Barriers to Initiation of Pediatric HIV Treatment in Uganda: A Mixed-Method Study

Abstract

Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, P = 0.014), living without parents (OR 3.93, P = 0.002), unemployment of the caregiver (OR 4.26, P = 0.001), lack of perinatal HIV prophylaxis (OR 5.66, P = 0.028), and high transportation costs to the clinic (OR 2.51, P = 0.072). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers' unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.

Barriers, facilitators and recommendations for the early infant diagnosis and treatment (EIDT) cascade: A qualitative study in Malawi

“…One strength of this study is that while other studies have reported decreases in the number of infants moving through the EIDT cascade, [3,4] and on barriers and facilitators to EIDT in general, [12,15] previous studies have not focused on distinct motivators, challenges and solutions for each step along the EIDT cascade. Limitations include that we only interviewed women who had their HIV-exposed child tested and were at the health facility for the result.…”

“…Another study focused on EIDT recommended sensitisation campaigns through radio and advertisements to increase uptake of EID. [12] Sample processing and transport (step 3) results indicate the need for the establishment of a strong sample transport system and a laboratory information system possibly using SMS. [13] In addition, having procedures that work for after-hours sample delivery and for reporting of results would address barriers.…”

Short Communication: High Rates of Thymidine Analogue Mutations and Dual-Class Resistance Among HIV-Infected Ugandan Children Failing First-Line Antiretroviral Therapy

“…The proportions of virus with drug resistance mutations were calculated with 95% confidence intervals (CI). Nutritional status was assessed by means of the World Health Organization (WHO) Child Growth Standards: WHO Anthro version 3.2.2 (age 0-5) and WHO Reference 2007 for height and weight (age [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. 17,18 Underweight was defined as a weightfor-age z-score < -2 standard deviation (SD) and stunted as a height-for-age z-score < -2 SD.…”

“…Site and cohort characteristics have been described previously. 12 Potential participants were informed of the study and screened for eligibility by the study staff. Children aged 12 years or below who initiated a first-or second-line ART regimen were enrolled.…”

Pediatric HIV/AIDS in sub-Saharan Africa: emerging issues and way forward

“…This informed the World Health Organization (WHO) policy statement that all HIV infected children less than 24 months be commenced on highly active anti-retroviral therapy (HAART) as soon as HIV diagnosis is made. Surprisingly, HIV infected children still present late at health facilities 16 . Virologic testing for confirming HIV infection in children less than 18 months is still a challenge.…”