent boys and girls aged 15-17 years. Results indicate that orphanhood and co-residence with a chronically ill or HIV-positive adult are not universally robust measures of child vulnerability across national and epidemic contexts. For wasting, early sexual debut, and to a lesser extent, school attendance, in the majority of surveys analyzed, there were few significant differences between orphans and non-orphans or children living with chronically ill or HIV-positive adults and children not living with chronically ill or HIV-positive adults. Of other factors analyzed, children living in households where the household head or eldest female had a primary education or higher were significantly more likely to be attending school, better household health and sanitation was significantly associated with less wasting, and greater household wealth was significantly associated both with less wasting and better school attendance. Of all marker of child vulnerability analyzed, only household wealth consistently showed power to differentiate across age-disaggregated outcomes. Overall, the findings indicate the need for a multivalent approach to defining child vulnerability, one which incorporates household wealth as a key predictor of child vulnerability.


Assuntos
Filho de Pais Incapacitados , Crianças Órfãs , Infecções por HIV/complicações , Nível de Saúde , Populações Vulneráveis , Adolescente , Análise de Variância , Criança , Pré-Escolar , Doença Crônica , Escolaridade , Feminino , Humanos , Lactente , Masculino , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Comportamento Sexual , Síndrome de Emaciação
5.
J Child Health Care ; 13(3): 198-211, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19713404

RESUMO

Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty.


Assuntos
Infecções por HIV/enfermagem , Pediatria/normas , Pobreza , Relações Profissional-Família , Avaliação de Programas e Projetos de Saúde , Síndrome de Imunodeficiência Adquirida , Adolescente , Adulto , Criança , Bem-Estar da Criança , Pré-Escolar , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Disparidades nos Níveis de Saúde , Hospitalização/estatística & dados numéricos , Hospitais Públicos/normas , Humanos , Lactente , Recém-Nascido , Masculino , Cuidados Paliativos , Projetos Piloto , Desenvolvimento de Programas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Apoio Social , Fatores Socioeconômicos , África do Sul
6.
AIDS Care ; 21 Suppl 1: 3-12, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-22380973

RESUMO

This paper provides an overview of the arguments for the central role of families, defined very broadly, and we emphasise the importance of efforts to strengthen families to support children affected by HIV and AIDS. We draw on work conducted in the Joint Learning Initiative on Children and AIDS's Learning Group 1: Strengthening Families, as well as published data and empirical literature to provide the rationale for family strengthening. We close with the following recommendations for strengthening families to ameliorate the effects of HIV and AIDS on children. Firstly, a developmental approach to poverty is an essential feature of responses to protect children affected by HIV and AIDS, necessary to safeguard their human capital. For this reason, access to essential services, such as health and education, as well as basic income security, must be at the heart of national strategic approaches. Secondly, we need to ensure that support garnered for children is directed to families. Unless we adopt a family oriented approach, we will not be in a position to interrupt the cycle of infection, provide treatment to all who need it and enable affected individuals to be cared for by those who love and feel responsible for them. Thirdly, income transfers, in a variety of forms, are desperately needed and positively indicated by available research. Basic economic security will relieve the worst distress experienced by families and enable them to continue to invest in the health care and education of their children. Lastly, interventions are needed to support distressed families and prevent knock-on negative outcomes through programmes such as home visiting, and protection and enhancement of children's potential through early child development efforts.


Assuntos
Bem-Estar da Criança , Filho de Pais Incapacitados/estatística & dados numéricos , Crianças Órfãs/estatística & dados numéricos , Saúde da Família , Infecções por HIV/epidemiologia , Estresse Psicológico/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Criança , Desenvolvimento Infantil , Bem-Estar da Criança/economia , Pré-Escolar , Saúde da Família/economia , Feminino , Apoio Financeiro , Infecções por HIV/economia , Infecções por HIV/reabilitação , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Renda , Lactente , Masculino
7.
AIDS Care ; 20(5): 527-36, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18484320

RESUMO

Global publications on the international AIDS epidemic report on the existence of an ever-increasing number of orphans and vulnerable children. It has been suggested that by the end of this decade there will be in excess of 25 million AIDS orphans globally, an issue which will require understanding and organisation of long-term medical, psychological and social support. This study provides a systematic review to examine the use, overuse and misuse of the term orphan and explores the benefits and limitations of this approach. It then summarises the knowledge on orphans to date. Using a search strategy of published studies and recent conference abstracts, 383 papers were identified where the concept of AIDS and Orphan was raised. The papers were systematically coded and reviewed to understand when and how a child is labelled an orphan, and to summarise the effect of orphanhood on outcome measures, most notably psychologically and physically. All controlled studies published prior to 2006 were reviewed. A consistent picture of negative effects of parental death (however defined) on a wide range of physical, socioeconomic and psychological outcomes were recorded. Seventeen studies met criteria for in-depth review (empirical, fully published, control group). The majority of studies are cross-sectional (two are longitudinal) and employ a very wide array of measures - both standardised and study specific. This detailed analysis shows a mixed picture on outcome. Although most studies report some negative effects, there are often no differences and some evidence of protective effects from quality of subsequent care and economic assistance. The lack of consistent measures and the blurring of definitions are stumbling blocks in this area.


Assuntos
Cuidadores , Bem-Estar da Criança/psicologia , Crianças Órfãs , Infecções por HIV , Poder Familiar/psicologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Poder Familiar/etnologia , Percepção Social
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