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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study
PLoS Medicine, Volume 11, No. 5, Article e1001649, Year 2014
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Description
Background:There is a substantial burden of HIV infection among older children in sub-Saharan Africa, the majority of whom are diagnosed after presentation with advanced disease. We investigated the provision and uptake of provider-initiated HIV testing and counselling (PITC) among children in primary health care facilities, and explored health care worker (HCW) perspectives on providing HIV testing to children.Methods and Findings:Children aged 6 to 15 y attending six primary care clinics in Harare, Zimbabwe, were offered PITC, with guardian consent and child assent. The reasons why testing did not occur in eligible children were recorded, and factors associated with HCWs offering and children/guardians refusing HIV testing were investigated using multivariable logistic regression. Semi-structured interviews were conducted with clinic nurses and counsellors to explore these factors. Among 2,831 eligible children, 2,151 (76%) were offered PITC, of whom 1,534 (54.2%) consented to HIV testing. The main reasons HCWs gave for not offering PITC were the perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian had significantly lower odds of being offered HIV testing. Male guardians were less likely to consent to their child being tested. 82 (5.3%) children tested HIV-positive, with 95% linking to care. Of the 940 guardians who tested with the child, 186 (19.8%) were HIV-positive.Conclusions:The HIV prevalence among children tested was high, highlighting the need for PITC. For PITC to be successfully implemented, clear legislation about consent and guardianship needs to be developed, and structural issues addressed. HCWs require training on counselling children and guardians, particularly male guardians, who are less likely to engage with health care services. Increased awareness of the risk of HIV infection in asymptomatic older children is needed.Please see later in the article for the Editors' Summary. © 2014 Kranzer et al.
Authors & Co-Authors
Kranzer, Katharina A.
Unknown Affiliation
Meghji, Jamilah Z.
Unknown Affiliation
Bandason, Tsitsi
Unknown Affiliation
Dauya, Ethel
Unknown Affiliation
Mungofa, Stanley
Unknown Affiliation
Busza, Joanna
Unknown Affiliation
Hatzold, Karin
Unknown Affiliation
Kidia, Khameer K.
Unknown Affiliation
Mujuru, Hilda Angela
Unknown Affiliation
Ferrand, Rashida Abbas
Unknown Affiliation
Statistics
Citations: 98
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pmed.1001649
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Mixed-methods
Study Locations
Zimbabwe
Participants Gender
Male