Yeap A D, Hamilton R, Charalambous S, Dwadwa T, Churchyard G J, Geissler P W, Grant A D
London School of Hygiene and Tropical Medicine, UK.
AIDS Care. 2010 Sep;22(9):1101-7. doi: 10.1080/09540121003602218.
Despite antiretroviral therapy rollout in South Africa, fewer children than expected are accessing HIV care services. Our objectives were to describe barriers and facilitators of uptake of HIV care among children. Our study involved six private-sector clinics which provide HIV care free-of-charge in and around Gauteng province, South Africa. In-depth interviews were conducted in July 2008 with 21 caregivers of HIV-infected children attending these clinics, 21 clinic staff members and three lead members of staff from affiliated care centres. Many children were only tested for HIV after being recurrently unwell. The main facility-related barriers reported were long queues, negative staff attitudes, missed testing opportunities at healthcare facilities and provider difficulties with paediatric counselling and venesection. Caregivers reported lack of money for transport, food and treatments for opportunistic infections, poor access to welfare grants and lack of coordination amongst multiple caregivers. Misperceptions about HIV, maternal guilt and fear of negative repercussions from disclosure were common. Reported facilitators included measures implemented by clinics to help with transport, support from family and day-care centres/orphanages, and seeing children's health improve on treatment. Participants felt that better public knowledge about HIV would facilitate uptake. Poverty and the implications of children's HIV infection for their families underlie many of these factors. Some staff-related and practical issues may be addressed by improved training and simple measures employed at clinics. However, changing caregiver attitudes may require interventions at both individual and societal levels. Healthcare providers should actively promote HIV testing and care-seeking for children.
尽管南非已推行抗逆转录病毒疗法，但接受艾滋病毒护理服务的儿童数量低于预期。我们的目标是描述儿童接受艾滋病毒护理的障碍和促进因素。我们的研究涉及南非豪登省及其周边地区的六家提供免费艾滋病毒护理的私立诊所。2008年7月，我们对这些诊所中21名感染艾滋病毒儿童的护理人员、21名诊所工作人员以及附属护理中心的三名主要工作人员进行了深入访谈。许多儿童只是在反复生病后才接受艾滋病毒检测。报告的与设施相关的主要障碍包括长队、工作人员态度消极、在医疗机构错过检测机会以及医护人员在儿科咨询和静脉切开方面存在困难。护理人员报告称，缺乏支付交通、食品和机会性感染治疗的费用，难以获得福利补助金，以及多名护理人员之间缺乏协调。对艾滋病毒的误解、母亲的内疚感以及担心披露信息会带来负面影响很常见。报告的促进因素包括诊所采取的帮助解决交通问题的措施、来自家庭和日托中心/孤儿院的支持，以及看到儿童在接受治疗后健康状况有所改善。参与者认为，提高公众对艾滋病毒的认识将有助于增加接受护理的人数。贫困以及儿童感染艾滋病毒对其家庭的影响是这些因素中的许多因素的根源。一些与工作人员相关的实际问题可以通过改善培训和诊所采取的简单措施来解决。然而，改变护理人员的态度可能需要在个人和社会层面进行干预。医疗保健提供者应积极推广对儿童进行艾滋病毒检测和寻求护理。
