Date Published: March 12, 2018
Author(s): Margaret Williams, Dalena R.M. van Rooyen, Esmeralda J. Ricks.
The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children.
To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics.
The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa.
The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied.
Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level.
Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.
Globally, an estimated 35 million people were living with human immunodeficiency virus (HIV) in 2013; 3.2 million of the 35 million are children under the age of 15 years, over 90% of whom live in sub-Saharan Africa. In the same area, 6000 people were newly infected with HIV and approximately 4200 people died from AIDS, mostly because of inadequate access to antiretroviral (ART) services.2 Globally, investments in the HIV and AIDS response have generated positive results. Improved care and treatment options have increased the lifespan of people living with HIV, provided they can access such treatment.3 In all low- and middle-income countries, only 23% of children (aged 0–14 years) living with HIV in 2013 received ART, compared to 37% of adults living with HIV. Child mortality statistics indicate that by the end of 2015, almost 6 million children will have died before their fifth birthday – most from preventable causes.3
This study aimed to provide an understanding of challenges for HCPs in providing ART for children attending PHC clinics. This was done by exploring and describing the experiences of HCPs related to their challenges regarding the provision of ART for HIV-positive children at PHC clinics in NMB Health District.
The following main theme and sub-themes, related to the challenges experienced by the HCPs who were interviewed, are presented below:
HIV infection in HIV-positive children is a life-threatening disease. Without treatment, and specifically adherence to treatment, HIV-positive children in resource-poor settings have a 45% – 59% mortality rate by 2 years of age.35 ART for HIV-positive children is an evolving discipline, which should be specialised owing to the intricacies in working comprehensively with children of all ages who require treatment, care and support for one of the most complex diseases of our time. Up until now, the focus has been on the provision of medications and management of physical disease. The rapid progression of paediatric HIV disease has highlighted the need to expand treatment, for this cadre of patients, to date with limited success. Certainly, better performance is required from health care systems in general, especially in the Eastern Cape, South Africa.
It is recommended that all interdisciplinary team members receive updates in knowledge and skills in order to effectively optimise comprehensive treatment, care and support for HIV-positive children requiring ART at PHC clinics.43 Particular emphasis should be placed upon committing to quality health care outcomes for all patients.
HIV disease in children is a chronic, manageable condition in all countries with access to ART. It is time to clarify treatment for HIV-positive children and assist HCPs in South Africa to become knowledgeable and confident in treating younger patients. Judging from the responses of the participants in this study, the workforce at the PHC level in NMB needs to be strengthened to provide sustainable care and equitable access, a task requiring competent management with leadership skills.