Exploration of Pain in Children on Antiretroviral Treatment in a Regional Hospital in South Africa

ABSTRACT

Background: Patients with human immunodeficiency virus (HIV) disease on antiretroviral therapy (ART) may experience pain for a variety of reasons; including the effects of the virus itself; associated opportunistic infections and the ART. Studies indicate that pain in adults on ART is frequent; can be severe; and is often undertreated. This study sought to explore the experience; and the prevalence of pain in young children aged 3-13 years on ART.Method: Primary caregivers of children aged 3-13 years on ART attending a paediatric ART clinic at a regional hospital in Durban participated in the study. Convenience sampling was used. The Wong-Baker FACEST Pain Rating Scale and a questionnaire adapted from Hirshefeld were used to investigate variables such as age; cluster of differentiation 4 (CD4) count; ART regimen; ART duration; and site; prevalence and impact of pain during activities. Data were analysed using a standard statistical programme.Results: Four hundred and twenty primary caregivers were interviewed. Most were mothers caring for their HIV-positive children; and the majority of the children were aged 3-7 years. Most children were on a first-line ART regimen; and half reported pain. Nociceptive pain (visceral or somatic) was the most common type of pain; and pain interfered with the daily activities of a third of the children. There was a significant association between CD4 count and pain (p-value = 0.040). Paracetamol was the most commonly used analgesic.Conclusion: Pain was a common problem; and generally was undertreated with analgesia. A need to improve pain assessment and management in this population group was identified