Exploring Facilitators and Barriers to Participation of HIV-Exposed and HIV-Infected Children in Care and Treatment Services in Two Provinces in Mozambique

Overview

Despite improvements in HIV pediatric care and treatment programs in Mozambique, engagement and retention of HIV-exposed and HIV-infected children in these services remain challenging. To explore the reasons behind these challenges, EGPAF conducted a qualitative study in August 2011 – January 2012 to identify barriers to HIV testing, enrollment into care, and follow-up services for HIV-exposed children in Mozambique.

Four participant groups―parents/caregivers with an HIV-exposed or infected child, grandmothers, healthcare professionals providing pediatric HIV services, and community leaders―were recruited from seven health facilities and surrounding communities in Maputo City, Maputo Province, and Cabo Delgado Province to participate in this qualitative study. Interviews and focus group discussions were conducted with these groups, and a resource inventory of pediatric services at these facilities was undertaken. Transcripts were transcribed and translated into Portuguese (for interviews conducted in local languages), and qualitative data was coded and analyzed.

Some of the most frequently reported barriers to engaging children in HIV services were alternative care-seeking due to perceptions of traditional or spiritual causes of disease, disbelief in positive test results, fear of death, and a general lack of willingness to attend facilities. In contrast, the facilitating factors most often cited by participant groups include children displaying visible illness, having hope for children’s future, perceptions that the facility was the appropriate place for HIV care and treatment, relationships with healthcare professionals, and institutional factors such as free services and medications and service integration. Further analysis will enhance our understanding of these factors, including the similarities and differences among participant groups and regions and any gaps or weaknesses in the provision of pediatric services at study facilities. Findings will result in recommendations for improving the engagement of children in HIV programs in Mozambique. Prior to this research, barriers and facilitators specific to engaging and maintaining Mozambican children in HIV care had not been systematically evaluated.

The abstract for this study was accepted to the 4th International Workshop on HIV Pediatrics in Washington, D.C. in July 2012. A manuscript to be submitted to a peer-reviewed journal is also being prepared.