The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5–18 years

Mathildah M Mokgatle,Sphiwe Madiba

doi:10.1186/s40249-015-0049-x

Mathildah M Mokgatle, Sphiwe Madiba

Open Access

https://doi.org/10.1186/s40249-015-0049-x

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Abstract

BackgroundProvider-initiated HIV testing and counseling (PITC) is offered as part of the normal standard of care to increase access to treatment for HIV-infected children. In practice, HIV diagnosis occurs in late childhood following recurrent and chronic infections. We investigated primary caregivers’ reported reasons for seeking HIV testing for children aged 5–18 years, determined the orphan status of the children, and compared the clinical profile and disease burden of orphans and non-orphans.MethodsThis was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment (ART) from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province, South Africa.ResultsThe sample consisted of 406 primary caregivers: 319 (78.6%) brought the child to the health facility for HIV testing because of chronic and recurrent infections. Almost half (n = 183, 45.1%) of the children were maternal orphans, 128 (31.5%) were paternal orphans, and 73 (39.9%) were double orphans. A univariate analysis showed that maternal orphans were significantly more likely to be older (OR = 2.57, p = 0.000, CI: 1.71–3.84), diagnosed late (OR = 2.48, p = 0.009, CI: 1.26–4.88), and to start ART later (OR = 2.5, p = 0.007, CI: 1.28–4.89) than non-orphans. There was a high burden of infection among the children prior to HIV diagnosis; 274 (69.4%) presented with multiple infections. Multiple logistic regression showed that ART start age (aOR = 1.19, p = 0.000, CI: 1.10–1.29) and time on ART (aOR = 2.30, p = 0.000, CI: 1.45–3.64) were significantly associated with orphanhood status. Half (n = 203, (50.2%) of the children were admitted to hospital prior to start of ART, and hospitalization was associated with multiple infections (OR = 1.27, p = 0.004, CI: 1.07–1.51).ConclusionsThe study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children. The health of maternal orphans was more compromised than non-orphans. Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0049-x) contains supplementary material, which is available to authorized users.

Highlights

Provider-initiated HIV testing and counseling (PITC) is offered as part of the normal standard of care to increase access to treatment for HIV-infected children
A primary caregiver was defined as an adult who lives in the same house with the child, is responsible for the day-today care for the child, and has knowledge about the child’s HIV diagnosis, antiretroviral treatment (ART) treatment, and care
Nurses working in primary health centers (PHC) facilities were trained to initiate ART before those working in eight-hour clinics, and this was evident during data collection where a large number of primary caregivers were recruited from PHC facilities

Summary

Introduction

Provider-initiated HIV testing and counseling (PITC) is offered as part of the normal standard of care to increase access to treatment for HIV-infected children. Provider-initiated testing and counseling (PITC) has been advocated as a strategy to increase access to treatment and care interventions for HIV-infected children [1], but there is evidence that millions of children living with HIV remain undiagnosed or present late in the course of their disease to healthcare facilities [2,3]. Implementation of PICT requires clear guidelines, including disclosure to children, age of consent for HIV tests, and care for older children and adolescents [7]. Offering PICT to sick children who present in health facilities is feasible and is an effective approach to identify undiagnosed HIV among older children [7,8]

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