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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Barriers to initiation of pediatric HIV treatment in Uganda: A mixed-method study
AIDS Research and Treatment, Volume 2012, Article 817506, Year 2012
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Description
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. © 2012 T. Sonia Boender et al.
Authors & Co-Authors
Boender, T. Sonia
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Sigaloff, Kim Catherina Eve
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Kayiwa, Joshua
Uganda, Kampala
Joint Clinical Research Center Uganda
Musiime, Victor
Uganda, Kampala
Joint Clinical Research Center Uganda
Calis, Job C.J.
Netherlands, Amsterdam
Emma Kinderziekenhuis
Hamers, Raph L.
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Nakatudde-Katumba, Lillian
Uganda, Kampala
Joint Clinical Research Center Uganda
Khauda, Elizabeth
Uganda, Kampala
Joint Clinical Research Center Uganda
Mukuye, Andrew
Uganda, Kampala
Joint Clinical Research Center Uganda
Ditai, James
Uganda, Kampala
Joint Clinical Research Center Uganda
Geelen, Sibyl P.M.
Netherlands, Utrecht
Wilhelmina Kinderziekenhuis
Mugyenyi, Peter N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Rinke de Wit, Tobias Floris
Netherlands, Amsterdam
Pharmaccess Foundation
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Kityo, Cissy Mutuluuza
Uganda, Kampala
Joint Clinical Research Center Uganda
Statistics
Citations: 14
Authors: 14
Affiliations: 5
Identifiers
Doi:
10.1155/2012/817506
e-ISSN:
20901259
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Locations
Uganda