Research Article: Healthcare Workers’ Perspectives on the Barriers to Providing HIV Services to Children in Sub-Saharan Africa

Date Published: March 3, 2019

Publisher: Hindawi

Author(s): Chipo Mutambo, Khumbulani Hlongwana.


In order to accelerate the HIV response to meet the UNAIDS 90-90-90 indicators for children, healthcare workers need to lead a scale-up of HIV services in primary healthcare settings. Such a scale-up will require investigation into existing barriers that prevent healthcare workers from effectively providing those services to children. Furthermore, if the identified barriers are not well understood, designing context-specific and effective public health response programmes may prove difficult.

This study reviews the current literature pertaining to healthcare workers’ perspectives on the barriers to providing HIV services to children in the primary care setting in Sub-Saharan Africa.

English articles published between 2010 and April 2018 were searched in electronic databases including Sabinet, MEDLINE, PubMed, and Google Scholar. Key search words used during the search were “healthcare workers’ perspectives” and “barriers to providing HIV testing to children” OR “barriers to ART adherence AND children” and “barriers to HIV disclosure AND children.” Results. There are various barriers to provider-initiated counselling and testing (PICT) of children and disclosure of HIV status to children, including the following: lack of child-friendly infrastructure at clinics; lack of consensus on legal age of consent for both HIV testing and disclosure; healthcare worker unfamiliarity with HIV testing and disclosure guidelines; lack of training in child psychology; and confusion around the healthcare worker’s role, which most believed was only to provide health education and clinical services and to correct false information, but not to participate in disclosure. Additionally, primary caregivers were reported to be a barrier to care and treatment of children as they continue to refuse HIV testing for their children and delay disclosure.

Training, mentoring, and providing healthcare workers with guidelines on how to provide child-focused HIV care have the potential to address the majority of the barriers to the provision of child-friendly HIV services to children. However, the need to educate primary caregivers on the importance of testing children and disclosing to them is equally important.

Partial Text

Sub-Saharan Africa (SSA) is home to 12% of the global population, yet it bears 71% (6.8 million) of the global burden of HIV [1, 2]. Sub-Saharan Africa is also home to 90% of the global burden of HIV-infected children aged <15 years [3]. While SSA's 33% decline in new infections among children aged 0-14 years achieved in 2016 is commendable, the HIV incidence rates remain unacceptably high in this age group [4]. Reduction in new infections has been attributed to improved antiretroviral treatment (ART) and access thereto and scale-up of effective prevention of mother-to-child transmission (PMTCT) programmes dubbed a significant public health success [2, 5]. However, despite the substantial impact of PMTCT in reducing child morbidity and mortality, immense challenges remain in the delivery of HIV services for children in low resource settings. One of the biggest challenges is that many HIV-infected pregnant women still do not access antenatal care and therefore miss out on the health facility-based PMTCT interventions [6]. After pregnancy, the opportunities for early infant diagnosis (EID) of HIV-exposed children are limited, and many children remain undiagnosed in their infancy. They often only present after they have developed advanced AIDS-defining illnesses, resulting in poor prognosis even after being given ART [6]. What are the healthcare worker's perspectives on barriers which prevent them from providing quality HIV testing and adherence and disclosure services to children in Sub-Saharan Africa? The systematic review process followed these four steps: (i) literature search, (ii) relevance screening, (iii) quality assessment and data extraction, and (iv) data analysis and summation. The selection of papers for inclusion in this systematic review involved a three-step process as follows. This literature review was part of a larger doctoral study approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) (Ref. No. BE298/18) and the KwaZulu-Natal Department of Health (Ref. No. KZ_201809_011). This study reviewed healthcare workers' perspectives on the barriers preventing them from providing quality HIV testing, adherence, and disclosure services to children in Sub-Saharan Africa. Child-centred approaches should be adopted by healthcare providers to ensure that children receive holistic and age-appropriate care. Developing formal guidelines, training and mentoring healthcare workers on these child-focused approaches, developing child-friendly job aides, and creating child-friendly areas have a potential to marginally improve the quality of HIV services provided to children in low resource settings. This will, in turn, push Sub-Saharan Africa closer to achieving its 90-90-90 goals.   Source:


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