Rural Realities in Pediatric HIV Service Delivery

This thesis presents data of a collaboration between different partners: Macha Research Trusts (previously called Malaria / Medical Institute at Macha) and Macha Mission Hospital in Macha, Zambia; AIDS relief Zambia and the Zambian Ministry of Health; Erasmus MC, University Medical Center Rotterdam, the Netherlands; and the Bloomberg School of Public Health, John’s Hopkins University, Baltimore, USA. Macha Hospital is one of the about 1,769 health facilities providing HIV and AIDS services in Zambia [1]. The hospital is unique due to the long history of community work, and the collaboration with the adjacent research institute, all situated in a rural village in Zambia. The data of the paediatric HIV cohort group receiving care at this rural Zambian hospital provides the basis for this thesis. Although most studies of HIV- infected children in sub-Saharan Africa are conducted in urban areas [2], where resources and infrastructure are greatest, the studies presented in this thesis were conducted in a rural community within the context of the observational cohort study of primarily perinatal infected children (PART study) that has been ongoing since 2007. While conducting research in a rural setting is challenging because of limited resources, these studies provide insight into the long-term consequences of HIV infection and treatment and the unique barriers and challenges associated with providing care and treatment in this setting. In this final chapter, we will summarize the presented studies, highlight some of the achieved successes and remaining challenges regarding paediatric HIV-care in resource-limited settings, and conclude with future perspectives.