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


CONCLUSIONS
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.
Rakai Health Sciences Program, Kalisizo, Uganda. fmakumbi@musph.ac.ug
Fredrick E
FE
Makumbi
Gertrude
G
Nakigozi
Joseph
J
Sekasanvu
Ivan
I
Lukabwe
Joseph
J
Kagaayi
Tom
T
Lutalo
Maria
M
Wawer
Ronald
R
Gray
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D054540:Child, Orphaned / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents