TY - JOUR
T1 - Barriers to initiation of pediatric HIV treatment in Uganda
T2 - A mixed-method study
AU - Boender, T. Sonia
AU - Sigaloff, Kim C.E.
AU - Kayiwa, Joshua
AU - Musiime, Victor
AU - Calis, Job C.J.
AU - Hamers, Raph L.
AU - Nakatudde, Lillian Katumba
AU - Khauda, Elizabeth
AU - Mukuye, Andrew
AU - Ditai, James
AU - Geelen, Sibyl P.
AU - Mugyenyi, Peter
AU - Rinke De Wit, Tobias F.
AU - Kityo, Cissy
PY - 2012/12/1
Y1 - 2012/12/1
N2 - Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, P=0.014), living without parents (OR 3.93, P=0.002), unemployment of the caregiver (OR 4.26, P=0.001), lack of perinatal HIV prophylaxis (OR 5.66, P=0.028), and high transportation costs to the clinic (OR 2.51, P=0.072). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers' unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.
AB - Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, P=0.014), living without parents (OR 3.93, P=0.002), unemployment of the caregiver (OR 4.26, P=0.001), lack of perinatal HIV prophylaxis (OR 5.66, P=0.028), and high transportation costs to the clinic (OR 2.51, P=0.072). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers' unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.
UR - http://www.scopus.com/inward/record.url?scp=84872460833&partnerID=8YFLogxK
U2 - 10.1155/2012/817506
DO - 10.1155/2012/817506
M3 - Article
AN - SCOPUS:84872460833
VL - 2012
JO - Aids research and treatment
JF - Aids research and treatment
SN - 2090-1240
M1 - 817506
ER -