Abstract
BackgroundChildren living with HIV (CLHIV) often experience HIV-related impairment and disability.AimThe study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework.SettingDistrict level semi-rural healthcare facility in KwaZulu-Natal.MethodsThe Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting.ResultsForty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions.ConclusionFunctional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.
Highlights
A significant number of children experience disabilities as a result of living with human immunodeficiency virus (HIV), including those on antiretroviral therapy (ART)
The Washington Group/UNICEF Module on Child Functioning used was designed for population-based comparisons of disability data,[18] the tool yields results that may assist in informing the integration of rehabilitation into the current healthcare system for children living with HIV (CLHIV)
Whilst disability prevalence studies in sub-Saharan Africa[2,10,15] have highlighted impairments frequently experienced by CLHIV using tools such as the ten question screen for disability (TQSD); this tool does not report on actual levels of child functioning
Summary
A significant number of children experience disabilities as a result of living with human immunodeficiency virus (HIV), including those on antiretroviral therapy (ART). Human immunodeficiency virus-related disability is understood by considering the life-related consequences of the disease as through the international classification of functioning, disability and health framework of impairments in body structure or function, limitations to activity as well as participation and environmental restrictions.[14] Human immunodeficiency virus-related disability is thought to result from the neurotoxic characteristics of the virus, from the side effects of antiretrovirals and from opportunistic infections such as meningitis and otitis media.[2,10] the influence of the child’s social context on disability outcomes is acknowledged.[14] Whilst some sub-Saharan research has investigated the prevalence and types of http://www.phcfm.org. Children living with HIV (CLHIV) often experience HIV-related impairment and disability
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