A variety of individual and collective factors contribute to the success or failure of HIV treatment among children and adolescents in Senegal, Dr. Bernard Tavern of the University of Montpellier and colleagues report in the following paper: Social science and medicine. Structural factors include geographic accessibility to health care, universal health insurance, and availability of psychosocial support. Social factors include the child’s age, family relationships, and social representations of HIV. These all influence treatment adherence and, in combination with biological factors such as nutrition and tolerance, determine the effectiveness of antiretroviral treatment.
Although AIDS-related mortality rates have declined significantly in recent decades, only a quarter of the 800,000 children living with HIV in West and Central Africa are tested and treated for HIV. Only. Treatment failure rates are higher for children in rural areas.
The researchers used a variety of medical anthropology methods, including interviews, observations, and case studies. The team collected data during three-week visits to 15 medical facilities from 2020 to 2021. This includes 11 rural health centers and 4 urban community hospitals in 11 of his 14 regions in Senegal.
The facility cared for 350 children. There were an average of 41 people in local hospitals and 18 people in health centers. Only 65 children had viral load measurements, 29 girls and 36 boys, with an average age of 12 years. The majority of the group had lost at least one of their biological parents (70%), and some children had lost both biological parents (15%). Treatment was successful in 27 of the children, but treatment failed in the remaining 38 of her children.
The team interviewed 37 children and adolescents (9 to 20 years old), 63 parents or guardians, and 47 health care workers. Most of the interviews were conducted using the local language. Interviews were also conducted with local and national health services, international organizations and non-governmental organizations involved in pediatric health care.
Interviews explored the history of HIV within the family, including experiences with HIV, treatment, and care mechanisms. The researchers observed the functioning of health care facilities and the interactions between health care workers and families during consultations.
result
All sites were influenced by ubiquitous structural factors.
- Availability of pediatric antiretrovirals is limited
- “Treatment anxiety” in the form of drug out-of-stocks that necessitates changes in prescription plans or parents having to go to other medical facilities
- Limited availability of viral load measurements delays diagnosis of treatment failure
- Inefficient health insurance systems leave families burdened with high costs
- Some people give up on treatment due to geographical distance and transportation costs.
- Lack of knowledge or challenges in applying knowledge among some healthcare providers
- Reluctance to discuss sexual health with adolescents
- Reduced peer support provided due to funding cuts
Researchers were unable to pinpoint where better treatment would mean improved treatment success rates because they lacked measurements of viral load. However, they believe they have observed a configuration that creates an environment for successful treatment. This combination has resulted in “true everyday resilience” that allows clinic teams to adapt to the various constraints of the healthcare system. It especially depends on team dynamics.
- A stable team of educators, social workers, and nurses who are familiar to patients. This is important because many clinical staff balance multiple priorities (HIV, malaria, tuberculosis, sexual health, vaccinations) and frequently move to new locations. This creates a gap in the availability of doctors to perform consultations and renew prescriptions. Instead, children attend appointments for several months, supervised by nurses, social workers, and sometimes fellow educators.
- The presence of fellow educators. They are usually the people with the longest longevity on the team. They bring local knowledge and often provide continuity of care for children.
- Excellent leadership and efficient staff team dynamics.
- Free and accessible healthcare. Some facilities have been able to maintain free services, while others only offer free antiretrovirals and viral load testing.
- Community-based organizations that can organize their own activities rather than being completely dependent on government funding.
It was clear that familial factors played an important role. Children who were informed about their girlfriend’s HIV status and whose families supported her HIV care often experienced successful treatment. The benefit of being informed earlier and having time to learn how to live with HIV and manage treatment meant they were more responsible and had better adherence. They were also able to express their fears and address issues with their caregivers. Dedicated parents and guardians can be allies in successful treatment. The researchers cited the following case study as an example:
“When her mother died, Absa, aged three, was taken in by her grandmother. Since then, her maternal family has rallied around her. Her aunt, who lives in Germany, and her uncle, who lives in Dakar, provide food and care for her. Her guardian, her aunt Penda, takes her to the hospital. Her grandmother makes sure she takes her medicine. At the age of 15, With the consent of the hospital social worker who had prepared Absa in advance, her aunt and grandmother revealed her situation and reassured her. She is a young woman who is doing well in school.”
On the other hand, in families with little support, children have to cope in isolation and are more likely to experience treatment failure. Additionally, a child’s girlfriend’s experience of living with HIV may mirror that of a parent’s living with HIV. for example:
“Mamadou (4 years old) was diagnosed when he was 2 years old. He lives with his paternal parents. His mother, Maguet, has not accepted his seropositivity and takes medication irregularly. Mamadou’s last viral load indicated treatment failure. Magette admits that she often forgets to give her medication, especially when she travels.
Because life is constantly changing, the factors that can influence a child’s experience of living with HIV are also in flux. One example is adherence. Adherence is an important component of good treatment efficacy, but it can change frequently depending on a variety of factors. Adolescence is a time when conflicts with caregivers are more likely to surface, as well as a time when HIV is often mentioned, which may lead to improved medication adherence.
conclusion
The researchers believe their results can inform both theory and practice by revealing the reality of individual situations and how it interacts with structural and social factors. I am. Care teams can use the model to support children living with HIV through interventions that create favorable conditions for treatment success. Examples of this include taking steps to address structural factors, such as providing transportation, care, and food assistance to families. You can also be more understanding and supportive by naming HIV as early as possible, helping families cope with it, and providing psychosocial support.
National strategies cannot take regional characteristics into account, as challenges vary from location to location. However, working with local facilities and teams on specific interventions may reduce the risk of treatment failure.