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Leshargie CT, Demant D, Burrowes S, Frawley J. Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis. BMJ Open 2022; 12:e063879. [PMID: 36351711 PMCID: PMC9664312 DOI: 10.1136/bmjopen-2022-063879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region. DESIGN We conducted an institution-based retrospective follow-up study. SETTINGS The study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia. PARTICIPANTS We included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020. PRIMARY AND SECONDARY OUTCOMES The incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association. RESULTS More than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200-350 cells/mm3 (aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98). CONCLUSIONS Our study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Raymond JM, Zolnikov TR. AIDS-Affected Orphans in Sub-Saharan Africa: A Scoping Review on Outcome Differences in Rural and Urban Environments. AIDS Behav 2018; 22:3429-3441. [PMID: 29721717 DOI: 10.1007/s10461-018-2134-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Currently, there are more than 11 million AIDS-affected orphans that suffer from various adverse effects, most of whom reside in sub-Saharan Africa. The difference between whether a child resides in a rural or urban environment can have a significant role in a child's education, health status and access to healthcare, and social or family relationships. A scoping review was conducted in order to understand any possible environment-based differences on orphans directly affected by HIV/AIDS in sub-Saharan Africa. There were 233 sources used for this review; however, 164 manuscripts focused more so on a general review of orphans within a rural or urban environment. Thus, after eliminating for various factors, 69 manuscripts were removed, which focused primarily on the social aspect of orphans due to HIV/AIDS. Rural environments provided more family support, while urban environments generally had more resources available to orphans (e.g. school fees). Unfortunately, both rural and urban environments were found to be fairly non-supportive of orphans and their development. This scoping review found, in general, that orphans in both urban and rural environments continue to suffer from the consequential effects of low parental support due to AIDS mortality. These conclusions suggest that specific support to orphans through school and social relationships encourage better development outcomes in sub-Saharan Africa.
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Rashid MA, Llanwarne N, Heyns N, Walter F, Mant J. What are the implications for practice that arise from studies of medication taking? A systematic review of qualitative research. PLoS One 2018; 13:e0195076. [PMID: 29768417 PMCID: PMC5955529 DOI: 10.1371/journal.pone.0195076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 02/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Despite several decades of evidence supporting the benefits of taking medications in various diseases and healthcare settings, a significant proportion of prescribed treatments are not taken. This review sought to synthesise qualitative research exploring experiences of medication taking around the world, and to determine whether there were consistent messages arising from these studies. Methods and findings 5 databases (MEDLINE, PsycINFO, EMBASE, SCOPUS, CINAHL) were systematically searched to identify published research papers using qualitative methodologies, which explored medication-taking experiences in patients, citizens, carers, relatives and clinicians. Data were extracted independently by at least two clinician reviewers. Implications for practice from individual papers were charted and coded using thematic content analysis. These were then cross-tabulated with research paper categories to explore emergent patterns with particular implications for practice. 192 papers from 34 different countries were included in the review. Implications for practice fitted into 11 categories: increase family involvement, increase clinician involvement, promote personalised management, address practical barriers, provide ongoing support, promote self-management, adopt a patient-centred approach, improve patient education, address system barriers, increase access to non-prescribing clinicians and improve clinician training. These implications for practice were generally evenly spread across research paper categories. Conclusions Implications for practice from the published qualitative literature exploring medication-taking are notably consistent across research methods, disease categories and geographical settings. More recent clinical trials of interventions to improve adherence have started to draw on these findings by focussing on improving clinical interactions and involving patients in healthcare decisions. Promoting patient education and self-management have been widely advocated, and improvements at a system level have been frequently cited in studies from developing countries and those relating to communicable diseases. Regardless of the setting, clinicians and policymakers around the world can focus efforts to improve medication-taking by considering a number of consistently emerging findings.
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Affiliation(s)
| | - Nadia Llanwarne
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Natalie Heyns
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Fiona Walter
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
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Kabogo J, Muniu E, Wamunyokoli F, Musoke R, Songok E. Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program. BMC Res Notes 2018; 11:134. [PMID: 29452597 PMCID: PMC5816400 DOI: 10.1186/s13104-018-3205-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We conducted a retrospective cohort study to evaluate the efficacy of the World Health Organization (WHO) "Universal Test and Treat" (UTT) policy, initiated in Kenya in September 2016. Under this policy, every human immunodeficiency virus (HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared intra- and inter-group viral suppression and ART adherence rates for pre-UTT (initiated on ART in March-August 2016) and UTT groups (initiated in September 2016). The study was conducted in a community outreach Program in Nairobi with 3500 HIV-infected children enrolled. RESULTS 122 children and adolescents were initiated on first-line ART pre-UTT, and 197 during the UTT period. The 6 month viral suppression rate was 79.7% pre-UTT versus 76.6% UTT (P < 0.05). Suboptimal adherence was higher in the UTT than pre-UTT period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was greater among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11-18 years. Our results show that successful implementation of the UTT policy in Africa is challenged by an increased risk of suboptimal adherence. There is a need to develop extra strategies to support adherence, especially among orphans and teenagers.
