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Incidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda: Alpha Network HIV Supplement

TitleIncidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda: Alpha Network HIV Supplement
Publication TypeJournal Article
Year of Publication2012
AuthorsMakumbi, FE, Nakigozi, G, Sekasanvu, J, Lukabwe, I, Kagaayi, J, Lutalo, T, Wawer, M, Gray, R
JournalTropical medicine & international health : TM & IH
Volume17
Paginatione94-102
Date PublishedAug
ISBN Number1365-3156; 1360-2276
Accession Number22716203
KeywordsAdolescent, Adult, Anti-Retroviral Agents/*therapeutic use, Antiretroviral Therapy, Highly Active, Child, Child, Orphaned/*statistics & numerical data, Child, Preschool, Counseling, Female, HIV Infections/*drug therapy/*epidemiology/mortality, HIV Seronegativity, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Socioeconomic Factors, Time Factors, Uganda/epidemiology, Young Adult
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 (, 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 (, 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.