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AIDS Research and Treatment
Volume 2012, Article ID 817506, 10 pages
Clinical Study

Barriers to Initiation of Pediatric HIV Treatment in Uganda: A Mixed-Method Study

1PharmAccess Foundation, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
2Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam Institute for Global Health and Development, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
3Joint Clinical Research Centre, Plot No. 101 Lubowa Hill, P.O. Box 10005, Kampala, Uganda
4Global Child Health Group, Emma Children’s Hospital, Academic Medical Center of the University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
5Joint Clinical Research Centre, Pallisa Road, Mbale, P.O. Box 10005, Kampala, Uganda
6Joint Clinical Research Centre, Kamwenge Road, Fort Portal, P.O. Box 10005, Kampala, Uganda
7Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands

Received 12 October 2011; Revised 28 November 2011; Accepted 29 November 2011

Academic Editor: Anthony Harries

Copyright © 2012 T. Sonia Boender et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, ), living without parents (OR 3.93, ), unemployment of the caregiver (OR 4.26, ), lack of perinatal HIV prophylaxis (OR 5.66, ), and high transportation costs to the clinic (OR 2.51, ). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers’ unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.