Factors influencing uptake of HIV care and treatment among children in South Africa-A qualitative study of caregivers and clinic staff

London School of Hygiene and Tropical Medicine, UK.
AIDS Care (Impact Factor: 1.6). 09/2010; 22(9):1101-7. DOI: 10.1080/09540121003602218
Source: PubMed

ABSTRACT Despite antiretroviral therapy rollout in South Africa, fewer children than expected are accessing HIV care services. Our objectives were to describe barriers and facilitators of uptake of HIV care among children. Our study involved six private-sector clinics which provide HIV care free-of-charge in and around Gauteng province, South Africa. In-depth interviews were conducted in July 2008 with 21 caregivers of HIV-infected children attending these clinics, 21 clinic staff members and three lead members of staff from affiliated care centres. Many children were only tested for HIV after being recurrently unwell. The main facility-related barriers reported were long queues, negative staff attitudes, missed testing opportunities at healthcare facilities and provider difficulties with paediatric counselling and venesection. Caregivers reported lack of money for transport, food and treatments for opportunistic infections, poor access to welfare grants and lack of coordination amongst multiple caregivers. Misperceptions about HIV, maternal guilt and fear of negative repercussions from disclosure were common. Reported facilitators included measures implemented by clinics to help with transport, support from family and day-care centres/orphanages, and seeing children's health improve on treatment. Participants felt that better public knowledge about HIV would facilitate uptake. Poverty and the implications of children's HIV infection for their families underlie many of these factors. Some staff-related and practical issues may be addressed by improved training and simple measures employed at clinics. However, changing caregiver attitudes may require interventions at both individual and societal levels. Healthcare providers should actively promote HIV testing and care-seeking for children.

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    • "Consistent with findings reported in other settings (Boender et al., 2012; Yeap et al., 2010), the logistical hurdles of cost, distance and time remained major barriers to accessing care at our study sites, despite the availability of " free " treatment. The introduction of mobile and home-based care services may contribute to addressing the hurdle of transport and time costs; however additional financial support is required for families deterred from accessing clinic care by significant additional costs including prescriptions and laboratory charges. "
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    ABSTRACT: We present qualitative research investigating demand-side barriers to uptake of paediatric HIV services in Kenya. We explore community perceptions of services in 3 provinces where paediatric treatment is readily available but under-utilised, aiming to focus on demand-side obstacles and derive strategies for increasing uptake. We conducted focus-group discussions with openly HIV-positive parents and caregivers of children aged up to 15 years (n = 7 groups), clinic- and community-based healthworkers (n = 13 groups); and individual in-depth interviews with managers and Ministry of Health representatives (n = 6 interviews). Results revealed low community awareness of medical indications for paediatric HIV testing, alongside widespread anxieties about potential infection routes. Care-seeking delays reflect strong perceived associations between antiretroviral treatment (ART) and mortality. Despite free drugs available from the Kenyan government, costs for laboratory services, medications for opportunistic infections, transportation and nutritional needs remain major obstacles. Attitudinal barriers include fatalistic beliefs about early death for infected children and reliance on traditional healers. Stigma reduces access, especially as paediatric testing represents a “window” into parental HIV status. Apprehensive caregivers fear the lifelong nature of ART and report adherence struggles. Even when paediatric ART is relatively accessible, demand-side barriers impede uptake and must be addressed at community and facility levels.
    Children and Youth Services Review 10/2014; 45. DOI:10.1016/j.childyouth.2014.03.034 · 1.27 Impact Factor
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    • "Community-based HIV counselling and testing for children is uncommon in sub-Saharan Africa including South Africa, and existing studies are largely among children already enrolled in HIV programmes or visiting health facilities (van Dijk et al., 2009; Yeap et al., 2010). We address this gap by identifying barriers to paediatric HIV treatment uptake at community level. "
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    ABSTRACT: Abstract In South Africa, a third of children born are exposed to HIV, while fewer undergo an HIV confirmatory test. Anti-retroviral therapy (ART) coverage among children remains low-despite roll-out of the national ART programme in South Africa in 2004. This study sought to understand critical barriers to seeking HIV-related care for children in rural South Africa. Data presented in this article derive from community-based qualitative research in poor rural villages in north-east South Africa; this includes 21 in-depth interviews in 2008 among caregivers of children identified as HIV-positive in 2007 from a randomly selected community-based sample. Using NVIVO 8, data were coded and analysed, using a constant comparative method to identify themes and their repetitions and variations. Structural barriers leading to poor access to health care, and social and systems barriers, all influenced paediatric HIV treatment seeking. Of concern was the expressed need to maintain secrecy regarding a child's HIV status to avoid stigma and discrimination, and misconceptions regarding the course of HIV disease in children; this led to a delay in seeking appropriate care. These barriers need to be addressed, including through focused awareness campaigns, improved access to health care and interventions to address rural poverty and development at both household and community levels. In addition, training of health care professionals to improve their attitudes and practice may be necessary. However, this study only provides the perspective of the caregivers; further studies with health care providers are needed to gain a fuller picture for appropriate policy and practice guidance.
    AIDS Care 12/2012; 25(6). DOI:10.1080/09540121.2012.748865 · 1.60 Impact Factor
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    • "Although government policies and efforts by international donors seek to make antiretrovirals (ARVs) freely available to children through national ART programs, other factors are holding back further scale-up of pediatric ART in Africa. A wide array of such factors or barriers has been put forward in the literature including health system and personal level barriers [9] [10]. The development of new strategies to overcome these barriers is essential to reduce child morbidity and mortality, thereby contributing to the achievement of the Millennium Development Goal 4 [11]. "
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    ABSTRACT: Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, P = 0.014), living without parents (OR 3.93, P = 0.002), unemployment of the caregiver (OR 4.26, P = 0.001), lack of perinatal HIV prophylaxis (OR 5.66, P = 0.028), and high transportation costs to the clinic (OR 2.51, P = 0.072). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers' unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.
    AIDS research and treatment 02/2012; 2012:817506. DOI:10.1155/2012/817506
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