This survey gave an insight of caregivers’ knowledge and attitude about PMTCT, paediatric HIV infection diagnostic, existing prevention and HIV treatment strategies for children in Ouagadougou in 2011. Firstly, this study showed that despite an overall knowledge of MTCT modes, a few misconceptions still existed. Secondly, we highlighted the low level of knowledge among caregivers about the importance of performing EID even in asymptomatic HIV-exposed children allowing an earlier access to ART. Our results are useful to understand the barriers of EID uptake and paediatric HIV care in West-African children.
A total of 21 % of caregivers refused to participate in this survey, highlighting the possible lack of confidentiality and fear of stigma already mentioned in a similar context [21]. This lack of confidentiality may have also influenced the information collected among the responders, mainly in minimizing their difficulties facing the health care system or the health care workers.
Nevertheless, we were able to understand to some extent, caregivers’ knowledge, attitudes and practices at the different stages of paediatric HIV care cascade.
Our results showed that caregivers were globally aware of the HIV infection disease. We assume that this is the result of HIV prevention campaigns at community level in Burkina Faso since the early years when first cases of HIV infection were reported [22, 23].
Similarly, knowledge about PMTCT and EID using blood samples method was appreciable among caregivers, and there was no statistically significant difference between the groups when it comes to the method used to test their children. This result could be related either to a lack of statistical power, or to an absence of difference in terms of knowledge attitude and practices. However, as we expected a difference in knowledge about PMTCT and EID method in favour of those who were already in contact with HIV health care providers (groups 1 + 2 + 3), because of their frequent interactions with health staff, we could raise the hypothesis that health visits were not efficiently utilized to raise their awareness. So, health care providers should take advantage of the medical visits to cope with these issues.
But, the lack of difference in terms of knowledge of the group 4 versus the groups 1 + 2 + 3 can also be related to the level of education: the level of education amongst group 4 is greatly elevated and could account for any of the differences seen between the two groups.
In addition, caregivers misunderstanding and low level of knowledge about EID in asymptomatic children still remained. This could impede the routine EID coverage, and ultimately delay the ART treatment. This could partially explain the EID bottleneck in the 2011 cascade of care in Ouagadougou, with only 29 % of HIV-exposed children testing within their fist year of life [21]. Improving the coverage of the paediatric HIV care cascade at each stage requires addressing these misunderstandings through awareness campaigns. For instance in South Africa, a study showed that EID rate can be improved by using some strategies including awareness campaigns [24].
Some caregivers were reluctant to the practice of an EID without their consent, highlighting the fear of a possible stigmatization or mistrust of health workers’ practices. Conversely, they did not perceive the importance of consent prior to the infant antiretroviral treatment, whereas this formal consent would increase caregivers’ adherence to their infant ARV treatment [11, 14].
It is interesting to notice that all of the caregivers thought that early antiretroviral treatment was necessary for all HIV-infected infants, and this would decrease the mortality and morbidity rate if the service was accessible to the population. This could explain why we recorded a small proportion of refusal among caregivers referred for their infant HIV treatment initiation in the recruitment phase of the MONOD trial, implemented in Ouagadougou. The results of this trial will be presented elsewhere.
Some issues related to staff practices, such as carrying out the HIV test without caregivers’ prior consent, may be addressed by improving training in paediatric wards, as it has already been reported in Côte d’Ivoire [9] and South Africa [25]. However, changing caregivers’ attitudes may require interventions to raise their awareness at both individual and community level.
As for healthcare providers, they should actively promote HIV testing and care-seeking for children, by seizing all opportunities with caregivers.
Before concluding, we could discuss a few study limits. Although, our sample size was limited, the sampling method was adapted to qualitatively understand some perceptions, at the different steps of the cascade of paediatric HIV care from access to PMTCT services, EID services, and child care in Ouagadougou.
In addition, considering a group of “caregivers of HIV exposed but confirmed uninfected children” could have enriched the understanding of KAP in Ouagadougou, but it was not feasible in the cross-sectional design at the time of attendance in paediatric care.