Optimizing Paediatric HIV Care in Kenya: Challenges in Early Infant diagnosis/Optimisation Des Soins Pediatriques En Rapport Avec le VIH/sida Au Kenya: Difficultes D'un Diagnostic Precoce Chez l'enfant/Optimizacion De la Atencion Pediatrica Para El VIH En Kenya: Problemas del Diagnostico Precoz En Al Infancia
Year: 2008
Type: article
Study design: Observational Study
Abstract: Background Kenya's population of 30 million people has nearly 1.2 million people living with HIV/AIDS with at least 250 000 in need of immediate antiretroviral therapy (ART). In 2003, the Kenyan Ministry of Health started a programme to rapidly scale up ART with the goal of progressively delivering effective ART, according to standardized regimes, to HIV-infected people in need of treatment, reaching 50% by the end of 2005 and 80% by the end of 2008. (1) As a medium-term goal, the Kenyan government adopted WHO's 3 by 5 initiative, which aimed at providing 95 000 people with ART by end of 2005, of whom 10% were to be children. By July 2005, 45 000 adults and more than 2000 children were on treatment, most of them older children. The obvious inequitable access to HIV treatment is of major concern considering that 90% of the HIV infections ate due to mother-to-child transmission of HIV and without treatment, hall of the infected children do not live to celebrate their second birthday and therefore need to be identified as early as possible to benefit from the newly availed antiretroviral (ARV) therapies. (2) There was therefore a need to conduct a survey to identify the gaps existing within the current delivery of paediatric HIV care. This paper specifically reports systems and structural barriers to early identification and staging of children exposed to, of infected with, HIV. Methods The existing Kenyan Ministry of Health policies on HIV diagnosis in children were reviewed. Institutions providing ARV were identified using the national ART register in seven of the eight provinces, and a convenient sample of 58 government and mission facilities/non-governmental organizations providing ART to children was chosen, where a rapid assessment was conducted in the months of August and September 2005. A standard tool of structured questions and checklists was used to obtain information. In addition, qualitative information was obtained through face-to-face and/or telephone interviews. The key respondents were medical superintendents and matrons in charge of the facilities; physician(s) and heads of pharmacy, laboratory, mother and child health clinics, as well as ART clinic personnel. All possible entry points for paediatric HIV care were assessed and included maternal and child health clinics, paediatric inpatient wards and outpatient services as well as the comprehensive HIV clinics. Voluntary counselling and testing centres located within the 58 facilities were also surveyed. The African Network for the Care of Children Affected by AIDS (ANECCA) 10-point package for comprehensive paediatric HIV care was used as the benchmark for monitoring and evaluating sites providing ART to children. (3) We also used the integrated management of childhood illnesses (IMCI) chart to asses the facilities' capacity to screen and stage HIV-infected children. However, this paper focuses only on barriers to the early confirmation of HIV status and staging of HIV-infected children. Results Policy environment In 2003, the National AIDS/STD Control Programme (NASCOP) developed a five-year strategic plan to guide the scaling-up of ART. A review of this strategic document showed that identification of HIV-infected/exposed children was not specifically provided for and the models of care adopted by the document precluded maternal and child health services as entry points for care for HIV-infected children. In 2004, NASCOP developed guidelines for HIV testing in clinical settings. (4) These guidelines provided for universal HIV testing in all paediatric wards and for children infected with, or suspected to have, tuberculosis. Health facility survey A total of 58 facilities were identified to be providing paediatric HIV services. These facilities were broadly classified as government, faith-based and nongovernmental organizations, and included two national referral hospitals, 11 district hospitals, six health centres sponsored by the government, 12 mission hospitals, 18 mission health centres and four children orphanages. …
Language: French
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2614863069