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Affiliation(s)
- Joseph Kabogo
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya.,Kenya Medical Research Institute (KEMRI), Mbagathi Road, Nairobi, Kenya
| | - Erastus Muniu
- Centre for Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Mbagathi Road, Nairobi, Kenya
| | - Fred Wamunyokoli
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya
| | - Rachel Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Elijah Songok
- Kenya Medical Research Institute (KEMRI), Mbagathi Road, Nairobi, Kenya.
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Okawa S, Mwanza Kabaghe S, Mwiya M, Kikuchi K, Jimba M, Kankasa C, Ishikawa N. Psychological well-being and adherence to antiretroviral therapy among adolescents living with HIV in Zambia. AIDS Care 2018; 30:634-642. [PMID: 29347827 DOI: 10.1080/09540121.2018.1425364] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physical and psychosocial changes during adolescence could influence the psychological well-being and adherence to antiretroviral therapy (ART) of adolescents living with HIV. However, few studies have assessed these two important issues in Zambia. This study aimed at addressing this gap by examining adolescents' depressive symptoms and ART adherence. This was a mixed-methods study conducted from April to July 2014. We recruited 200 adolescents, ages 15 to 19, who were already aware of their HIV status. We measured depressive symptoms using the short form of the Center for Epidemiologic Studies Depression Scale, and self-reported three-day adherence to ART. We performed logistic regression analysis to identify factors associated with depressive symptoms and non-adherence to ART. For qualitative data, we examined challenges over ART adherence using thematic analysis. Out of 190 adolescents, 25.3% showed high scores of depressive symptoms. Factors associated with depressive symptoms were unsatisfactory relationships with family (Adjusted Odds Ratio [AOR] 3.01; 95% Confidence Interval [CI] 1.20-7.56); unsatisfactory relationships with health workers (AOR 2.68; 95% CI 1.04-6.93); and experience of stigma (AOR 2.99; 95% CI 1.07-8.41). Of all participants, 94.2% were taking ART, but 28.3% were non-adherent. Factors associated with non-adherence to ART were loss of a mother (AOR 3.00; 95% CI 1.05-8.58) and lack of basic knowledge about HIV (AOR 3.25; 95% CI 1.43-7.40). Qualitative data identified the following challenges to ART adherence: management of medication, physical reactions to medicine, and psychosocial distress. The evidence suggests that depressive symptoms and non-adherence to ART were priority issues in late adolescence in Zambia. Health workers should be aware of these issues, and the care and treatment services should be tailored to respond to age-specific needs.
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Affiliation(s)
- Sumiyo Okawa
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Sylvia Mwanza Kabaghe
- b Department of Educational Psychology, Sociology, and Special Education, School of Education , University of Zambia , Lusaka , Zambia.,c Paediatric HIV Centre of Excellence , University Teaching Hospital , Lusaka , Zambia
| | - Mwiya Mwiya
- c Paediatric HIV Centre of Excellence , University Teaching Hospital , Lusaka , Zambia
| | - Kimiyo Kikuchi
- d Institute of Decision Science for a Sustainable Society , Kyushu University , Fukuoka , Japan
| | - Masamine Jimba
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Chipepo Kankasa
- c Paediatric HIV Centre of Excellence , University Teaching Hospital , Lusaka , Zambia
| | - Naoko Ishikawa
- e Bureau of International Health Cooperation , National Center for Global Health and Medicine , Tokyo , Japan
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Gichane MW, Sullivan KA, Shayo AM, Mmbaga BT, O' Donnell K, Cunningham CK, Dow DE. Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania. AIDS Care 2017; 30:701-705. [PMID: 29058461 DOI: 10.1080/09540121.2017.1391986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Youth living with HIV in sub-Saharan Africa face numerous challenges in adhering to HIV treatment. The AIDS epidemic has left many of these youth orphaned due to AIDS-related death of one or both parents. It is imperative to understand the family context of youth living with HIV in order to develop responsive interventions to improve adherence to antiretroviral therapy. We conducted qualitative in-depth interviews with 17 HIV-infected AIDS orphans, ages 13-24 years, screened positive for mental health difficulties according to the Patient Health Questionaire-9 (PHQ-9) or UCLA PTSD Reaction Index (PTSD-RI), and receiving outpatient HIV care at an adolescent medical clinic in Moshi, Tanzania. Treatment-related support varied by orphan status. Paternal orphans cared for by their biological mothers and maternal orphans cared for by grandmothers described adherence support such as assistance taking medication and attending clinic. Double orphans did not report adherence support. Several maternal and double orphans faced direct interference from caregivers and household members when they attempted to take their medications. Caregivers play a significant role in treatment adherence and must be considered in interventions to increase medication adherence in HIV-infected orphans. Findings from this study informed caregiver participation in Sauti ya Vijana (The Voice of Youth), a mental health intervention for youth living with HIV in Tanzania.
