Dissertation barriers to timely initiation of antiretroviral therapy among HIV infected children admitted to mulago hospital paediatric wards.

Abstract

BACKGROUND: The median survival of HIV infected children in the absence of treatment is 2 years, thus early initiation of ART is desirable. In Uganda, ART is now being provided free of charge. However, some children still do not access treatment. No study has been done n our setting to establish what could be the possible barriers to timely initiation of ART. OBJECTIVE: To determine the proportion of children eligible to start antiretroviral therapy who have not yet started by 4 weeks after discharge, and the factors that hinder access to timely initiation of antiretroviral therapy in these children. METHODS: A Cross sectional study was conducted on the paediatric ward at Mulago Hospital hospital and the paediatric infectious disease clinic (PIDC). 113 newly diagnosed HIV infected children in WHO clinical stage 3 and 4, aged 3 months to 12 years were recruited. Questionnaires to assess factors affecting timely initiation of ART were administered at recruitment and at 4 weeks after discharge. Home visits were also done. Qualitative data was collected using focus group discussions and in-depth interviews. RESULTS: The proportion of children who were eligible to start antiretroviral therapy but had not yet started by 4 weeks after discharge was 97.3% (110/113). Default and incomplete adherence counselling were the major barriers that prevented initiation of ART. CONCLUSION: 97.3% of the children had not started ART by 4 weeks. Caregiver factors were the main barriers that prevented initiation of ART in these children.