Child-Centred Care in HIV Service Provision for Children in Resource Constrained Settings: A Narrative Review of Literature

Abstract

Introduction Child-centred care approaches are increasingly gaining traction in healthcare; and are being applied in the delivery of HIV care for children in resource constrained settings. However, very little is known about their potential benefits. Methods We synthesised literature from primary and secondary publications exploring the philosophical underpinnings of the concept of child-centred care, and its application to HIV service delivery for children in resource constrained settings. We concluded the review by suggesting a conceptual framework for mainstreaming and integrating child-centred care approaches in the management of HIV in resource constrained settings. Results The philosophical underpinnings of child-centred care stem from human rights (child-rights), holism, the ecological model, and life-cycle approaches. Although there is no standard definition of child-centred care in the context of HIV, the literature review highlighted several phrases used to describe the “child-centredness” of HIV care for children. These phrases include: (i) Respect for child-healthcare rights. (ii) Using the lifecycle approach to accommodate children of different ages. (iii) Provision of age-appropriate HIV services. (iv) Meaningful participation and inclusion of the child in the healthcare consultation process. (v) Using age-appropriate language to increase the child's understanding during healthcare consultations. (vi) Age-appropriate disclosure. (vii) Primary caregiver (PCG) participation and preparation (equipping the PCGs with information on how to support their children). (viii) Creation of a child-friendly healthcare environment. (ix) Consideration of the child ecological systems to have a holistic understanding of the child. (x) Partnership and collaborative approach between children, PCGs, and healthcare workers (HCWs). Conclusion Child-centred care approaches can potentially increase child-participation, promote positive health outcomes and resilience in children living with a communicable, highly stigmatised and chronic condition such as HIV. More evidence from controlled studies is required to provide concrete results to support the application of child-centred care approaches in HIV care services.

‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

“…Improved family relationships and family-HCW interactions could improve adherence to HIV treatment, retention in HIV care and clinical outcomes for HIV-positive children [7,8,14]. Additionally, improved partnership between children, caregivers and their HCWs can promote transparency, truthfulness, and promote HIV status disclosure [15].…”

“…Both caregivers and HCWs experienced some difficulties with FCCM. HCWs had concerns as families were not visiting health facilities together as a unit as required by FCCM principles [15,26,27] and by how the FCCM pilot program was designed. HCWs struggled synchronizing clinic visits appointments dates for families mainly due to schedule conflicts for school-going HIV-positive children and teenagers participating in weekend Teen Clubs for psychosocial support.…”

Exploring the mechanism through which a child-friendly storybook addresses barriers to child-participation during HIV care in primary healthcare settings in KwaZulu-Natal, South Africa

“…For PLWHIV to cooperate, they need to be active participants during their care journey [ 11 , 12 ]. Children living with HIV can no longer be passive bystanders during their care and care consultation [ 13 ]. The increased participation of children on chronic medication due to the proliferation of child-centred approaches has shown evidence of a positive impact on children’s experiences of optimal care, satisfaction, and positive health outcomes in resource-rich countries [ 2 , 3 , 5 ].…”

“…The increased participation of children on chronic medication due to the proliferation of child-centred approaches has shown evidence of a positive impact on children’s experiences of optimal care, satisfaction, and positive health outcomes in resource-rich countries [ 2 , 3 , 5 ]. Therefore, poor resource settings are also beginning to adopt these important lessons by advocating for increased child-participation in response to the increasing number of CLWHIV on antiretroviral therapy (ART) who now, due to the scale-up of the Universal Treat All policy, need quality care in PHCs [ 13 , 14 ].…”

“…In such settings, cost-effective and practical tools for improving HCW capacity to remember HIV counselling, testing and disclosure guidelines are necessary to alleviate some of these challenges [ 23 , 37 – 39 ]. In addition, the use of multi-purpose simplified guidelines a potential to capacitate HCWs with knowledge and guidance to deliver child-centred HIV care to children and psychosocial support to their PCGs [ 13 , 38 ].…”