Bajaria Shraddha, Exavery Amon, Toroka Noreen, Abdul Ramadhani
Ifakara Health Institute, Dar es Salaam, Tanzania.
Pact, Dar es Salaam, Tanzania.
BMC Public Health. 2021 Feb 16;21(1):365. doi: 10.1186/s12889-021-10415-6.
Despite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers' vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers' disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania.
Data for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0-19 years were collected during the project's quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers.
The majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers' education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households.
These results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.
尽管在坦桑尼亚为扩大咨询与检测服务以及护理与治疗诊所（CTCs）做出了广泛努力，但诊断点与CTCs之间的联系仍然很低。研究关注了诸如缺乏训练有素的卫生服务提供者、转诊系统不完善、经济成本或到卫生设施的距离等障碍，但较少评估照顾者的脆弱性（如残疾）与他们所照顾的孤儿及弱势儿童（OVCs）与卫生设施联系之间的关联。本研究描述了照顾者残疾的程度，并评估其与坦桑尼亚感染艾滋病毒/艾滋病的OVCs获得成功护理联系之间的关系。
本分析的数据来自美国国际开发署在坦桑尼亚79个委员会开展的“Kizazi Kipya”项目。在该项目每季度的常规数据收集期间（2017年10月至2018年9月），收集了0至19岁OVCs的艾滋病毒风险、服务使用情况和抗逆转录病毒治疗依从性数据。在项目受益人的筛查和登记过程中收集了照顾者的特征。使用广义估计方程模型分析了与14538名艾滋病毒呈阳性的OVCs与CTCs建立联系的相关因素，这些OVCs由11834名照顾者照料。
大多数照顾者（70%）为女性，完成了小学教育（67%），54%已婚或同居。在所有OVCs中，3%与残疾照顾者生活在一起；其中89%为身体残疾，11%为精神残疾。与残疾照顾者生活在一起的OVCs获得护理联系的可能性较小（比值比0.76，95%置信区间0.58，0.99）。与OVCs获得护理联系呈正相关的因素包括照顾者的高教育水平（比值比1.99，95%置信区间1.51，2.63）以及与艾滋病毒呈阳性的照顾者生活在一起的OVCs（比值比1.25，95%置信区间1.12，1.41）。与低社会经济地位家庭中的OVCs相比，生活在高社会经济地位家庭中的OVCs获得护理联系的可能性较小（比值比0.76，95%置信区间0.67，0.86）。
这些结果表明，与残疾照顾者生活在一起的艾滋病毒呈阳性的OVCs获得护理联系的情况较差。研究结果强调需要关注以残疾为主导的家庭，以促进包容性并改善获得艾滋病毒服务（的机会）。
