Parental HIV care seeking behaviour and its impact on the quality of paediatrics HIV care

Abstract

Most HIV positive children (>90%) acquire HN infection from their parents (vertical transmissionjThis may occur in -utero, during delivery or through breastfeeding. This implies that the parents of HIV positive children are most likely HIV infected and may succumb to AIDS if no health intervention is made. The health and welfare of the parents of a HN infected child should be of major concern to the child health care provider, because of their direct impact on the quality of life of the HIV infected child in terms of nutrition, finances, security, housing, healthcare, education and emotional support. With the introduction of provider initiated counselling and testing for HN in the children's wards and clinics, child health care providers are often the first to diagnoseHN in a family and are often the only health care workers available to the parents before the parents seek treatment for themselves. Objectives This study sought to identify parents with children on antiretroviral treatment at Kenyatta National Hospital Comprehensive Care Centre (KNH CCC) who are untested or those who are HIV positive but are not on regular HIV care and follow up; identify factors that prevent them from embarking on HIV care and assess the impact of their HIV care seeking behaviour on the care of their children. Methods This was a descriptive cross sectional study employing both qualitative (focus group discussions and in depth interviews) and quantitative methods (questionnaires and medical records) to obtain data on recruited parents and their children. Results The biological parents of 191 children were interviewed in the quantitative phase of this study. Knowledge of their HIV status was high with 187 (97.9%) knowing theirHN serostatus and only 4 (2.1%) of the respondents being unaware of their HIV serostatus. Enrolment in HIV care was also high with 172 (92%) of the parents enrolled inHN care and only 14 (7.5%) of parents reporting not having enrolled inHN care. However 18 (20%) of the respondents' spouses (most of whom were fathers) were not enrolled in HIV care despite of their known HIV positive status. Most of the respondents 68 (39.5%) cited supportive counselling as a factor that encouraged them to get tested and embark on HIV care while 38 (22.1%) said that they embarked on HIV care when they noticed the health improvement of their children on HAART. Non enrolment in HIV care was associated with not knowing one's spouse's HIV status (p=0.05), being of higher economic status (p=0.017) and caregivers who were fathers (p=0.075). There was statistically no difference in the quality of HIV care in children by parental knowledge of their own HIV status and parental HIV care seeking behaviour. Conclusion Knowledge of HIV status and enrolment into HIV care is high among the parents of children on HAART in KNHCCC. The parents who were unaware of their HIV status were 4 (2.1%) while those who were aware of their HIV positive serostatus and were not enrolled in HIV care were 14 (7.5%). Denial and gender dynamics are the two major barriers to testing for HIV and enrolment in HIV care and follow up. There was no significant difference in the quality of paediatric HIV care by parental HIV care seeking behaviour.

Conclusion Knowledge of HIV status and enrolment into HIV care is high among the parents of children on HAART in KNHCCC. The parents who were unaware of their HIV status were 4 (2.1%) while those who were aware of their HIV positive serostatus and were not enrolled in HIV care were 14 (7.5%). Denial and gender dynamics are the two major barriers to testing for HIV and enrolment in HIV care and follow up. There was no significant difference in the quality of paediatric HIV care by parental HIV care seeking behaviour.