Health care for children and adolescents with HIV: a comparison of services

a cross-sectional study was conducted with 71 family members and caregivers, using the children's version of the Primary Care Assessment Tool (PCATool-Brazil). The Mann-Whitney or Student's t-test and Pearson's chi-square or Fisher's exact test were used for the analysis.

Results:

primary care services and, predominantly, specialized HIV services, were identified as the regular health care sources. There were no significant differences in quality, since their scores were close to the ideal level.

Conclusion:

the attributes of these services need to be improved, which would entail reformulating their structural and performance aspects. In addition, it is imperative to recognize primary health care as an integral place for promoting the health of children and adolescents with HIV.

Descriptors:
Child Health; Adolescent Health; Primary Health Care; Health Services Assessment; HIV

Variables	Total (N = 71)		Specialized service (n = 56)		Primary Health Care (n = 15)		P value
Variables	n	%	n	%	n	%
Sociodemographic characteristics
Age of child/adolescent							<0.001^† † Fisher’s exact test.
Up to 12 years old	35	49.0	35	62.5	0	0.0
13 to 19 years old	36	51.0	21	37.5	15	100.0
City of origin							0.079^† † Fisher’s exact test.
Santa Maria	35	49.0	31	55.0	4	27.0
Other	36	51.0	25	45.0	11	73.0
Main caregiver							0.549^* * Pearson’s Chi-square test;
Mother	38	54.0	31	55.0	7	47.0
Other	33	46.0	25	45.0	8	53.0
Income (n = 69)							0.575^* * Pearson’s Chi-square test;
Up to 1,000 BRL	37	54.0	28	52.0	9	60.0
Over 1,000 BRL	32	46.0	26	48.0	6	40.0
Years of education of family member/caregiver							0.008^† † Fisher’s exact test.
Up to 6 years	41	58.0	37	66.0	4	27.0
Over 6 years	30	42.0	19	34.0	11	73.0
Clinical characteristics
How the child/adolescent contracted HIV							1.000^† † Fisher’s exact test.
Vertical transmission	64	90.0	50	89.0	14	93.0
Other	7	10.0	6	11.0	1	7.0
Time since diagnosis							0.009^† † Fisher’s exact test.
Up to 8.5 years	36	51.0	33	59.0	3	20.0
Over 8.5 years	35	49.0	23	41.0	12	80.0
Child/adolescent undergoing drug treatment							0.006^† † Fisher’s exact test.
No	5	7.0	1	2.0	4	27.0
Yes	66	93.0	55	98.0	11	73.0
Health service use characteristics
Knows health service closest to home							1.000^† † Fisher’s exact test.
No	4	6.0	3	5.0	1	7.0
Yes	67	94.0	53	95.0	14	93.0
Type of service closest to home (N = 66)							1.000^† † Fisher’s exact test.
PHC	63	95.0	48	94.0	15	100.0
Other	3	5.0	3	6.0	0	0.0
Goes to the service closest to home							0.002^† † Fisher’s exact test.
No	40	56.0	37	66.0	3	20.0
Yes	31	44.0	19	34.0	12	70.0

Attributes	Scores (0-10)
	Specialized service (n = 56)					Primary Health Care (n = 15)					P value^ Mann-Whitney test or Student’s t-test; SD = Standard deviation.
	Mean	SD	Median	Minimum	Maximum	Mean	SD	Median	Minimum	Maximum
Strength of affiliation^† † Asymmetric distribution;	8.15	2.10	10.00	3	10	8.00	2.10	6.67	3	10	0.763
First contact access – use^† † Asymmetric distribution;	8.41	2.59	10.00	0	10	9.03	1.24	10.00	6	10	0.834
First contact access – accessibility^† † Asymmetric distribution;	7.19	2.03	7.78	1	10	7.70	1.94	7.78	4	10	0.445
Longitudinality^* * Normal distribution;	8.02	1.12	8.18	5	10	7.67	1.93	7.88	2	10	0.750
Coordination – care integration^† † Asymmetric distribution;	8.09	2.43	9.33	0	10	8.16	2.32	9.33	4	10	0.978
Coordination – information system^† † Asymmetric distribution;	7.71	2.17	7.78	2	10	7.18	2.48	7.78	2	10	0.476
Comprehensiveness – services available^* * Normal distribution;	7.14	1.63	7.41	3	10	6.94	1.67	6.85	3	10	0.872
Comprehensiveness – services provided^† † Asymmetric distribution;	6.57	3.49	7.67	0	10	6.42	4.04	8.33	0	10	0.958
Family centeredness^† † Asymmetric distribution;	5.21	2.93	5.28	0	10	4.48	3.54	4.44	0	10	0.449
Community orientation^† † Asymmetric distribution;	2.53	3.18	1.67	0	10	1.92	3.33	0.00	0	10	0.310
Essential score^* * Normal distribution;	7.02	1.43	7.22	4	9	6.93	1.63	6.45	4	9	0.459
Derivative score^† † Asymmetric distribution;	3.67	2.37	3.33	0	10	3.07	3.04	2.22	0	10	0.178
Overall score^* * Normal distribution;	6.43	1.34	6.49	3	8	6.13	1.61	5.53	3	8	0.341

