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From Transmission to Transition: Lessons Learnt from the Thai Paediatric Antiretroviral Programme

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Tulloch, Olivia, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Ananworanich, Jintanat, Chasombat, Sanchai, Kosalaraksa, Pope, Jirawattanapisal, Thidaporn, Lakonphon, Sudrak, Lumbiganon, Pagakrong and Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 (2014) 'From Transmission to Transition: Lessons Learnt from the Thai Paediatric Antiretroviral Programme'. PLoS ONE, Vol 9, Issue 6, e99061.

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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.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
WS Pediatrics > WS 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0099061
Depositing User: Faye Moody
Date Deposited: 20 Jun 2014 08:48
Last Modified: 17 Oct 2019 10:51
URI: https://archive.lstmed.ac.uk/id/eprint/3752

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