20th International AIDS Conference - Melbourne, Australia


THPE081 - Poster Exhibition

Trends in characteristics and factors for delayed enrollment of pediatrics in HIV care and treatment services in DSM, Tanzania

D. Sando

Management and Development for Health, Strategic Information, Dar es Salaam, Tanzania, United Republic of

Background: Few studies have described factors leading to late enrollment and time-based trends of children enrolling in HIV and AIDS care. We present findings of a study that explored factors affecting timely enrollment and trends in baseline characteristics of children enrolling into 26 public HIV care facilities.
Methods: We used data collected from all children enrolled in October 2004 to September 2011, and interviewed key informants both from districts and facilities. We used year of enrollment as the predictor, analyzed continuous variables using log-binomial regression and continuous variables using linear regression. P-values under 0.05 were considered significant. In qualitative, we used grounded theory to analyze thematically factors identified to hamper scale up of services.
Results: We enrolled a total of 6,579 children with median age of 5 years. Over the period of follow up, proportion of children presented with advanced stage (III or IV) rose from 35% to 58%. The median age at enrollment rose from 5 to 6 years (p < 0.0001), with the fraction of children under two decreasing from 35% to 29%, while the fraction of children over ten rose from 16% to 27%. About 49% of the children were male. The median Hemoglobin level rose from 9.1g/dl to 10.3g/dl (P < 0.0001).
Key bottlenecks identified included issues on inadequate coverage of Early Infant Diagnosis (EID) services, with only 64% of HIV exposed infants receiving the test, fragmentation of PMTCT, EID and HAART services within the same facilities and insufficient capacity of service providers in management of pediatric HIV.
Conclusions: Our study found that children are being enrolled in care and treatment services at an older age and with more advanced disease. Late enrollment is associated with issues pertaining to programmatic and health system factors. We recommend more efforts be focused in scaling up early HIV infant diagnosis.

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