Barriers to antiretroviral therapy initiation for HIV-positive children aged 2–18 months in Swaziland

Abstract

Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82-18.33 and OR 6.20, 95% CI 1.30-29.60 respectively). Children who lived ≤30 and 31-60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03-0.78 and OR 0.21, 95% CI 0.04-0.98) compared with those who lived more than 60 minutes away. Children who received immunisation after 6 months were 22.59 times more likely to initiate ART (OR 22.59, 95% CI 7.00-21.72) than those who did not. Infants of caregivers who had excellent or good relationships with their healthcare provider were 4.32 times more likely to initiate ART (OR 4.32, 95% CI 1.01-18.59) than those of caregivers who had average or poor relationships with healthcare providers. The significant predictors of ART initiation identified in this study should be regarded as priority areas for intervention among HIV-positive women in Swaziland.

<p>Correlates of Uptake of Antiretroviral Therapy in HIV-Positive Orphans and Vulnerable Children Aged 0–14 Years in Tanzania</p>

“…The frequency of visiting a clinic, distance to the nearest clinic, and caregiver relationship with their health provider were observed in Swaziland. 8 Another study in Kahama district in north-western Tanzania found a lack of transport fare and long distance to the health facility being barriers to attending clinics for ART uptake in children. 9 The same study also observed that being divorced or widowed and primary education level of the caregivers were associated with poor uptake of ART in children.…”

Ineffective health control: concept analysis

“…For PLWHA, their needs go beyond treating the disease and involve an entire emotional and social context that permeates the difficulties in dealing daily with situations such as depressive symptoms, stigma, discrimination, a reframing of their life history, in addition to adverse effects related to the therapeutic regimen. From the analysis, it was possible to identify five critical attributes (4) : patient's refusal to follow the therapeutic plan (7,(9)(10)13,21,(23)(24)(25)27,(31)(32)34,37,(40)(41)(45)(46)49,51) ; abandonment of treatment leading to ineffective results and worsening of symptoms (8,11,14,(16)(17)22,26,(28)(29)(35)(36)(38)(39)42,44,46,(48)(49)(50) ; difficulty in reaching goals agreed between the person and the health professional (6,12,15,(18)(19)(20)37,…”

“…The antecedents of the concept are shown in Chart 2 and its consequences in Chart 3, in association with related factors and defining characteristics, respectively, both expressed in the NANDA-I taxonomy with reference to the diagnosis "Ineffective Health Control". Alcohol use (9,21,25,31,(33)(34)40) NM Side effects to medications (7,11,14,(17)(18)22,45) NM Depression (9,14,16,24,(32)(33)49) NM Use of illicit drugs (17,21,23,25,31,33) NM Stigma (8)(9)11,20,50) NM Low education level (8,(14)(15)31,33) NM Anxiety (16)(17)24,(32)(33) NM Financial difficulties (8,20,26,31,43) Perceived barrier Difficulty of adequate access to care (7)…”

“…This step sought to determine the empirical references for the attributes, considered classes or categories of real phenomena that, by their existence, demonstrate the occurrence of the concept. Thus, the following empirical references were identified: interview scripts (6,8,10,13,16,(19)(20)22,26,31,36,41,44,50) ; questionnaires (9,(14)(15)23,25,29,43,48) ; Questionnaire to Evaluate the Adherence to HIV Therapy (CEAT-VIH) (17)(18)24,32,38,45,51) ; focus groups (30,(46)(47) ; pharmacy information from the health service (31,33,42) ; medication count (21,40) ; phone calls (34) ; and patient self-assessment (12) .…”

“…Inefficient decisions to achieve treatment goals (21,25,31,34) Ineffective choices in daily life to achieve health goals Complications associated with the development of the disease (13,29,39,44) NM Neurological and cognitive disorders (13,29,39,44) NM Cardiovascular disorders (13,29,39,44) NM Coloproctological manifestations (13,29,39,44) NM Periodontal changes (13,29,39,44) NM Ocular manifestations (13,29,39,44) NM Renal disorders (13,29,39,44) NM Neoplasms (13,29,39,44) NM Opportunistic infections (8,14) NM Tuberculosis / HIV co-infection (8,14) NM Failure in the practice of reducing risk factors (6)(7) Failure to act to reduce risk factors Failure to incorporate treatment into daily life (6)(7) Failure to include the treatment regimen in daily life Development of minor mental disorders (27) NM Memory deficits…”