Successful paediatric HIV treatment in rural primary care in Africa

Janssen, Nikki; Ndirangu, James; Newell, Marie‐Louise; Bland, Ruth

doi:10.1136/adc.2009.169367

Cited by 56 publications

(72 citation statements)

References 31 publications

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“…The Hlabisa HIV Treatment and Care Programme, initiated in late 2004, is a partnership between the Department of Health and Africa Centre, providing free services at 17 local government primary healthcare clinics (PHCs) [24]. The number of women on treatment by the end of December 2008 was 4688 (68% of all adults on treatment),of whom 40% live in the DSA [25].…”

Section: Methodsmentioning

confidence: 99%

Decline in early life mortality in a high HIV prevalence rural area of South Africa: evidence of HIV prevention or treatment impact?

Ndirangu

Newell

Tanser

et al. 2010

Aids

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Objective We present early life mortality rates in a largely rural population with high antenatal HIV prevalence, and investigate temporal and spatial associations with a prevention of mother-to-child transmission (PMTCT) programme, an HIV treatment programme, and maternal HIV. Design A retrospective cohort analysis. Methods All births from January 2000 to January 2007 to women in the Africa Centre demographic surveillance were included. Under-two child mortality rates (U2MR) computed as deaths per 1000 live-births per year; factors associated with mortality risk assessed with Weibull regression. Availability of PMTCT (single-dose nevirapine; sdNVP) and antiretroviral therapy (ART) in a programme included in multivariable analysis. Results Eight hundred and forty-eight (6.2%) of 13 583 children under 2 years died. Deaths in under twos declined by 49% between 2001 and 2006, from 86.3 to 44.1 deaths per thousand live-births. Mortality was independently associated with birth season (adjusted hazard ratio 1.16, 95% confidence interval 1.02–1.33), maternal education (1.21, 1.02–1.43), maternal HIV (4.34, 3.11–6.04) and ART availability (0.46, 0.33–0.65). Children born at home (unlikely to have received sdNVP) had a 35% higher risk of dying than children born in a facility where sdNVP was available (1.35, 1.04–1.74). For 2005 births the availability of PMTCT and ART in public health programmes would have explained 8 and 31% of the decline in U2MR since 2000. Conclusion These findings confirm the importance of maternal survival, and highlight the importance of the PMTCT and especially maternal HIV treatment with direct benefits of improved survival of their young children.

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Section: Methodsmentioning

confidence: 99%

Decline in early life mortality in a high HIV prevalence rural area of South Africa: evidence of HIV prevention or treatment impact?

Ndirangu

Newell

Tanser

et al. 2010

Aids

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“…Considerable efforts to control the spread of HIV in the region have been made with an increasingly higher number of people receiving free combined antiretroviral therapy (cART) (Joint United Nations Programme on HIV/AIDS & World Health Organization 2009; World Health Organization, United Nations Children's Fund, UNAIDS 2009). As a result, mortality and morbidity rates among HIV-infected children have significantly reduced (Bolton-Moore, Mubiana-Mbewe, Cantrell, Chintu, Stringer, Chi, et al 2007;Ellis & Molyneux 2007;Janssen, Ndirangu, Newell & Bland 2010;Kiboneka, Wangisi, Nabiryo, Tembe, Kusemererwa, Olupot-Olupot, et al 2008;KIDS-ART-LINC Collaboration 2009;Nyandiko, Ayaya, Nabakwe, Tenge, Sidle, Yiannoutsos, et al 2006;Puthanakit, Aurpibul, Oberdorfer, Akarathum, Kanjananit, Wannarit, et al 2007;Wamalwa, Farquhar, Obimbo, Selig, Mbori-Ngacha, Richardson, et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Wachira

Middlestadt²,

Vreeman³

et al. 2012

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.Methods: Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIVinfected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed.Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. Conclusion:The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.Keywords: HIV care, loss to follow-up in children, caregivers. RésuméObjectif : Dans l'objectif de réduire les perdus de vue pédiatriques dans les programmes de prise en charge clinique du VIH en Afrique subsaharienne, nous avons cherché à comprendre les facteurs personnels et socioculturels associés au comportement des aidants emmenant les enfants séropositifs et exposés au VIH à leurs sessions de traitement à l'Ouest du Kenya.Méthodes : De mai à août 2010, des entretiens détaillés ont été menés auprès de 26 aidants sélectionnés à cette fin en charge d'enfants séropositifs (7), exposés au VIH (17) et de statut sérologique inconnu (2), documentés comme perdus de vue à partir d'un centre de traitement du VIH urbain et rural. Tous étaient des femmes, et une majorité d'entre elles (77 %) étaient les parents biologiques de ces enfants. Les entretiens ont été enregistrés sur cassette, retranscrits et leur contenu analysés.Résultats : L'analyse thématique du contenu des perceptions des femmes a révélé que leurs décisions quant au fait d'emmener leurs enfants en traitement pour le VIH impliquaient des facteurs ...

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“…The second is the decentralized model of healthcare delivery, where HIV and ART services are relocated from district hospitals and delivered at peripheral clinics to increase patient access by bringing services closer to their homes, particularly in rural areas. This can be done by providing ART services, including evaluation, treatment initiation and treatment monitoring, at the clinic level, with supervision from a team of physicians or medical officers, as in the Lusikisiki [75], Hlabisa [76], and Mseleni [77] district programs in South Africa, nurse-based programs in Rwanda [78,79], and the Scott area program in Lesotho [80]. Alternatively, evaluation and treatment initiation can be performed at the hospital level, with subsequent treatment monitoring at the clinic level for children who adequately respond to treatment, as in the Macha, Zambia program [unpublished data].…”

Section: Retention In Carementioning

confidence: 99%

Feasibility and Challenges in Providing Antiretroviral Treatment to Children in Sub-Saharan Africa

Dijk¹,

Moss²,

Sutcliffe

2011

CPR

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The scale-up of pediatric antiretroviral therapy (ART) in sub-Saharan Africa over the past decade involved unprecedented political and donor commitment. These pediatric ART programs have demonstrated they can provide ART to human immunodeficiency virus (HIV)-infected children and that these children achieve treatment outcomes comparable to children in high-resource settings. Several obstacles, however, have hindered program implementation and impacted treatment outcomes. Challenges particularly affecting children include shortages of properly trained healthcare providers, lack of laboratory capacity for infant diagnosis and pediatric treatment monitoring, poor adherence, disclosure of HIV infection status and attrition. Innovative solutions to these challenges have been developed and programs are demonstrating they can successfully expand services to increase ART coverage in affected communities. As programs optimize the care and treatment of children, and more efficiently provide HIV services within the health care system, new challenges arise, including integration of child and family health services, use of electronic health records and the potential need for rationing antiretroviral drugs. Further evaluation of innovative solutions to these challenges and barriers to care, as well as continued commitment on the part of governments and donors, will be required if all HIV-infected children are to receive proper care.

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Successful paediatric HIV treatment in rural primary care in Africa

Cited by 56 publications

References 31 publications

Decline in early life mortality in a high HIV prevalence rural area of South Africa: evidence of HIV prevention or treatment impact?

Decline in early life mortality in a high HIV prevalence rural area of South Africa: evidence of HIV prevention or treatment impact?

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Feasibility and Challenges in Providing Antiretroviral Treatment to Children in Sub-Saharan Africa

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