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Access to HIV prevention and care for HIV-exposed and HIV-infected children: a qualitative study in rural and urban Mozambique.

De Schacht C, Lucas C, Mboa C, Gill M, Macasse E, Dimande SA, Bobrow EA, Guay L - BMC Public Health (2014)

Bottom Line: Study participants reported factors such as seeking care outside of the conventional health system and disbelief in test results as barriers to use of HIV services.The results suggest that individual-level factors are critical drivers that influence the health-seeking behavior of caregivers of HIV-exposed and HIV-infected children in Mozambique.Noted strategies are to provide more information and awareness on the benefits of early pediatric testing and treatment with positive messages that incorporate success stories, to reach more pregnant women and mother-child pairs postpartum, and to provide counseling during tracing visits.

View Article: PubMed Central - PubMed

Affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Avenida Kwame Nkrumah 417, Maputo, Mozambique. carolineds11@gmail.com.

ABSTRACT

Background: Follow-up of HIV-exposed children for the delivery of prevention of mother-to-child transmission services and for early diagnosis and treatment of HIV infection is critical to their survival. Despite efforts, uptake of postnatal care for these children remains low in many sub-Saharan African countries.

Methods: A qualitative study was conducted in three provinces in Mozambique to identify motivators and barriers to improve uptake of and retention in HIV prevention, care and treatment services for HIV-exposed and HIV-infected children. Participant recommendations were also gathered. Individual interviews (n = 79) and focus group discussions (n = 32) were conducted with parents/caregivers, grandmothers, community leaders and health care workers. Using a socioecological framework, the main themes identified were organized into multiple spheres of influence, specifically at the individual, interpersonal, institutional, community and policy levels.

Results: Study participants reported factors such as seeking care outside of the conventional health system and disbelief in test results as barriers to use of HIV services. Other key barriers included fear of disclosure at the interpersonal level and poor patient flow and long waiting time at the institutional level. Key facilitators for accessing care included having hope for children's future, symptomatic illness in children, and the belief that health facilities were the appropriate places to get care.

Conclusions: The results suggest that individual-level factors are critical drivers that influence the health-seeking behavior of caregivers of HIV-exposed and HIV-infected children in Mozambique. Noted strategies are to provide more information and awareness on the benefits of early pediatric testing and treatment with positive messages that incorporate success stories, to reach more pregnant women and mother-child pairs postpartum, and to provide counseling during tracing visits. Increasing uptake and retention may be achieved by improving patient flow at the institutional level at health facilities, by addressing concerns with family decision makers, and by working with community leaders to support the uptake of services for HIV-exposed children for essential preventive care.

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Related in: MedlinePlus

The Conceptual Framework reflecting the five levels of influence on access to HIV prevention and care for HIV-exposed and HIV-infected children in Mozambique.
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Fig1: The Conceptual Framework reflecting the five levels of influence on access to HIV prevention and care for HIV-exposed and HIV-infected children in Mozambique.

Mentions: A conceptual framework was elaborated and adapted from the socioecological framework developed by McLeroy et al.[15], organizing the qualitative results into five levels of influence: individual, interpersonal, institutional, community and policy. Figure 1 displays the factors included in the framework. Individual-level factors were defined as a person’s knowledge, perceptions and behavior specifically focused on health-seeking behaviors, acceptance of HIV test results, motivators to access of care, and perceptions of illness as being “visible” versus asymptomatic. Interpersonal-level factors included issues of disclosure within the family, social support within the family, and general social support. Institutional-level factors centered on the health facilities available in communities with important determinants including patient flow, payment for health care, and distance needed to travel to access care. Community-level factors included influences on decision making to seek care, disclosure beyond the family, and wider issues of social support. At the policy level, the highlighted determinant was defined as the content and implementation of the National PMTCT policy which dictates how facilities provide care for HIV-exposed and HIV-infected children.Figure 1


Access to HIV prevention and care for HIV-exposed and HIV-infected children: a qualitative study in rural and urban Mozambique.

