The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5–18 years  

作　　者：Mathildah M Mokgatle Sphiwe Madiba 

机构地区：[1]Department of Biostatistics,School of Public Health,Sefako Makgatho Health Sciences University,P O Box 215,Medunsa,South Africa [2]Department of Environmental and Occupational Health,School of Public Health,Sefako Makgatho Health Sciences University,Medunsa,South Africa

出　　处：《Infectious Diseases of Poverty》2015年第1期153-164,152,共13页贫困所致传染病（英文）

基　　金：This study was funded by the University of Limpopo.The authors would also like to thank the field workers and all the caregivers who participated and shared their time and experiences with us.We also acknowledge the healthcare workers who supported the data collection process.

摘　　要：Background:Provider-initiated HIV testing and counseling(PITC)is offered as part of the normal standard of care to increase access to treatment for HIV-infected children.In practice,HIV diagnosis occurs in late childhood following recurrent and chronic infections.We investigated primary caregivers’reported reasons for seeking HIV testing for children aged 5–18 years,determined the orphan status of the children,and compared the clinical profile and disease burden of orphans and non-orphans.Methods:This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment(ART)from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province,South Africa.Results:The sample consisted of 406 primary caregivers:319(78.6%)brought the child to the health facility for HIV testing because of chronic and recurrent infections.Almost half(n=183,45.1%)of the children were maternal orphans,128(31.5%)were paternal orphans,and 73(39.9%)were double orphans.A univariate analysis showed that maternal orphans were significantly more likely to be older(OR=2.57,p=0.000,CI:1.71–3.84),diagnosed late(OR=2.48,p=0.009,CI:1.26–4.88),and to start ART later(OR=2.5,p=0.007,CI:1.28–4.89)than non-orphans.There was a high burden of infection among the children prior to HIV diagnosis;274(69.4%)presented with multiple infections.Multiple logistic regression showed that ART start age(aOR=1.19,p=0.000,CI:1.10–1.29)and time on ART(aOR=2.30,p=0.000,CI:1.45–3.64)were significantly associated with orphanhood status.Half(n=203,(50.2%)of the children were admitted to hospital prior to start of ART,and hospitalization was associated with multiple infections(OR=1.27,p=0.004,CI:1.07–1.51).Conclusions:The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children.The health of maternal orphans was more compromised than non-orphans.Routine PICT should be strengthened to increase community awareness a

关 键 词：Primary level of care HOSPITALIZATION Provider-initiated testing and counseling Perinatally infected olderchildren Burden of disease Orphanhood South Africa 

分 类 号：R51[医药卫生—内科学]