Factors influencing utilization of paediatric HIV care and treatment services in Njombe Region, Tanzania

Abstract

Introduction and Background: HIV/AIDS is one of the major cause of child death in Tanzania (UNICEF, 2012). However, utilization of HIV care and treatment services is very low in this setting (NACP, 2013). This study therefore set out to establish the level (measured as a proportion of children using at least 50% of the defined services) and factors associated with children‟s (0-14 years) low utilization of care and treatment services in Njombe region, a setting most affected by HIV/AIDS in Tanzania. Methods: A community survey was conducted using both qualitative and quantitative methods. Quantitave tools were administered to 417 caretakers, resident in 57 wards. The caretakers were obtained through multistage sampling with wards as clusters and the initial respondent in each ward being randomly selected. The main outcome was utilization of care and treatment services measured as a binary variable. Exploratory, bivariate and multivariate analyses were conducted. The measure of association was prevalence rate ratio-PRR (obtained via a „modified‟ Poisson regression model), because the outcome was higher than 10%. All the quantitative data were analyzed using STATA version 12. Qualitative data were analyzed manually and involved development of descriptive codes, organizing concepts and identification of themes. Results: The mean (SD) age of children was 9.4 (3.2) years and 51.6% (215/417) were female. Caretaker‟s characteristics were; 78.4% (327/417) females, 53.0% (221/417) married and 47.6% (179/416) aged 18-39 years. Only 35.7% of the children had utilized the services. Factors significantly associated with increased use were preschoolers aged 4-5 years compared to toddlers 1-3 years, (adj.PRR: 3.95: 95% CI: 1.09-14.25); female children compared to their male counterparts (adj.PRR: 1.52, 95% CI: 1.16-2.01); those who perceived waiting time as fair compared to those who perceived it as very long (adj. PRR:1.70, 95% CI: 1.22-2.35) and those who did not pay for the services compared to those who paid (adj. PRR: xiv 3.48, 95% CI: 1.55-10.55). Lack of commitment, poverty, stigma, HIV disclosure, discrimination and witchcraft beliefs, shortage of staffs and drugs (ARVs and cotrimoxazole), shortage of trained staffs and distance to the health facilities influenced utilization. Conclusion and recommendation: Utilization of HIV care and treatment services in Njombe region is still very low (35.7%). Factors associated with utilization were child‟s age and sex, caretaker‟s age and lack of commitment. Other barriers were socio-cultural challenges especially stigma, discrimination and witchcraft beliefs and facility factors including shortages of drugs and trained staffs. Efforts directed towards these could be important interventions to address the poor uptake. Offering caretakers with HIV infected children opportunities to meet, support, and encourage one another at the household, village and ward level will restore their commitment and lessen the problems of stigma and discrimination. Developing policies that will comprehensively address utilization of paediatric care remains a crucial strategy.