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Affiliation(s)
- Margaret W Gichane
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,b Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Kristen A Sullivan
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,c Department of Social Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Aisa M Shayo
- e Pediatric and Child Health Department , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Blandina T Mmbaga
- d Kilimanjaro Christian Medical Centre-Duke Collaboration , Moshi , Tanzania.,e Pediatric and Child Health Department , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Karen O' Donnell
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,f Center for Child & Family Health , Duke University , Durham , USA
| | - Coleen K Cunningham
- g Department of Pediatrics, Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , USA.,h Duke University Global Health Institute , Durham , USA
| | - Dorothy E Dow
- d Kilimanjaro Christian Medical Centre-Duke Collaboration , Moshi , Tanzania.,g Department of Pediatrics, Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , USA.,h Duke University Global Health Institute , Durham , USA
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Gray ME, Nieburg P, Dillingham R. Pediatric Human Immunodeficiency Virus Continuum of Care: A Concise Review of Evidence-Based Practice. Pediatr Clin North Am 2017; 64:879-891. [PMID: 28734516 PMCID: PMC5576578 DOI: 10.1016/j.pcl.2017.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Children and adolescents living with human immunodeficiency virus (HIV) represent a population that requires a unique approach to HIV care. Prevention, testing, initiation of antiretroviral therapy (ART), and retention and engagement in care are critical steps. Each step requires providers to address age-specific barriers, so that successful and prolonged viral suppression can occur. Adherence to ART, disclosure of HIV-positive status, and stigma are examples of struggles faced by youth, their families, and health care providers. A multifaceted approach and thoughtful transitions of care are needed, but with sustained ART, youth living with HIV can survive and thrive with the expectation of a normal lifespan.
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Affiliation(s)
- Megan E. Gray
- Division of Infectious Diseases and International Health. University of Virginia, Charlottesville, VA
| | - Phillip Nieburg
- Visiting Associate Professor of Pediatrics. University of Virginia, Charlottesville, VA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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8
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Kikuchi K, Poudel KC, Rwibasira JM, Majyambere A, Mutabazi V, Nyonsenga SP, Muhayimpundu R, Jimba M. Caring for perinatally HIV-infected children: call for mental care for the children and the caregivers. AIDS Care 2017; 29:1280-1286. [PMID: 28359213 DOI: 10.1080/09540121.2017.1307917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy has dramatically improved the survival rate of perinatally HIV-infected children. For them to thrive, it is necessary to understand better their mental health issues. Caregivers play an important role in children's daily care and caregiver mental health may relate to children's mental health. However, this association has rarely been studied. Accordingly, the present study examined the associations between depression of caregivers and that of perinatally HIV-infected children in Kigali, Rwanda. We conducted a cross-sectional study of 475 perinatally HIV-infected children aged 7-14 years and their caregivers. We collected children's depression score data via face-to-face interviews with children using the Beck Depression Inventory for Youth. We also collected sociodemographic data using a semi-structured questionnaire with caregivers. In addition, we measured children's weight, height, and collected their clinical records. Data were analyzed via linear and logistic regression analyses. Of all children, 22% had symptoms of depression. Among those who had depressive symptoms (n= 105), 49% had never received psychological support. In both the linear and logistic regression analysis, caregiver's high depression scores were positively associated with children's higher depression scores (AOR: 3.064, 95% CI: 1.723, 4.855, and AOR: 1.759, 95% CI: 1.129, 2.740, respectively). Taking Efavirenz and low height-for-age were also positively associated with higher depression scores among HIV-infected children. Mental health needs to be addressed to improve quality of life of perinatally HIV-infected children. Caregiver's depression was positively associated with children's depressive symptoms. Caring for both children and the caregivers' mental health may prevent the mutual fostering of depression.
