ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania

Exavery, Amon; Charles, John B.; Barankena, Asheri; Kuhlik, Erica; Mubyazi, Godfrey M.; Tani, Kassimu; Ally, Amal; Minja, Epifania; Koler, Alison; Kikoyo, Levina; Jere, Elizabeth

doi:10.1186/s12889-020-09361-6

Cited by 14 publications

(16 citation statements)

References 53 publications

(75 reference statements)

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“…e project criteria are detailed elsewhere [15]. After the eligible beneficiaries' consent to be enrolled in the program, the needs of the household are identified and case-specific care plans are developed by community workers.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania

Bajaria

Exavery²,

Toroka³

et al. 2020

AIDS Research and Treatment

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Background. The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods. Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results. Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age p < 0.001 , school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers’ higher education level p < 0.001 , and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion. The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.

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Section: Study Design and Data Sourcementioning

confidence: 99%

Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania

Bajaria

Exavery²,

Toroka³

et al. 2020

AIDS Research and Treatment

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“…In Tanzania the THIS report showed that 41.5% of male adults 15 years or older had suppressed viral loads compared to 57.2% of their female peers (29). Regarding disability, in a study in Tanzania, care givers with mental or physical disability were 16% less likely to report adhering to HIV treatment (20). None of these studies showed differences between men with and without disability in suppressing their HIV viral loads.…”

Section: Discussionmentioning

confidence: 97%

Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

Chipanta

Mitra

Amo-Agyei

et al. 2023

Preprint

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Background Persons with disability may have a higher HIV prevalence and be less likely than persons without disability to know their HIV-positive status, access antiretroviral therapy (ART), and suppress their HIV viral load (HIV testing, treatment, and care cascade, also known as the 90—90—90 and the 95—95—95 targets set to be achieved by 2020 and 2025, respectively). Methods Using the Tanzania HIV Impact Survey (THIS) data collected between October 2016 and August 2017, we assessed differences in HIV prevalence and progress towards achieving the 2020 HIV testing, treatment, and care cascade target between persons with and without disability. We presented the sample characteristics by disability status and analyzed the achievement of the cascade target by disability status, and sex. We used multivariate logistic regressions, and adjusted for age, sex, rural-urban-residence, education, wealth, and region. Results The sample comprised 1,831 people living with HIV (PLHIV) with a median age of 32 years (IQR 21—45). Approximately 11.8% (95% Confidence Interval [CI]: 10.2%—13.6%, n= 212) of PLHIV in Tanzania were disabled. HIV prevalence was higher (6.2%, 95% CI: 5.3%—7.4%) among persons with disability than persons without disability (4.7%, 95% CI: 4.4% — 5.1%); Women with disability were more aware of their HIV-positive status (n = 101, 79.0%, 95% CI: 68.0%—87.0% versus n = 703, 63.0%, 95% CI: 59.1%—66.7%) and accessed ART more frequently (n = 98, 98.7%, 95% CI: 95.3%—99.7% versus n = 661, 94.7%, 95% CI: 92.6%—96.3%) than women without disability. After adjusting for socio-demographic characteristics, the odds of having HIV and of accessing ART were not statistically different between PLHIV with and without disability. However, PLHIV with disability had higher odds of being aware of their HIV-positive status (aOR 1.69, 95% 1.05—2.71) than PLHIV without disability. Men on ART with disability had lower odds (aOR = 0.23, 95% CI: 0.06—0.86) to suppress HIV viral loads than their counterparts without disability. Conclusion We found no differences in HIV prevalence and access to ART between persons with and without disability in Tanzania. Whereas PLHIV disability, women in particular, were advantaged in knowing their HIV-positive status, men on ART with disability may have been disadvantaged in having suppressed HIV viral loads. These differences are correctable by disability-inclusive HIV programming. HIV surveys in multiple countries sampling more persons with disability are required to measure differences in HIV prevalence better and in attaining the 2025 HIV testing and treatment cascade target for both persons with and without disability.

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“…The standard of HIV/AIDS care was also impaired by microeconomic factors [ 88 ]. Financial assistance for the poor, which includes increasing the country’s health insurance coverage, is an important strategy [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Universal Health Coverage for Antiretroviral Treatment: A Review

Endalamaw

Gilks

Ambaw

et al. 2022

Infectious Disease Reports

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Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers’ inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship.

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ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania

Cited by 14 publications

References 53 publications

Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania

Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania

Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

Universal Health Coverage for Antiretroviral Treatment: A Review

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