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General practice and the care of children with HIV infection: 6 month prospective interview study
1Department of Epidemiology and Public Health, Imperial College School of Medicine, London W2 1PG. m.boulton@ic.ac.uk
Insights
Parents of children with HIV primarily use hospital teams for care, with general practitioners (GPs) mainly handling routine prescriptions. Addressing parental concerns about GP competence and confidentiality is key to expanding the GP role in pediatric HIV management.
Area of Science:
- Pediatric Infectious Diseases
- Primary Care Medicine
- Public Health
Background:
- Children with HIV infection require ongoing medical care, often involving specialized pediatric teams.
- The role of primary care physicians, specifically general practitioners (GPs), in managing these children's health needs is not fully understood.
- Parental perceptions significantly influence healthcare-seeking behaviors and the utilization of primary care services.
Purpose of the Study:
- To investigate the utilization patterns of primary care services by children living with HIV.
- To explore parental attitudes towards the involvement of general practitioners in the care of their HIV-infected children.
- To identify barriers and facilitators influencing the use of general practice for pediatric HIV care.
Main Methods:
- A 6-month prospective study combining quantitative and qualitative data collection.
- Quantitative analysis of parent-maintained "contact diaries" to track primary care visits.
- Qualitative analysis through face-to-face interviews with parents of children with HIV.
Main Results:
- Twenty-four families participated, with most mothers being of Black African origin.
- Children with symptomatic HIV infection had more frequent GP visits (7.5/year) than those with AIDS (5.8/year).
- Parents viewed hospital-based pediatric HIV teams as their primary care source, citing parental anxiety, perceived GP incompetence, and confidentiality concerns as barriers to using general practice.
Conclusions:
- Parents of children with HIV predominantly rely on specialist pediatric HIV teams for medical care.
- General practice is primarily utilized for routine prescription management.
- Enhancing the GP's role requires collaboration with specialist providers and addressing parental concerns regarding competence and confidentiality.
Objectives:
To describe the use of primary care services by children infected with HIV and to explore the attitudes of their parents to the role of general practitioners in their children's care.
Design:
A 6 month prospective study. Quantitative analysis of "contact diaries" kept by parents; qualitative analysis of face to face interviews with parents.
Participants:
Parents of children receiving care at a regional referral centre in London.
Results:
Twenty four families (80% response rate) were recruited to the study. In 19 families the mother was black African. Half the children had been diagnosed with symptomatic HIV infection, half with AIDS. All the children were registered with a general practitioner who knew of the child's HIV infection. In five families there had initially been tensions in their relationship with their general practitioner but by the time of the study all but one family had established at least an "acceptable" relationship. Children with symptomatic HIV infection saw their general practitioner a mean of 7.5 times per patient year; for children with AIDS the figure was 5.8. Parents regarded the paediatric HIV team at the hospital as their primary source of medical care. Three factors constrained their use of general practice: their own anxieties about distinguishing "normal" symptoms from those related to HIV infection; their view that their general practitioner did not feel competent to treat HIV infected children; and their concerns about maintaining confidentiality in the surgery.
Conclusions:
Parents remain oriented towards the paediatric HIV team as their primary source of medical care and use general practice largely for routine prescriptions for their children. Any further development of the general practitioner's role will need to build on existing relationships with specialist providers and take account of parents' concerns.