Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"'If you build it, will they come?' An investigation into barriers to pediatric HIV treatment and care in Kenya"
Katie Schenk, Karusa Kiragu, Julie Murugi, and Avina Sarna

Issues
Government-run clinics providing pediatric HIV testing and treatment in Kenya report low uptake, even when antiretroviral drugs are supplied free of charge. This diagnostic study explored barriers to demand for pediatric antiretroviral treatment at three clinic sites in Kenya, in order to derive lessons for interventions.

Description
Researchers investigated barriers to pediatric HIV treatment and care, using quantitative and qualitative approaches (surveys, focus group discussions, in-depth interviews) among male and female community members and health workers.

Lessons learned
Despite availability of free antiretroviral drugs from the Kenyan government, additional client costs, including transport and consultation fees, remain major obstacles, resulting in postponing or avoiding medical care for children suspected to be HIV-positive. Additional concerns about ongoing costs, especially food, further constrain caregivers. Knowledge of pediatric HIV, including transmission modes, indications for testing, and local treatment options were limited, and misconceptions prevailed: Barely half of community-based survey respondents could name three indications for pediatric HIV testing. Attitudinal barriers to care include fatalistic beliefs and a reliance on traditional healers. Stigma manifests in multiple ways to reduce access to care: In particular, because child testing represents a "window" into the HIV status of parents, especially mothers. Caregiver treatment literacy is poor, and treatment delays reflect a strong perceived association between ARVs and mortality. Caregivers of children on treatment report struggling with adherence.

Next steps
Even when a supply of pediatric ART is relatively accessible, there remain many demand-side barriers responsible for low uptake. Equipping facilities to provide pediatric HIV services and supplying free or low-cost drugs represent only the first steps in a complex, difficult process for children and caregivers. HIV-positive children are not simply smaller versions of their adult counterparts: Their unique, rapidly changing needs must be recognized. Results indicate starting points for interventions in the community and at facilities to increase knowledge and reduce stigma.

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