Incidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda

Fredrick Edward Makumbi · Gertrude F. Nakigozi · Joseph Sekasanvu · Ivan Lukabwe · Joseph Kagaayi · Tom Lutalo +2 more

18 citations0/0 files storedTropical Medicine & International Health

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Poverty, Education, and Child Welfare HIV/AIDS Research and Interventions HIV/AIDS Impact and Responses

Abstract

OBJECTIVE: To compare the incidence of orphanhood among children <15 years of age before and after implementing HIV care in Rakai, Uganda. METHODS: Annual household censuses and surveys were conducted on January 2001 to September 2009 in a community cohort, where HIV care including antiretroviral therapy (ART) started in June 2004. Data included parental survival of children aged 0-14 years and HIV status from consenting adults aged 15-49 years. The incidence of orphanhood was estimated as the number of new orphans divided by person-years, determined during three time periods: Pre-HIV care roll-out (January 2001-June 2003) 1-3 years before the advent of HIV care in Rakai programme, HIV care transition from September 2003-May 2006, and the expanded HIV care period from August 2006-September 2009. Poisson regression was used to estimate incidence rate ratios (IRR) of orphanhood and 95% confidence intervals, and the Population attributable fraction (PAF) of incident orphanhood due to HIV+ parental status was estimated as pd*(RR-1)/RR. RESULTS: A total of 20,823, 21,770 and 23,700 children aged 0-14 years were censused at the three periods, respectively. The prevalence of orphanhood significantly declined; 17.2% during Pre-HIV care roll-out, 16.0% at HIV care transition and 12.6% at expanded HIV care period (chi2 trend, P < 0.0001). The incidence of orphanhood also declined significantly with increasing HIV care from 2.10/100 person-years (py), 1.57/100 py and 1.07/100 py (chi2 trend, P < 0.0001). The largest declines were observed among children with HIV+ parent(s), 8.2/100 pyr, 5.2/100 pys and 3.4/100 pyr. PAF also declined from 35.3% in the pre-HIV care to 27.6% in the expanded HIV care periods. CONCLUSION: After the availability of ART, there was a decline in PAF of incident orphanhood due to parental HIV+ status, and in the incidence of orphanhood especially among children with HIV-infected parents.

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References

2010Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: a systematic analysis 2006Epidemiology of health and vulnerability among children orphaned and made vulnerable by HIV/AIDS in sub-Saharan Africa 2007The effects of high HIV prevalence on orphanhood and living arrangements of children in Malawi, Tanzania, and South Africa 2009The association of single and double orphanhood with symptoms of depression among children and adolescents in Namibia 2008The intergenerational impact of the African orphans crisis: a cohort study from an HIV/AIDS affected area 2005Rising incidence and prevalence of orphanhood in Manicaland, Zimbabwe, 1998 to 2003 2003Does biological relatedness affect child survival?2005The incidence and prevalence of orphanhood associated with parental HIV infection: a population-based study in Rakai, Uganda

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