Early diagnosis is critical to ensure good outcomes in HIV-infected children : outlining barriers to care

dc.contributor.authorFeucht, Ute Dagmar
dc.contributor.authorMeyer, Anell
dc.contributor.authorThomas, Winifred Nancy
dc.contributor.authorForsyth, Brian William Cameron
dc.contributor.authorKruger, Mariana
dc.contributor.emailute.feucht@up.ac.zaen_ZA
dc.date.accessioned2015-09-14T08:04:58Z
dc.date.available2015-09-14T08:04:58Z
dc.date.issued2016
dc.description.abstractHIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data was reviewed of all children aged <15 years referred over a one-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one quarter (24.5%) were of school-going age, 34.5% in the preschool group, 18% between 6-12 months old and 23% below six months of age (median age=1.5 years [IQR 0.5- 4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the 2nd & 3rd pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to- Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART-services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.en_ZA
dc.description.embargo2016-08-30en_ZA
dc.description.librarianhb2015en_ZA
dc.description.urihttp://www.tandfonline.com/loi/caic20en_ZA
dc.identifier.citationUte D. Feucht, Anell Meyer, Winifred N. Thomas, Brian W. C. Ute D. Feucht, Anell Meyer, Winifred N. Thomas, Brian W. C. Forsyth & Mariana Kruger (2016) Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care, AIDS Care, 28:1, 32-42, DOI: 10.1080/09540121.2015.1066748.en_ZA
dc.identifier.issn0954-0121 (print)
dc.identifier.issn1360-0451 (online)
dc.identifier.other10.1080/09540121.2015.1066748
dc.identifier.urihttp://hdl.handle.net/2263/49821
dc.language.isoenen_ZA
dc.publisherRoutledgeen_ZA
dc.rights© 2015 Taylor & Francis. This is an electronic version of an article published in AIDS Care, vol. 28, no. 1, pp. 32-42, 2016. doi : 10.1080/09540121.2015.1066748. AIDS Care is available online at : http://www.tandfonline.comloi/caic20.en_ZA
dc.subjectChildrenen_ZA
dc.subjectHIV diagnosisen_ZA
dc.subjectBarriers to careen_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.subjectAntiretroviral therapy (ART)en_ZA
dc.titleEarly diagnosis is critical to ensure good outcomes in HIV-infected children : outlining barriers to careen_ZA
dc.typePostprint Articleen_ZA

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