ArticleBMC infectious diseases2009
Barriers to the care of HIV-infected children in rural Zambia: a cross-sectional analysis.
Article in BMC infectious diseases, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
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Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- Incidence and Prevalence of Opportunistic and Other Infections and the Impact of Antiretroviral Therapy Among HIV-infected Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Pooled it
- Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review.AIDS and behavior · 2014Pooled it
- Article
- Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008-2018: a cohort study.BMC pediatrics · 2021Article
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- 'They care rudely!': resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia.BMJ global health · 2018Article
- Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe.Journal of the International AIDS Society · 2017Article
- Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.Health research policy and systems · 2017Review
- Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study.BMC pediatrics · 2017Observational
- Measles and Rubella Seroprevalence Among HIV-infected and Uninfected Zambian Youth.The Pediatric infectious disease journal · 2017Article
- Retention in Care and Patient-Reported Reasons for Undocumented Transfer or Stopping Care Among HIV-Infected Patients on Antiretroviral Therapy in Eastern Africa: Application of a Sampling-Based Approach.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- Non-Uptake of HIV Testing in Children at Risk in Two Urban and Rural Settings in Zambia: A Mixed-Methods Study.PloS one · 2016Article
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- Scaling up paediatric HIV care with an integrated, family-centred approach: an observational case study from Uganda.PloS one · 2013Observational
- Cost-effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV-1 infections in rural Zambia: a modeling study.PloS one · 2013Article
- "It's my secret": barriers to paediatric HIV treatment in a poor rural South African setting.AIDS care · 2013Article
- Mortality and loss to programme before antiretroviral therapy among HIV-infected children eligible for treatment in The Gambia, West Africa.AIDS research and therapy · 2012Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundSuccessful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia.
methodsCross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected from caretakers and medical records.
results192 HIV-infected children were enrolled from September 2007 through September 2008, 28% of whom were receiving antiretroviral therapy (ART) at enrollment. The median age was 3.3 years for children not receiving ART (IQR 1.8, 6.7) and 4.5 years for children receiving ART (IQR 2.7, 8.6). 91% travelled more than one hour to the clinic and 26% travelled more than 5 hours. Most participants (73%) reported difficulties accessing the clinic, including insufficient money (60%), lack of transportation (54%) and roads in poor condition (32%). The 54 children who were receiving ART at study enrollment had been on ART a median of 8.6 months (IQR: 2.7, 19.5). The median percentage of CD4+ T cells was 12.4 (IQR: 9.2, 18.6) at the start of ART, and increased to 28.6 (IQR: 23.5, 36.1) at the initial study visit. However, the proportion of children who were underweight decreased only slightly, from 70% at initiation of ART to 61% at the initial study visit.
conclusionHIV-infected children in rural southern Zambia have long travel times to access care and may have poorer weight gain on ART than children in urban areas. Despite these barriers, these children had a substantial rise in CD4+ T cell counts in the first year of ART although longer follow-up may indicate these gains are not sustained.
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