Linkage to long term care of newly diagnosed Hiv exposed and HIV infected children at Kenyatta national hospital

Abstract

Despite efforts to scale up provider initiated testing and counselling (PITC) and early infant diagnosis (EID) services, it is not known what proportion of newly diagnosed HIV infected and exposed children are successfully linked into long term care. The purpose of the study was to determine the proportion of newly diagnosed HIV exposed and infected children in K..l\ffi who .are successfully linked to long term care and to identify and describe the common barriers to HIV care after diagnosis. Methods This was a short longitudinal survey. We enrolled and followed up newly diagnosed HN exposed children and infected children referred for long term care from KNH. We verified linkage one week after the expected date of appointment as follows; by medical record for children referred to KNH CCC, Mbagathi district Hospital CCC and Lea Toto clinics and by telephone for those referred to other sites. Structured phone based questionnaires were used to evaluate barriers to care. Results We enrolled 195 children, 104 (53%) females and 91 (47%) males. Median age was 12 months (Interquartile range [IQR] of 5 to 21 months). One hundred and forty two children (73%) were confirmed HN infected and 53(27%) were of indeterminate status. Ninety eight children (50%) were successfully linked into long term HIV care while 87(45%) were not linked. Ten children (5%) were lost to follow up. The most common barrier to care was nondisclosure of the child's HIV status to spouse (32%); this was closely followed by lack of information on long term HIV care (12%), lack of money for transport (11%) and family disruptions following revelation of the child's HIV status (11%). Other barriers included caregiver indecision to start care (8%), unavailability due to ill health (5%) or commitment at work (2%), stigma (6%), maternal death (5%) and seeking care from faith based healers (5%) or traditional healers (2%). A few caregivers (3%) were unable to explain reasons for defaulting. Conclusion Only half of newly diagnosed HIV exposed and HIV infected children are successfully linked .•.. to long term care. The main barriers to care emanate from the family unit, stigma and inadequate counselling and support of caregivers of these children.