Pediatric HIV treatment, care and support services at health center levels in Ethiopia

Abstract

Background: Ethiopia is one of the countries hit hard by the HIV epidemic. There is low enrollment rate to care & treatment among HIV patients in general and pediatric HIV cases in particular. Decentralization to primary health care (PHC) with task shifting to mid-level health workers has been the main strategy used to improve access to pediatric HIV care and treatment. This study attempts to compare the knowledge and skill of health care providers at PHC level and the enrollment rate of pediatrics HIV infected and HIV exposed infants and overall quality of care at the supported and non-supported health centers. The support provided was capacity building of health care providers through training and intensive mentoring.
Methods: An analytic retrospective cohort study was conducted on 117 health centers in Oromia, Tigrai, Amhara and Southern nations and nationalities and peoples’ (SNNPR) regions. Two categories of study population were compared:, the health centers & the health care providers in ’the supported health centers’ with the health centers & the health care providers in ‘non-supported health centers’. Pretested data collection tool was used to collect data from both categories of study population, specifically the health care providers and from the health centers national HIV/ART registers.
Results : A total of 117 health care providers were assessed, 50.4% were females, their mean age was 30.32 (±6.24) with range between 22 and 50 yrs.; 62.4% were married; 68.4% were diploma nurses, 23.9% were health officers and the rest 7.7% were BSC(degree) nurses.
Knowledge and skills on clinical examination and diagnosis was found to be ‘good' (≥70%) in the supported health centers (86.1%) compared to the non-supported (50%) with RR (95%CI) = 1.72(1.23, 2.41). Similarly skill in clinical laboratory, Cotrimoxazole and ART drug prescription, ART patient follow-up for toxicity and failure; HIV Exposed infant follow up and diagnosis and keeping good medical record was found to be better in the supported than non-supported ones and the difference was statistically significant. A paired sample T- test showed statistically significant result with mean increment of 20.61 in the enrollment of new pediatrics patients on HIV care and mean increment of 13.93 of those enrolled on ART care in the supported health centers between the two years period.
Conclusion: Over all on most of the parameters measured the supported clinics showed better quality of care. Moreover, this study has shown that middle level health workers can manage pediatrics patients effectively at PHC setting if provided with technical support. Data from this study also identified gaps and weaknesses that need to be addressed but also reviewed strengths in the current approach.