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 (, 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 (, 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.
Conclusion 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.