	PCATool-Brazil
Variables	Specialized service (n = 56)					Primary Health Care Service (n = 15)
	High overall score (≥ 6.6)		Low overall score (< 6.6)		P value	High overall score (≥ 6.6)		Low overall score (< 6.6)		P value
	n	%	n	%		n	%	n	%
Age of child/adolescent					0.094^* * Pearson’s Chi-square test;					-
Up to 12 years old	12	50.0	23	72.0		-	-	-	-
13 to 19 years old	12	50.0	9	28.0		5	100.0	10	100.0
City of origin					0.351^* * Pearson’s Chi-square test;					0.230^† † Fisher’s exact test.
Santa Maria	15	62.5	16	50.0		0	0.0	4	40.0
Other	9	37.5	16	50.0		5	100.0	6	60.0
How HIV was contracted					1.000^† † Fisher’s exact test.					0.333^† † Fisher’s exact test.
Vertical transmission	21	87.5	29	91.0		4	80.0	10	100.0
Other	3	12.5	3	9.0		1	20.0	0	0.0
Time since diagnosis					0.084^* * Pearson’s Chi-square test;					0.505^† † Fisher’s exact test.
Up to 8.5 years	11	46.0	22	69.0		0	0.0	3	30.0
Over 8.5 years	13	54.0	10	31.0		5	100.0	7	70.0
Child/adolescent receives treatment					1.000^† † Fisher’s exact test.					0.560^† † Fisher’s exact test.
No	0	0.0	1	3.0		2	40.0	2	20.0
Yes	24	100.0	31	97.0		3	60.0	8	80.0
Main caregiver					0.698^* * Pearson’s Chi-square test;					0.282^† † Fisher’s exact test.
Mother	14	58.0	17	53.0		1	20.0	6	60.0
Other	10	42.0	15	47.0		4	80.0	4	40.0
Years of education of family member/caregiver					0.221^* * Pearson’s Chi-square test;					0.230^† † Fisher’s exact test.
Up to 6 years	18	75.0	19	59.0		0	0.0	4	40.0
Over 6 years	6	25.0	13	41.0		5	100.0	6	60.0
Income					0.967^* * Pearson’s Chi-square test;					1.000^† † Fisher’s exact test.
Up to 1,000 BRL	12	52.0	16	52.0		3	60.0	6	60.0
Over 1,000 BRL	11	48.0	15	48.0		2	40.0	4	40.0
Knows health service closest to home					1.000^† † Fisher’s exact test.					1.000^† † Fisher’s exact test.
No	1	4.00	2	6.0		0	0.00	1	10.0
Yes	23	96.0	30	94.0		5	100.0	9	90.0
Type of service closest to home					0.258^† † Fisher’s exact test.					-
PHC	21	100.0	27	90.0		5	100.0	10	100.0
Other	0	0.0	3	10.0		-	-	-	-
Goes to the service closest to home					0.103^* * Pearson’s Chi-square test;					0.241^* * Pearson’s Chi-square test;
No	13	54.0	24	75.0		2	40.0	1	10.0
Yes	11	46.0	8	25.0		3	60.0	9	90.0

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[1] CORRESPONDING AUTHOR: Clarissa Bohrer da Silva. E-mail: clabohrer@gmail.com