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Affiliation(s)
- Kimiyo Kikuchi
- a Institute of Decision Science for a Sustainable Society (IDS3) , Kyushu University , Fukuoka , Japan.,b Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Krishna C Poudel
- c Department of Health Promotion and Policy, School of Public Health and Health Sciences , University of Massachusetts-Amherst , Amherst , USA
| | | | | | | | | | | | - Masamine Jimba
- b Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
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Huy BV, Teeraananchai S, Oanh LN, Tucker J, Kurniati N, Hansudewechakul R, Truong KH, Khol V, Nguyen LV, Chau Do V, Lumbiganon P, Kongstan N, Bunupuradah T, Sudjaritruk T, Kumarasamy N, Yusoff NKN, Mohd Razali KA, Wati DK, Fong MS, Nallusamy R, Kariminia A, Sohn AH. Impact of orphan status on HIV treatment outcomes and retention in care of children and adolescents in Asia. J Virus Erad 2016; 2:227-231. [PMID: 27781105 PMCID: PMC5075350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An analysis of the impact of orphanhood at antiretroviral therapy (ART) initiation on HIV outcomes in Asia included 4300 children; 51% were male. At ART initiation, 1805 (42%) were non-orphans (median age: 3 years), 1437 (33%) were single orphans (6 years) and 1058 (25%) were double orphans (7 years). Ten-year post-ART survival was 93.4-95.2% across orphan categories. Clinic transfers were higher among single and double orphans than non-orphans (41% vs 11%, P<0.001). On multivariate analysis, children ≥3 years at ART initiation (hazard ratio 1.58 vs <3 years, 95% confidence interval: 1.11-2.24) were more likely to be lost to follow-up. Although post-ART mortality and retention did not differ by orphan status, orphans were at greater risk of starting ART at older ages, and with more severe immunosuppression and poorer growth.
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Affiliation(s)
- Bui Vu Huy
- Hanoi Medical University,
Hanoi,
Vietnam;
| | | | - Le Ngoc Oanh
- Worldwide Orphans Foundation,
Ho Chi Minh City,
Vietnam;
| | - John Tucker
- New Hope for Cambodian Children,
Phnom Penh,
Cambodia;
| | - Nia Kurniati
- Cipto Mangunkusumo – Faculty of Medicine Universitas Indonesia,
Jakarta,
Indonesia;
| | | | | | - Vohith Khol
- National Centre for HIV/AIDS Dermatology and STDs and University of Health Sciences,
Phnom Penh,
Cambodia;
| | | | - Viet Chau Do
- Children's Hospital 2,
Ho Chi Minh City,
Vietnam;
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine,
Khon Kaen University,
Khon Kaen,
Thailand;
| | - Nantaka Kongstan
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital,
Mahidol University,
Bangkok,
Thailand;
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine,
Chiang Mai University and Research Institute for Health Sciences,
Chiang Mai,
Thailand;
| | | | | | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research,
Bangkok,
Thailand.,Corresponding author: Annette H Sohn,
TREAT Asia/amfAR,
388 Sukhumvit Road, 2104 Klongtoey,
Bangkok10110,
Thailand
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10
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Impact of orphan status on HIV treatment outcomes and retention in care of children and adolescents in Asia. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Falling through the gaps: how should HIV programmes respond to families that persistently deny treatment to children? J Int AIDS Soc 2016; 19:20789. [PMID: 27221666 PMCID: PMC4879178 DOI: 10.7448/ias.19.1.20789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/13/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Children living with HIV rely on adult caregivers for access to HIV testing and care, including clinical monitoring and adherence to treatment. Yet, many caregivers confront barriers to ensuring children's care, including fear of disclosure of the child's or the parents’ HIV status, competing family demands, fluctuating care arrangements and broader structural factors such as entrenched poverty or alternative beliefs about HIV's aetiology and treatment. Thus, many children are “falling through the gaps” because their access to testing and care is mediated by guardians who appear unable or unwilling to facilitate it. These children are likely to suffer treatment failure or death due to their caregivers’ recalcitrance. Discussion This Commentary presents three cases from paediatric HIV services in Zimbabwe that highlight the complexities facing health care providers in providing HIV testing and care to children, and discusses the implications as a child's rights issue requiring both legal and programmatic responses. The cases provide examples of how disagreements between family members about appropriate care, conflicts between a child and caregiver and religious objections to medical treatment interrupt children's engagement with HIV services. In all three cases, no social or legal mechanisms were in place for health staff to intervene and prevent “loss to follow up.” Conclusions We suggest that conceptualizing this as a child's rights issue may be a useful way to raise the debate and move towards improved treatment access. Our cases reflect policy failure to facilitate access to children's HIV testing and treatment, and are likely to be similar across international settings. We propose sharing experiences and encouraging dialogue between health practitioners and global advocates for children's right to health to raise awareness that children are the bearers of rights even if they lack legal capacity, and that the failure of either the state or their caregiver to facilitate access to care is in fact a rights violation.
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