Hydrodynamics: problems and paradoxes

Abstract

Background: Follow-up of HIV-exposed children for the delivery ofprevention of mother-to-child transmission services and for earlydiagnosis and treatment of HIV infection is critical to their survival.Despite efforts, uptake of postnatal care for these children remains lowin many sub-Saharan African countries.Methods: A qualitative study was conducted in three provinces inMozambique to identify motivators and barriers to improve uptake of andretention in HIV prevention, care and treatment services for HIV-exposedand HIV-infected children. Participant recommendations were alsogathered. Individual interviews (n = 79) and focus group discussions (n= 32) were conducted with parents/caregivers, grandmothers, communityleaders and health care workers. Using a socioecological framework, themain themes identified were organized into multiple spheres ofinfluence, specifically at the individual, interpersonal, institutional,community and policy levels.Results: Study participants reported factors such as seeking careoutside of the conventional health system and disbelief in test resultsas barriers to use of HIV services. Other key barriers included fear ofdisclosure at the interpersonal level and poor patient flow and longwaiting time at the institutional level. Key facilitators for accessingcare included having hope for children's future, symptomatic illness inchildren, and the belief that health facilities were the appropriateplaces to get care.Conclusions: The results suggest that individual-level factors arecritical drivers that influence the health-seeking behavior ofcaregivers of HIV-exposed and HIV-infected children in Mozambique. Notedstrategies are to provide more information and awareness on the benefitsof early pediatric testing and treatment with positive messages thatincorporate success stories, to reach more pregnant women andmother-child pairs postpartum, and to provide counseling during tracingvisits. Increasing uptake and retention may be achieved by improvingpatient flow at the institutional level at health facilities, byaddressing concerns with family decision makers, and by working withcommunity leaders to support the uptake of services for HIV-exposedchildren for essential preventive care.