Abstract
BackgroundSuccessful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia.MethodsCross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected from caretakers and medical records.Results192 HIV-infected children were enrolled from September 2007 through September 2008, 28% of whom were receiving antiretroviral therapy (ART) at enrollment. The median age was 3.3 years for children not receiving ART (IQR 1.8, 6.7) and 4.5 years for children receiving ART (IQR 2.7, 8.6). 91% travelled more than one hour to the clinic and 26% travelled more than 5 hours. Most participants (73%) reported difficulties accessing the clinic, including insufficient money (60%), lack of transportation (54%) and roads in poor condition (32%). The 54 children who were receiving ART at study enrollment had been on ART a median of 8.6 months (IQR: 2.7, 19.5). The median percentage of CD4+ T cells was 12.4 (IQR: 9.2, 18.6) at the start of ART, and increased to 28.6 (IQR: 23.5, 36.1) at the initial study visit. However, the proportion of children who were underweight decreased only slightly, from 70% at initiation of ART to 61% at the initial study visit.ConclusionHIV-infected children in rural southern Zambia have long travel times to access care and may have poorer weight gain on ART than children in urban areas. Despite these barriers, these children had a substantial rise in CD4+ T cell counts in the first year of ART although longer follow-up may indicate these gains are not sustained.
Highlights
Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas
We evaluated barriers to the care of HIV-infected children attending an HIV clinic in rural southern Zambia, with the goal of developing strategies to optimize the care of these children
Macha Hospital provides care to approximately 4000 HIVinfected adults and children through the Government of Zambia's antiretroviral treatment program, with additional support from the President's Emergency Plan for HIV-infected children are referred to the clinic from voluntary counseling and testing programs, outpatient clinics and hospitals
Summary
Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. BMC Infectious Diseases 2009, 9:169 http://www.biomedcentral.com/1471-2334/9/169 increase access to life-prolonging treatment for children in developing countries, with the number of children in subSaharan Africa receiving antiretroviral therapy increasing from approximately 50,000 in 2005 to over 150,000 by the end of 2007 [3]. HIV care services have primarily been implemented in urban areas and have lagged behind in rural areas, where there are shortages of trained personnel and the health care system faces many challenges [10]. Barriers faced by residents in rural areas may prevent them from accessing HIV care, including lower treatment literacy [11], greater distances and travel times to clinics [3], and fewer financial resources for transportation [12,13]
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