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Shabanova V, Emuren L, Gan G, Antwi S, Renner L, Amissah K, Kusah JT, Lartey M, Reynolds NR, Paintsil E. Pediatric HIV Disclosure Intervention Improves Immunologic Outcome at 48 Weeks: The Sankofa Trial Experience. J Acquir Immune Defic Syndr 2023; 94:371-380. [PMID: 37643414 PMCID: PMC10617661 DOI: 10.1097/qai.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The World Health Organization recommends disclosure of HIV status to children and adolescents living with HIV (CALWH). HIV disclosure improves adherence to antiretroviral therapy and immunologic and virologic outcomes. However, the prevalence of HIV disclosure is low in sub-Saharan Africa. We assessed the longitudinal effect of the Sankofa Pediatric HIV disclosure intervention on immunologic and virologic outcomes among CALWH in Ghana. METHODS We conducted a secondary analysis of a two-arm site-randomized clinical trial among CALWH aged 7-18 years. Data were collected at baseline, 24, and 48 weeks. Generalized linear mixed models were used to compare immunologic (CD4) and virologic (viral load) outcomes as both continuous and categorical variables by disclosure status and by intervention group. RESULTS Among participants who had their HIV status disclosed during this study, the proportion with CD4 percent >25% increased from 56.5% at baseline to 75.4% at week 48 ( P = 0.03), with a slight increase in the undisclosed group (69.5% vs. 74.3%, P = 0.56). In the intervention arm, there was a steady increase in proportion with CD4 percent >25% from 47.1% at baseline to 67.8% at week 48 ( P = 0.01) while it remained unchanged in the control arm (80.5% vs. 81.3% [ P = 0.89]). Concurrently, declines in detectable viral load were observed in both disclosed (63.3% vs. 51.5%, P = 0.16) and undisclosed (69.9% vs. 62.0%, P = 0.17) groups while the intervention group experienced a meaningful drop from 72.9% to 57.6% at 24 weeks ( P = 0.04), which was maintained at 48 weeks. CONCLUSIONS A structured, culturally relevant disclosure intervention can improve clinical outcomes.
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Affiliation(s)
| | - Leonard Emuren
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Geliang Gan
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Sampson Antwi
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Kofi Amissah
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jonas Tettey Kusah
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | | | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Mbebe S, Rabie S, Coetzee BJ. Factors influencing the transition from paediatric to adult HIV care in the Western Cape, South Africa: perspectives of health care providers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:175-184. [PMID: 37905477 DOI: 10.2989/16085906.2023.2246435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/01/2023] [Indexed: 11/02/2023]
Abstract
Transitioning to adult care for HIV-infected adolescents is a critical process in determining long-term health outcomes. Poor transitioning to adult care can lead to several adverse HIV-related outcomes for adolescents living with HIV, including disruption of care, non-adherence to ART and virological failure. In this qualitative study, we explore the barriers to and facilitators of the transition to adult care among HIV-infected youth from the perspectives of health care workers and allied staff. We enrolled 24 health care workers and allied staff from two infectious diseases clinics in the Western Cape of South Africa. Participants took part in a once-off, semi-structured interview that was conducted face-to-face at the respective clinics. Interviews were audio-recorded and transcribed verbatim for thematic analysis using ATLAS.ti. Two superordinate themes and seven subthemes emerged from the data. We found that barriers to the transition process were related to a lack of preparedness and readiness to transition at both an institutional level and at the level of the caregiver and adolescent. At the institutional level, a lack of a transition policy and limited time and resources available for the transition process were salient barriers. At the caregiver-adolescent level, adolescents' desire for normality and caregivers' reluctance to devolve responsibility of care to their children were important barriers to the transition process. Facilitators prepare adolescents and caregivers for transition from an early age. Our findings highlight the importance of considering both adolescent, caregiver and institutional factors when preparing for the transition process. Our findings also show that pressure on the health care system precludes the time required for this process. However, counselling for transition from an early age might be an important way to negate these issues.
