Poor linkage to care for HIV-positive OVC with disabled caregivers: a longitudinal study in Tanzania

Abstract

Background Despite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania. Methods Data for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0–19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers. Results The majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers’ education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households. Conclusion These results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.

Socioeconomic status and other factors associated with HIV status among OVC in Democratic Republic of Congo (DRC)

“…These explanations must be substantiated with additional research, perhaps requiring qualitative or mixed methods. Our findings suggest the lower odds of HIV+ status among OVC in households <$30 may be attributable to healthcare accessibility issues for extremely poor OVCs and the resulting inability to get diagnoses; however, this was inconsistent with the Tanzania study that found that OVC in a lower socioeconomic status ( 34 ).…”

“…Our findings of the higher proportion of HIV-negative OVC in the parent/guardian group that were themselves HIV+ are noteworthy, and several explanations can be proposed as follows: ( 1 ) HIV+ parents/guardians may have had better knowledge and skills to prevent their children or OVC from HIV transmission; ( 2 ) When extended families need to place an orphan or vulnerable child with someone other than their parents, the extended family may choose an HIV-negative parent/guardian who likely has some combination of more resources, better health, and less vulnerability vs. an HIV+ person; ( 3 ) HIV+ parents, once they know their status, may decide to not have more children to protect their children from infection and stigmatization ( 32 , 33 ); and ( 4 ) DRC's successful PMTCT program, protecting HIV+ women from giving birth to an HIV infected baby likely plays a key role. These results are consistent with the findings of a recent study conducted in Tanzania and South Sudan regarding the impact of the OVC's caregivers and access to clinical care and support services for HIV+ OVC ( 34 – 36 ). These explanations must be substantiated with additional research, perhaps requiring qualitative or mixed methods.…”

Interventions connecting young people living in Africa to healthcare; a systematic review using the RE-AIM framework

“…Four studies targeted individuals <25 years ( 49 – 52 ). Seventeen studies targeted linkage to care for HIV treatment among the study population ( 44 , 45 , 50 , 51 , 53 – 63 ). In addition to HIV linkage to care, two of the studies also had links to healthcare for sexual and reproductive health services (HIV, family planning, and male circumcision ( 55 , 56 , 63 ).…”

“…The most common strengths among the interventions were conducting a longitudinal follow-up of study participants over time, selecting and assigning participants, and descriptive reporting of the intervention. Weaknesses observed by the majority of the studies were the lack of acknowledgment of the participation rate ( 44 , 45 , 50 , 51 , 54 – 63 ), description of the non-participant ( 44 , 45 , 50 , 51 , 53 – 61 ), and the quality of life ( 44 , 45 , 50 , 51 , 53 – 63 ). Attrition was mentioned in two studies but not analyzed ( 45 , 54 ); only one study examined the attrition rate ( 66 ).…”

“…Only three studies focused on recruitment and strategies among the interventions, mainly for young people. They had as objectives the linkage of young people to healthcare ( 50 , 51 , 66 ), while one focused on children <13 linked to healthcare ( 49 ). The sample size in these studies ranged from n = 711 ( 51 ) to n = 14538 ( 50 ).…”