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PLoS One. 2014 Jun 3;9(6):e99061. doi: 10.1371/journal.pone.0099061. eCollection 2014.

From transmission to transition: lessons learnt from the Thai paediatric antiretroviral programme.

Author information

1
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
2
SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
3
Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
4
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
5
SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.

Abstract

BACKGROUND:

The Thai HIV programme is a leader in the public health approach to HIV treatment. Starting at transmission of HIV and ending with transition to adult services this paper assesses the paediatric HIV treatment continuum from three perspectives: service-user, provider and policy maker, to understand what works well and why.

METHODS:

A qualitative research design was used to assess and triangulate the stakeholder perspectives. Semi-structured interviews were conducted with ART service-users (n = 35), policy actors (n = 20); telephone interviews with prior caregivers of orphans (n = 10); and three focus group discussions with service-providers (hospital staff and volunteers) from a district, provincial and a university hospital.

FINDINGS:

Children accessing HIV care were often orphaned, cared for by elderly relatives and experiencing multiple vulnerabilities. Services were divided into three stages, 1. Diagnosis and linkage: Despite strong policies there were supply and demand-side gaps in the prevention of mother-to-child transmission 'cascade' preventing early diagnosis and/or treatment. 2. Maintenance on ART - Children did well on treatment; caregivers took adherence seriously and valued the quality of services. Drug resistance, adherence and psychosocial issues were important concerns from all perspectives. 3. Adolescents and transition: Adolescent service-users faced greater complexity in their physical and emotional lives for which providers lacked skills; transition from the security of paediatric clinic was a daunting prospect. Dedicated healthcare providers felt they struggled to deliver services that met service-users' diverse needs at all stages. Child- and adolescent-specific elements of HIV policy were considered low priority.

CONCLUSIONS:

Using the notion of the continuum of care a number of strengths and weaknesses were identified. Features of paediatric services need to evolve alongside the changing needs of service users. Peer-support volunteers have potential to add continuity and support at all stages. It is critical that adolescents receive targeted support, particularly during transition to adult services.

PMID:
24893160
PMCID:
PMC4043947
DOI:
10.1371/journal.pone.0099061
[Indexed for MEDLINE]
Free PMC Article

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