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Challenges faced by health workers in providing counselling services to HIV-positive children in Uganda: a
Joseph Rujumba1, Cissy L Mbasaalaki-Mwaka, Grace Ndeezi
1Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda. jrujumba@yahoo.com
Insights
Providing HIV counselling and testing for children in Uganda is challenging due to health worker skill gaps and system constraints. Improving paediatric HIV care requires targeted training and child-friendly services.
Area of Science:
- Public Health
- Paediatric Infectious Diseases
- Global Health
Background:
- HIV counselling and testing (HCT) for children presents significant challenges in HIV-endemic nations like Uganda.
- Health workers face numerous obstacles in delivering effective HCT services to paediatric populations.
Purpose of the Study:
- To explore the multifaceted challenges encountered by health workers in providing HCT services to children in Uganda.
- To identify barriers at both the individual health worker and healthcare system levels.
Main Methods:
- A descriptive study was conducted in Kampala and Kabarole districts, Uganda.
- Data were gathered through semi-structured interviews with health workers and key informant interviews with administrators.
- Qualitative data were analyzed thematically, and quantitative data were summarized using frequency tables.
Main Results:
- Children's difficulty in self-expression, fear, and dependence on adults complicated counselling.
- Caretakers' reluctance to disclose HIV status, inconsistency, and socio-economic factors posed additional challenges.
- Health workers cited a lack of counselling skills, knowledge gaps, heavy workloads, and inadequate support services.
Conclusions:
- Key challenges include knowledge gaps in paediatric HIV, insufficient counselling skills, and health system limitations.
- Enhanced training for health workers on child counselling, disclosure, and psychosocial support is crucial.
- Implementing child-friendly services, updated guidelines, and appropriate paediatric antiretroviral formulations are recommended to improve care.
Background:
The delivery of HIV counselling and testing services for children remains an uphill task for many health workers in HIV-endemic countries, including Uganda. We conducted a descriptive study to explore the challenges of providing HIV counselling and testing services to children in Uganda.
Methods:
A descriptive study was conducted in the districts of Kampala and Kabarole in Uganda. The data were collected using semi-structured individual interviews and focus group discussions with health workers who are involved in the care of HIV-positive children. Key informant interviews were conducted with the administrators of the 10 study healthcare institutions. Quantitative data were summarized using frequency tables, while qualitative data were analyzed using the content thematic approach.
Results:
Counselling children was reported to be a difficult exercise due to some children being unable to express themselves, being dependent on adults for their care, being fearful, and requiring more time to open up during counselling. This was compounded by some caretakers' unwillingness and difficulty to disclose the HIV status of their children. Other issues about the caretakers were: lack of consistency in caretakers; old age; sickness; and poverty. Health workers mentioned the following as some of the challenges they face in the delivery of HIV counselling and testing services for children: lack of counselling skills; failure to cope with the knowledge demand; difficulty to facilitate disclosure; heavy work load; and lack of other support services. Institutions were found to be constrained by limited space and lack of antiretrovirals for children.
Conclusions:
The major challenges in the delivery of paediatric HIV services were related to the knowledge gap in paediatric HIV and the lack of counselling skills, as well as health system-related constraints. There is a need to train health workers in child-counselling skills, especially in the issues of disclosure, sexuality and sexual abuse, as well as in addressing fears related to death and an uncertain future, in order to improve paediatric HIV care. Provision of child-friendly services, guidelines and antiretroviral formulations for children may provide a window of hope to improve HIV counselling and testing services for children.
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