Reasons for Delay in Initiation of Antiretroviral Therapy in a Population of HIV-Infected South African Children

Abstract

The aim of this study was to determine the reasons for delay of antiretroviral therapy (ART) in eligible HIV-infected children after the implementation of the South African National ART programme in April 2004, and to describe implemented interventions to improve ART access. This descriptive, retrospective audit included all HIV-infected children attending an ART clinic from April to December 2004, summarizing the following: (i) demographic data; (ii) HIV disease stage; (iii) CD4+ counts/percentages; (iv) ART eligibility and (v) reasons for ART delay. There were 276 study participants with a mean age of 4 years 4 months (range: 1 month-13 years). According to the South African national guidelines, 243 children were eligible for ART, but only 96 children were initiated on treatment during the study period, which was 39.5% of the eligible group and 34.8% of the total group. Important reasons for treatment delay were: (i) co-infection with tuberculosis (26.4%); (ii) lack of human resources (20.3%); (iii) socio-economic obstacles (17.3%) and (iv) incorrect disease stage classification (13.7%). Paediatric ART clinics need to co-operate closely with existing tuberculosis clinics for the effective management of tuberculosis co-infection; address socio-economic factors of HIV-affected families, especially the legal guardianship in orphans and improve their own staff capacity and the education of medical staff in HIV/AIDS management.

A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland

“…Like Boender et al’s (2012) study on the barriers to paediatric treatment initiation in Uganda, far distances to the clinic sites were also cited as barriers to ART initiation in this study. Another barrier that was found to child ART enrolment was co-infection with TB, which was also found in a similar retrospective study conducted in South Africa (Feucht, et al, 2007). Hence, there is a need to improve the integration and coordination of HIV and TB services offered to children in Swaziland to ensure timely treatment for both conditions.…”

“…Research focused on barriers to ART initiation among HIV-positive infants in resource-limited settings have identified several barriers, the most common barriers identified were financial constraints, fear of disclosing the child’s status to family members and friends, lack of spousal involvement and fear of stigma (Aluisio, Richardson, Bosire, Mbori-Ngacha, & Farquhar, 2011; Boender et al 2012; Byamugisha et al 2011; Coetzee, Kagee, & Bland, 2014; Donahue, Dube, & Dow, 2012; Feucht, Kinzer and Kruger, 2007; Hodgson et al 2014; Yeap et al 2010). Some of the mothers in these studies mentioned that if the husband or father knew of the child’s HIV status he would try to keep the child from taking the medications; therefore, many mothers keep the clinic visits and medication a secret, but this can prove to be challenging when the mother needs to administer the medicine to the child.…”

Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda

“…Thus, while the provision of free ARVs has increased rapidly, the Ugandan government and global funding agencies need to proportionately address the socio-contextual aspects of HIV care to positively influence timely and appropriate HIV care Corresponds to L 18 by reviewer 2 [9,[48][49][50][51]. Similar findings have been reported by other researchers in South Africa, Zambia and Malawi [21,52,53]. Several authorities also emphasize that the concept of seeking and accessing health care must be a shared responsibility between individual, organizational, community and public policy structures [46,47,54].…”

“…Reasons for late ART initiation identified in previous quantitative studies from both high-and low-income countries may be divided into health systems-related weaknesses such as lack of human resources, lost blood results [18]; delayed diagnosis and inappropriate treatment criteria [19,20], and other factors relating more to socio-economic obstacles [21], misconceptions about ARVs [22,23] stigma leading to self denial [18,24], and sometimes delaying HIV testing until the patient is too ill to seek care due to severe disease progression or co-infection with tuberculosis [25,26]. There is also emerging and worrying evidence from qualitative research in Tanzania that indicates enhanced stigma associated with increased ART access [27][28][29].…”

HIV Infection and AIDS Among Young Women in South Africa

“…As is the case in many southern African countries, South Africa has an inadequate number and uneven spread of health sector workers, especially in HIV treatment programs (85,86),. It is, therefore, neccesary that prevention programs face human resources challenges as the country scales-up HIV prevention efforts.…”