Barriers to timely antiretroviral therapy initiation among HIV infected children attending TASO clinics at Tororo, Mulago and Jinja

Abstract

Background: statistics show an increase in the prevalence and incidence of HIV among children yet these figures do not match with the numbers on treatment. Records showed evidence of delayed ART initiation (initiation beyond 1 week and 2 weeks for children below 2 years and 2 and above years respectively) among HIV infected children in 3 TASO centers at an average of 2 months from date eligibility was determined during the course of the year but there were no documented reasons for the low ART enrolment and delays in initiation. Objectives: The study aimed at assessing the barriers to having timely initiation on ART among HIV infected children at TASO Tororo Jinja and Mulago. Methods: A cross sectional study using quantitative and qualitative methods was conducted at 3 TASO centers to determine the factors associated with delayed ART initiation among children. STATA 12 was used to analyze Quantitative data while and Qualitative data was analyzed by thematic analysis. Results: A total of 352 caregivers of HIV infected children on ART were interviewed. A total of 4 children below 2 years out of 8, and 77% of children 2 years and above had delayed ART initiation. The strong predictors of delayed ART initiation after multivariate analysis were; unemployment of the child’s caretaker (OR 2.6, CI; 1.43-4.79, p=0.001), child attending school (OR 2.6, CI; 1.23-5.37, p=0.009),children with HIV negative siblings (OR 4.7, CI; 1.61-13.51, p=0.002), higher education level of the guardian (OR 2.9, CI; 1.22-6.80, p=0.012),child being orphaned (OR 1.6, CI; 0.92-2.92, p=0.031) and delays in doing CD4 before ART initiation (OR 2.0, CI; 0.99-3.92, p=0.048). Disclosure of guardians HIV serostatus was only significant at bivariate analysis. A total of twelve interviews and three focus group findings were conducted, supporting the findings of associated factors to delays and also pointing out missing CD4 results, clinic human resource gaps, lack of follow up of children and stigma as important barriers. Conclusion: Over 50% of HIV infected children on ART had delayed initiation. The delays were associated with caregiver and health system factors. Recommendations: HIV clinics need to have adequate health workers and other resources for follow up to enroll children on ART, and referral linkages with health facilities near patient homes could address challenges of transport burden and stigma associated with delayed initiation