Health Behavior, Indiana University, Bloomington, USA.
SAHARA J. 2012;9(1):20-9. doi: 10.1080/17290376.2012.665255.
With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.
Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIV-infected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed.
Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care.
The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.
为了减少撒哈拉以南非洲国家艾滋病毒临床护理项目中儿童失访（LTFU）的情况，我们试图了解与肯尼亚西部照顾艾滋病毒感染和暴露儿童的照顾者行为相关的个人和社会文化因素。
2010 年 5 月至 8 月，对 26 名有目的抽样的照顾者进行了深入访谈，这些照顾者照顾着艾滋病毒感染（7 名）、艾滋病毒暴露（17 名）和艾滋病毒未知状态（2 名）的儿童，他们都被记录为从城市和农村艾滋病毒护理诊所中失访的儿童。所有的访谈对象都是女性，其中大多数（77%）是亲生父母。访谈内容被录音、转录和内容分析。
对这些女性的看法的主题内容分析显示，她们决定定期带孩子去接受艾滋病毒护理涉及多个层面的因素，包括：（1）个人层面：交通成本、食物供应、因工作承诺而产生的时间限制、母亲和孩子的艾滋病毒状况披露、孩子健康的感知和宗教信仰；（2）人际层面：不支持的男性伴侣、家庭的耻辱感和家庭冲突；（3）社区层面：文化规范、社区动态的变化和感知的耻辱感；（4）卫生保健系统层面：诊所位置、缺乏以患者为中心的护理、诊所延迟和不同的预约时间表（母亲和孩子）。此外，这些不同层面的因素相互作用，相互影响，说明了女性在带孩子接受艾滋病毒护理方面所面临的挑战。
这些女性照顾者对儿童继续接受艾滋病毒护理的看法背后的因素的复杂性和相互关联性表明，减少儿科 LTFU 的干预措施需要全面和解决多个社会生态层面的问题。建议采用以患者为中心的护理，将以家庭为中心的方法融入艾滋病毒儿科护理中。
