Abstract #279  -  HIV+ children and young people have complex family and health contexts: results from a case note review in a London treatment centre
Authors:   Presenting Author:   Dr Tomas campbell - Newham Primary Care NHS Trsut
Additional Authors:  Ms Hannah Beer, Dr Jayne Griffiths, Ms Precious Legemah, Ms Mbalu Saine,
Aim: Most HIV+ children in London are of African origin and acquired HIV vertically. African families in the United Kingdom (UK) face many challenges in addition to coping with HIV disease including immigration concerns, integration into a new social and educational system, housing and financial concerns. The Sun Clinic is a family centred HIV treatment centre which provides integrated and multi-disciplinary care to HIV+ parents and children. This systematic case note review was conducted to review the health status and psychosocial context of children and young people attending clinic in order to better identify psychosocial progress and clinical challenges.
Method / Issue: A pro-forma was developed and focused on: demographics, family composition, current child health, parental health and disclosure of HIV status (both parental and child) interface with social services and access to community based support. 40 medical and psychology records (21 females, 19 males) were examined. Missing data was provided by interviews with psychologists, clinical nurse specialists and a paediatrician.
Results / Comments: 72.5% were aged 12+ years (age range 2-18 years). 72.5% had commenced ARV medication: 50% had reported adherence difficulties. 12.5% reported severe side effects. 10% had not commenced ARVs against medical advice. 62% had a history of other health problems including TB, shingles, pneumonia, meningitis. 39% of mothers had mental health issues. 68% of children had been disclosed to about their status and 58% were aware of their parents’ HIV status. 53% of children had experienced an HIV-related death in the family. 25% of children lived in families in which there were 2 or more HIV+ children. In 9 families there were a total of 17 untested children living elsewhere. 25% have been referred to social services for child protection usually for neglect. Most children accessed a range of clinical support and NGO services.
Discussion: These data provide a snapshot of the complex social, health and family issues faced by HIV+ children and young people. The majority of young people in this cohort are aged over 12 years and will be dealing with puberty and adolescent issues. Adherence difficulties to ARVs, child protection issues, parental mental health and disclosure of own HIV status and parental HIV remain of concern. This review highlighted that there are significant gaps in clinical knowledge about these childrens’ social and family context as there is missing data. Information about fathers HIV and health status is almost completely absent from clinical records. Strategies to increase timely identification of child and parental difficulties will be discussed as will interventions to increase adherence, facilitate disclosure and reduce impact of poorer parental mental health. Strategies to facilitate increased treatment competency and transition to adult services will be also addressed.
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