De Schacht C, Lucas C, Mboa C, Gill M, Macasse E, Dimande SA, Bobrow EA, Guay L - BMC Public Health (2014)

The Conceptual Framework reflecting the five levels of influence on access to HIV prevention and care for HIV-exposed and HIV-infected children in Mozambique.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4265432&req=5

Fig1: The Conceptual Framework reflecting the five levels of influence on access to HIV prevention and care for HIV-exposed and HIV-infected children in Mozambique.
Mentions: A conceptual framework was elaborated and adapted from the socioecological framework developed by McLeroy et al.[15], organizing the qualitative results into five levels of influence: individual, interpersonal, institutional, community and policy. Figure 1 displays the factors included in the framework. Individual-level factors were defined as a person’s knowledge, perceptions and behavior specifically focused on health-seeking behaviors, acceptance of HIV test results, motivators to access of care, and perceptions of illness as being “visible” versus asymptomatic. Interpersonal-level factors included issues of disclosure within the family, social support within the family, and general social support. Institutional-level factors centered on the health facilities available in communities with important determinants including patient flow, payment for health care, and distance needed to travel to access care. Community-level factors included influences on decision making to seek care, disclosure beyond the family, and wider issues of social support. At the policy level, the highlighted determinant was defined as the content and implementation of the National PMTCT policy which dictates how facilities provide care for HIV-exposed and HIV-infected children.Figure 1

Bottom Line: Study participants reported factors such as seeking care outside of the conventional health system and disbelief in test results as barriers to use of HIV services.The results suggest that individual-level factors are critical drivers that influence the health-seeking behavior of caregivers of HIV-exposed and HIV-infected children in Mozambique.Noted strategies are to provide more information and awareness on the benefits of early pediatric testing and treatment with positive messages that incorporate success stories, to reach more pregnant women and mother-child pairs postpartum, and to provide counseling during tracing visits.

View Article: PubMed Central - PubMed

Affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Avenida Kwame Nkrumah 417, Maputo, Mozambique. carolineds11@gmail.com.

ABSTRACT

Background: Follow-up of HIV-exposed children for the delivery of prevention of mother-to-child transmission services and for early diagnosis and treatment of HIV infection is critical to their survival. Despite efforts, uptake of postnatal care for these children remains low in many sub-Saharan African countries.

Methods: A qualitative study was conducted in three provinces in Mozambique to identify motivators and barriers to improve uptake of and retention in HIV prevention, care and treatment services for HIV-exposed and HIV-infected children. Participant recommendations were also gathered. Individual interviews (n = 79) and focus group discussions (n = 32) were conducted with parents/caregivers, grandmothers, community leaders and health care workers. Using a socioecological framework, the main themes identified were organized into multiple spheres of influence, specifically at the individual, interpersonal, institutional, community and policy levels.

Results: Study participants reported factors such as seeking care outside of the conventional health system and disbelief in test results as barriers to use of HIV services. Other key barriers included fear of disclosure at the interpersonal level and poor patient flow and long waiting time at the institutional level. Key facilitators for accessing care included having hope for children's future, symptomatic illness in children, and the belief that health facilities were the appropriate places to get care.

Conclusions: The results suggest that individual-level factors are critical drivers that influence the health-seeking behavior of caregivers of HIV-exposed and HIV-infected children in Mozambique. Noted strategies are to provide more information and awareness on the benefits of early pediatric testing and treatment with positive messages that incorporate success stories, to reach more pregnant women and mother-child pairs postpartum, and to provide counseling during tracing visits. Increasing uptake and retention may be achieved by improving patient flow at the institutional level at health facilities, by addressing concerns with family decision makers, and by working with community leaders to support the uptake of services for HIV-exposed children for essential preventive care.

Show MeSH
Related in: MedlinePlus