Article

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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    • "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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    • "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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