Factors affecting access to comprehensive HIV care among HIV Positive children(0-15years)in Chipata District, Eastern Province, Zambia

Abstract

Background This cross-sectional study described factors affecting access to antiretroviral therapy among HIV-positive children (0-15 years) out of the comprehensive HIV Care program using informal caregivers in Chipata district, Eastern Province of Zambia. Methods Data was collected between November, 2013 and March 2014. The study sampled162 respondents aged 18 years and above. These were the caregivers of HIV positive children out of the ART program from 30 Government clinics in Chipata. Data collection was done using a structured close-ended questionnaire. Data collected included among others socio-demographic factors, community factors, interpersonal and personal factors that affect access to comprehensive HIV care and treatment. Results The study revealed that N-301 (39%) children living with HIV were reported to be out of ART program and only 771 were on the ART program by 2012. Out of 162 respondents, 125 (77.2%) were aged between 24 and 39 years, 136 (84%) were biological parents with the 145 (89.5%) of respondents being females and 92 (57%) of respondents were married. 91 (56.2%) were from urban area, 98 (60.5%) had attained at least primary education, 87 (53.7%) respondents reported to be on ART program and accessing ART. In terms of level of knowledge score on basic pediatric HIV topic; 115 (71%) of the respondents were knowledgeable. HIV stigma was exhibited by 97 (59.9%) respondents after the stigma score test. Those found to be living more than 5km from ART services were 102(63%). Unadjusted regression model revealed that respondents in rural areas were less likely to have their children access HIV care because of perceived long distance and long waiting time than those in urban areas. OR: 0.26 (CI 95%) P-value < 0.001 and OR: 0.22 (CI 95%) P-value < 0.001 respectively which was significant. Those that perceived the waiting time to be more than 2 weeks before accessing ART were 112(69.3%). In terms of desired ART services for children, 128 (79%) respondents wanted a separate ART clinic for children. Conclusion Despite the study revealing that most children had stable family structures, parents of mature prime age group and relative good knowledge on HIV issues, access to ART among HIV positive children still remain a huge public health challenge in Chipata, Eastern province of Zambia. High burden of poverty, stigma among caregivers, long distance and long waiting time were factors which were highlighted as barriers to comprehensive ART care among HIV positive children out of the HIV program in rural areas. Therefore, there is need to urgently come up with strategies using health service structures to improve access such as integration of ART services at clinic level in rural areas. Key words: Antiretroviral treatment access, HIV positive children out of program, factors.

DEFINITIONS AND KEY WORDS  ART Access: refers to physical access to affordable, non-discriminatory ART care among children, including information about ART services. Children: defined age group of 0-15 years old. Comprehensive HIV care for HIV positive children: refers to earlier and compulsory initiation of ART in infants and children, attention to nutrition for children on ART, psychosocial support matters, adherence, screening for opportunistic diseases and monitoring of antiretroviral efficacy and toxicity. Caregiver: defined as unpaid personnel within the family, neighbourhood or community related or unrelated to HIV infected child and is responsible for the child’s health needs. HIV infected children out of the program: children not registered in any ART program. Paediatric antiretroviral therapy coverage: Proportion of children 0-15 years on ART program out of the total adults on ART in the same area. Current on ART: refers to clients active on ART program who are receiving ARVs as scheduled. Mobile antiretroviral therapy: ART services at host Health facility with support from a supporting static accredited ART facility through a “Mobile ART Service Unit (MAS)” comprising of human resource, laboratory services and technical assistance. Household food security: ability to secure, either from production or purchase of food adequate to meet dietary needs of all members to the family to sustain a health and active life.