Factors associated with paediatric anti retroviral therapy enrolment in Gomba district

Abstract

Back ground Paediatric HIV/AIDS is on the rise among children globally. Currently children account for 14% of new HIV infections and 18% of HIV/AIDS related deaths. However, if diagnosed and treatment initiated early; mortality among children living with HIV is reduced by 76% and; these children can live normal lives. With no interventions however, 50% of these children die before their 2nd birth days. To reverse this burden therefore, WHO/UNAIDS and the Ugandan government recommend that all children diagnosed with HIV be enrolled into ART care. Gomba district launched ART services in 2001 but the district’s HMIS indicates that their paediatric ART enrolment is 2.0% against the national 15% target.

Objectives This study was to determine the proportion of children enrolled into ART care; identify individual factors; establish community factors and; determine the health system factors associated with paediatric ART enrolment.

Methodology A cross sectional study involving both qualitative and quantitative data collection was carried out in Gomba district between March and April 2013. Leslie Kish formula was used to generate the sample of respondents. The respondents were simple randomly sampled and interviewed using semi structured questionnaires. Key informants were purposively sampled and interviewed using KI guides. Univariate and multivariate analysis was performed on quantitative data. Thematic content analysis was performed for qualitative data.

Results In total, 320 respondents and 14 KI were interviewed. The assessed enrolment was 11.3% of the total number of people receiving ART in the district. Respondents who earned US $ 40 or more per month were more likely to enroll their children (AOR= 5.2, 95% CI; 1.34-19.84) as compared to those respondents who earned less than US $ 40 per month. Respondents who lacked adequate knowledge on importance of ART enrolment were less likely to enroll their children (AOR= 0.1, 95% CI; 0.02-0.30) as compared to respondents who had adequate knowledge. Respondents from communities that; used herbal medicines as substitutes for ARVs (AOR= 0.0, 95% CI; 0.00-0.11) and/or; lacked HIV outreach services were less likely to enroll their children (AOR= 0.0, 95% CI; 0.01-0.11) as compared to respondents who took their children to health facilities and/or had community HIV outreaches. Respondents who took more than a month to receive a child’s HIV test results were less likely to enroll their children into care (AOR= 0.1, 95% CI; 0.01-0.60) compared to respondents to received the child’s HIV result in just one day.

Conclusion and recommendation The assessed enrolment was lower than the national enrolment target. Peadiatric ART enrolment in the district can however be improved by: Increasing individual’s knowledge on importance of enrolling a child, enhancing financial and physical accesses to ART care, discouraging the use of herbal medicines as substitutes for ARVs in communities and reducing the duration of a child’s HIV diagnosis process.