Cent Eur J Public Health 2017, 25(1):55-63

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa

Daniel A. Adeyinka¹, Meirion R. Evans², Chamberline E. Ozigbu¹, Hugo van Woerden^2,3, Esther F. Adeyinka⁴, Olanrewaju Oladimeji^5,6, Chris Aimakhu^7,8, Deborah Odoh¹, Dick Chamla⁹

¹ National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria

² Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK

³ Public Health Directorate, National Health Service, Highland, Inverness, UK

⁴ Department of Nursing, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

⁵ Liverpool School of Tropical Medicine, Liverpool, UK

⁶ Centre for Community Health Care, Research and Development, Abuja, Nigeria

⁷ Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria

⁸ College of Medicine, University of Ibadan, Ibadan, Nigeria

⁹ Health Section, UNICEF, New York, USA

Objective: Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets.

Methods: Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage.

Results: Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices.

Conclusions: Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.

Keywords: HIV infections, sub-Saharan Africa, child, antiretroviral agents, delivery of health care, socioeconomic factors

Received: June 29, 2015; Revised: April 28, 2016; Accepted: April 28, 2016; Published: March 1, 2017  Show citation