Healthcare Workers’ Perspectives on the Barriers to Providing HIV Services to Children in Sub-Saharan Africa

Table 2

A summary of the barriers to providing HIV testing, adherence, and disclosure services to children in Sub-Saharan Africa.

Themes	Key barriers	Studies identified
Healthcare worker-related barriers	(i) Healthcare workers lack formal training on child-friendly approaches to enable them to provide adequate HIV services to children	[7–17]
	(ii) Healthcare workers have inadequate knowledge and understanding around HIV and the law	[12, 13]
	(iii) Inadequate knowledge of providing children with HIV services	[14]
	(iv) Lack of child-friendly job aides to improve their communication with both children and their primary caregivers	[9, 11]
	(v) Inadequate buy-in by healthcare workers into provider-initiated counselling and testing (PICT) for children	[12, 16]
	(vi) Confusion on child and primary caregiver consent for HIV testing, counselling, and disclosure	[12, 13]
	(vii) Healthcare workers lack the confidence to provide HIV services to children as they are not trained	[9]
	(viii) Healthcare workers have concerns about the safety of providing provider-initiated counselling and testing (PICT) to children who are sometimes unaccompanied as it has legal implications	[9]
	(ix) Healthcare workers complained of facing time constraints when providing primary caregivers and their children with disclosure support	[8, 13]
Primary caregiver-related barriers	(i) Healthcare workers reported that stigma is still rife which prevents primary caregivers from disclosing to their children	[7, 8, 11, 13]
	(ii) Children do not pick up their own medication; instead, primary caregivers pick it up which makes it difficult for healthcare workers to effectively clinically monitor them	[17]
	(iii) Primary caregivers lack an understanding of the benefits of disclosure which makes them unwilling to agree to disclose to their children	[12, 13, 16]
System-related barriers	(i) No training courses for healthcare workers are available concerning the provision of child-focused HIV care	[12, 16]
	(ii) No recommendations and guidelines are available to guide healthcare workers concerning the provision of child-focused HIV services to children	[8, 12, 15]
	(iii) Staff shortages in facilities prevent healthcare workers from providing HIV services to children	[8]
	(iv) The Integrated Management of Childhood Illness (IMCI) programme does not provide adequate HIV information for healthcare workers to use when providing HIV support and care to children	[16]
	(v) The Integrated Management of Childhood Illness (IMCI) programme clinical stationery is a limitation to full service delivery as a recording of HIV suspects may expose healthcare workers to legal liability	[16]
	(vi) Healthcare workers cited the lack of child-friendly and palatable antiretroviral formulations as barriers to adherence	[17]
	(vii) Healthcare workers also cited HIV testing kits and kit stock-outs as barriers to testing children in primary healthcare settings	[9]
	(viii) Healthcare workers also cited the lack of child-friendly areas in health facilities as barriers to improving children’s healthcare experiences	[14]