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

BMC Public Health

Laura Guay³  Emily A Bobrow⁵  Stélio A Dimande⁴  Eugenia Macasse²  Michelle Gill⁵  Catarina Mboa¹  Carlota Lucas¹  Caroline De Schacht¹ 

[1] Elizabeth Glaser Pediatric AIDS Foundation, Avenida Kwame Nkrumah 417, Maputo, Mozambique;Central Hospital Maputo, Mozambique, Av. Eduardo Mondlane/Av. Agostinho Neto, Maputo, Mozambique;The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, 950 New Hampshire Ave NW, 5th floor, Washington, DC 20052, USA;Provincial Health Directorate, Matola, Maputo Province, Mozambique, Praça do Município 111.29, Matola, Mozambique;Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Ave NW, Suite 200, Washington, DC 20036, USA

关键词: Early infant diagnosis;    Infant HIV testing;    HIV-exposed children;    Mozambique;    Pediatric HIV;    Motivators;    Barriers;    Prevention of mother-to-child transmission;   

Others  :  1122867
DOI  :  10.1186/1471-2458-14-1240

 received in 2014-02-24, accepted in 2014-11-26,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 De Schacht et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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