Objective To compare the incidence of orphanhood among children <15years of age before and after implementing HIV care in Rakai, Uganda. Methods Annual household censuses and surveys were conducted on January 2001 to September 2009 in a community cohort, where HIV care including antiretroviral therapy (ART) started in June 2004. Data included parental survival of children aged 0-14years and HIV status from consenting adults aged 15-49years. The incidence of orphanhood was estimated as the number of new orphans divided by person-years, determined during three time periods: Pre-HIV care roll-out (January 2001-June 2003) 1-3years before the advent of HIV care in Rakai programme, HIV care transition from September 2003-May 2006, and the expanded HIV care period from August 2006-September 2009. Poisson regression was used to estimate incidence rate ratios (IRR) of orphanhood and 95% confidence intervals, and the Population attributable fraction (PAF) of incident orphanhood due to HIV+ parental status was estimated as pd*(RR-1)/RR. Results A total of 20823, 21770 and 23700 children aged 0-14years were censused at the three periods, respectively. The prevalence of orphanhood significantly declined; 17.2% during Pre-HIV care roll-out, 16.0% at HIV care transition and 12.6% at expanded HIV care period (P<0.0001). The incidence of orphanhood also declined significantly with increasing HIV care from 2.10/100person-years (py), 1.57/100py and 1.07/100py (P<0.0001). The largest declines were observed among children with HIV+ parent(s), 8.2/100pyr, 5.2/100pys and 3.4/100pyr. PAF also declined from 35.3% in the pre-HIV care to 27.6% in the expanded HIV care periods. Conclusion After the availability of ART, there was a decline in PAF of incident orphanhood due to parental HIV+ status, and in the incidence of orphanhood especially among children with HIV-infected parents.
- Antiretroviral therapy
- HIV care
- Population attribution fraction
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Infectious Diseases