Incidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda: Alpha Network HIV Supplement F. E. Makumbi et al. Orphanhood before and after HIV care

Fredrick E. Makumbi, Gertrude Nakigozi, Joseph Sekasanvu, Ivan Lukabwe, Joseph Kagaayi, Tom Lutalo, Maria Wawer, Ronald Gray

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e94-e102
JournalTropical Medicine and International Health
Volume17
Issue number8
DOIs
StatePublished - Aug 2012

Keywords

  • Antiretroviral therapy
  • HIV care
  • Incidence
  • Orphanhood
  • Population attribution fraction
  • Uganda

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Fingerprint

Dive into the research topics of 'Incidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda: Alpha Network HIV Supplement F. E. Makumbi et al. Orphanhood before and after HIV care'. Together they form a unique fingerprint.

Cite this