Scaling-up access to antiretroviral therapy for children: A cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia

Janneke H. Van Dijk, William J Moss, Francis Hamangaba, Bornface Munsanje, Catherine Sutcliffe

Research output: Contribution to journalArticle

Abstract

Background: Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia. Methods: Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility. Results: Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ) and CD4+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4+ T-cell percentages. Conclusions: HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas.

Original languageEnglish (US)
Article numbere104884
JournalPLoS One
Volume9
Issue number8
DOIs
StatePublished - Aug 14 2014

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Mobile Health Units
Zambia
cohort studies
outreach
Cohort Studies
HIV
therapeutics
T-cells
Travel time
Therapeutics
Child Care
travel
Health care
public transportation
Rural Health Services
rural health
T-lymphocytes
T-Lymphocytes
Weights and Measures
Quality of service

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Scaling-up access to antiretroviral therapy for children : A cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia. / Van Dijk, Janneke H.; Moss, William J; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine.

In: PLoS One, Vol. 9, No. 8, e104884, 14.08.2014.

Research output: Contribution to journalArticle

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