Social factors related to quality of life among HIV infected children in Ubon Ratchathani province, Thailand

Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
The Southeast Asian journal of tropical medicine and public health (Impact Factor: 0.72). 09/2010; 41(5):1136-44.
Source: PubMed

ABSTRACT A cross-sectional study was conducted to determine the social factors and quality of life of HIV infected children attending the Pediatric Infectious Disease Clinic, Sappasithiprasong Hospital, Ubon Ratchathani Province, Thailand. Data were collected during October-November 2008, by interviewing caretakers and their children using a structured questionnaire. The children's families were in need of improved social support (84.5%), since community resources provided limited support, such as clothes, food, financial support, consultation, and information. The HIV infected children's quality of life needed improvement (78.7%). The factors associated with quality of life included having others as main caretakers (OR 4.64, 95% CI 1.45-14.78), parental death (OR 4.19, 95% CI 1.55-11.31), age of caregivers above 45 years old (OR 9.52, 95% CI 2.62-34.53), and family income less than THB 5,000 per month (OR 5.25, 95% CI 1.14-23.39). However, on multivariate analysis, only age of caregiver was a significant predictor for quality of life of the child. Children who were cared for by caregivers aged 45 years or above had a better quality of life than those whose caregivers were 20-45 years old (OR 6.32, 95% CI 1.12-35.62). Therefore, to improve quality of life among HIV infected children, age of caregiver is an important factor to be considered. Government and non-government organizations should focus on supporting caregivers in terms of food, financial, and emotional support based on resources available in the community.

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    • "Respondents only included only those who are enrolled in care, the perspectives of those who have poorer access to services or avoid HIV services are important if the system is to be responsive to their needs. Service-user respondents were selected by health care workers, interviewed at health facilities and were recruited from a cultural group previously documented as averse to expressing criticism [40], [41]; efforts were made to mitigate bias but it may be that respondents were unwilling to criticise. It was possible to recruit few adolescents for interview, therefore the service-user perspective is largely one of adults used as proxy respondents for children. "
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    ABSTRACT: Background The Thai HIV programme is a leader in the public health approach to HIV treatment. Starting at transmission of HIV and ending with transition to adult services this paper assesses the paediatric HIV treatment continuum from three perspectives: service-user, provider and policy maker, to understand what works well and why. Methods A qualitative research design was used to assess and triangulate the stakeholder perspectives. Semi-structured interviews were conducted with ART service-users (n = 35), policy actors (n = 20); telephone interviews with prior caregivers of orphans (n = 10); and three focus group discussions with service-providers (hospital staff and volunteers) from a district, provincial and a university hospital. Findings Children accessing HIV care were often orphaned, cared for by elderly relatives and experiencing multiple vulnerabilities. Services were divided into three stages, 1. Diagnosis and linkage: Despite strong policies there were supply and demand-side gaps in the prevention of mother-to-child transmission ‘cascade’ preventing early diagnosis and/or treatment. 2. Maintenance on ART - Children did well on treatment; caregivers took adherence seriously and valued the quality of services. Drug resistance, adherence and psychosocial issues were important concerns from all perspectives. 3. Adolescents and transition: Adolescent service-users faced greater complexity in their physical and emotional lives for which providers lacked skills; transition from the security of paediatric clinic was a daunting prospect. Dedicated healthcare providers felt they struggled to deliver services that met service-users' diverse needs at all stages. Child- and adolescent-specific elements of HIV policy were considered low priority. Conclusions Using the notion of the continuum of care a number of strengths and weaknesses were identified. Features of paediatric services need to evolve alongside the changing needs of service users. Peer-support volunteers have potential to add continuity and support at all stages. It is critical that adolescents receive targeted support, particularly during transition to adult services.
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    ABSTRACT: Abstract Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N=149) versus deferred groups (ART when at CD4 <15%, N=150) and also compared with QOL data from age-matched healthy controls (N=275). Primary caregivers completed PACTG QOL questionnaires at week 0 and every 24 weeks until 144 weeks. Children were enrolled during March 2006 to September 2008. Mean (SD) age of children was 6.3 (2.8) years, 58% were female, 60% were Thai, %CDC N:A:B:C was 2:62:36:0%. During 144 weeks, all children in the early-group and 69 (46%) of deferred-group children started ART. There was no significant difference of QOL scores between treatment groups at baseline (all p>0.05) and at week 144 (all p>0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception (p=0.04), physical resilience (p=0.02), psychosocial well-being (p=0.04), social and role functioning (p<0.01), and symptoms (p=0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p<0.05) and 5 of 7 domains at weeks 144 (p<0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.
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    ABSTRACT: In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n=31) with co-providers and hospital staff; interviews with ART service-users (n=35). Nationally, key informant interviews were conducted with policy actors (n=20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers’ contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and experience of volunteers into a holistic model of care.
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