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Affiliation(s)
- Sylvie Mbebe
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Stephan Rabie
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bronwyne J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Puffer ES, Finnegan A, Schenk K, Langhaug L, Rusakaniko S, Choi Y, Mahaso S, Simmons R, Green EP. Comparing fears about paediatric HIV disclosure to the lived experiences of parents and guardians: a prospective cohort study. Psychol Health 2023; 38:1587-1605. [PMID: 35188010 PMCID: PMC9392813 DOI: 10.1080/08870446.2022.2041637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/16/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being. DESIGN We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status. MAIN OUTCOME MEASURES We used three waves of data to compare caregivers' pre-disclosure worries to post-disclosure reports and to characterise associations between disclosure and well-being of the child (Strengths and Difficulties Questionnaire), caregiver (Patient Health Questionnaire-9), and family (Family Relationship Quality) over time. RESULTS Caregivers' pre-disclosure worries and fears about how their child would react to disclosure of their HIV status largely went unrealised. Furthermore, we did not find strong evidence of clinically-important increases in problems on average following disclosure. CONCLUSION Findings support the call to identify supportive intervention strategies that address caregiver fears at the beginning of the disclosure process.
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Affiliation(s)
- Eve S. Puffer
- Duke University, Department of Psychology and Neuroscience, Durham, NC, USA
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Amy Finnegan
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Lisa Langhaug
- Regional Psychosocial Support Initiative, Harare, Zimbabwe
| | | | - Yujung Choi
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Ryan Simmons
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Eric P. Green
- Duke University, Duke Global Health Institute, Durham, NC, USA
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Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators to ART adherence among ART non-adherence people living with HIV in Cameroon: A qualitative phenomenological study. PLoS One 2023; 18:e0291487. [PMID: 37699048 PMCID: PMC10497158 DOI: 10.1371/journal.pone.0291487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) needs to be taken for life with near perfect levels of adherence for it to be effective. Nonetheless, ART non-adherence is still observed in sub-Saharan African (SSA) countries such as Cameroon. The objective of this study was to assess the factors influencing non-adherence and or adherence among people living with HIV (PLWH) who have experienced non-adherence to ART in Cameroon. METHODS A descriptive qualitative study of PLWH who have experienced non-adherence with ART in Cameroon was conducted. Data were collected using in-depth interviews. Collected data were analyzed using the NVIVO 12 software. RESULTS In total, 43 participants participated in this study. The Southwest and Littoral regions each contributed 15 (34.88%) of participants, participants' mean age was 37.1 years (SD: 9.81) and majority 34 (82.93%) were females. ART adherence barriers include those related to patient (forgetfulness, business with other things, unwillingness to swallow drugs daily), medication (side effects), health service (arrogance of caregivers, occasional drug shortages at treatment centre, poor counseling of patient), stigma (fear of status disclosure), use of alternative treatment (traditional medicine, prayers and deliverance), resource limitation (limited food, limited finances), environmental/social (limited or no home support), and political instability (disruption of free circulation by ghost towns, roadblocks and gunshots in some regions). ART adherence facilitators include social support (family and peer support), aligning treatment with patient's daily routines (align ART with schedule of family members), use of reminders (phone alarm, sound of church bell), health sector/caregiver support (messages to patient, financial support, proper counseling), and patient's awareness of HIV status/ART knowledge (awareness of HIV positive status, Knowledge of ART benefits). CONCLUSION ART adherence barriers in Cameroon include those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. ART adherence facilitators include social support, aligning treatment with patient's daily routines, use of reminders, health sector/caregiver support, and patient's awareness of HIV status/ART knowledge. Given these barriers and facilitators, continuous information provision and consistent support both from patients' families and caregivers are needed to improve adherence among patients. Further studies including many regions and larger samples using both in-depth and focused group discussions as well as quantitative approaches are required to uncover the burden related to ART non-adherence.
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Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Magill EB, Nyandiko W, Baum A, Aluoch J, Chory A, Ashimoshi C, Lidweye J, Njoroge T, Sang F, Nyagaya J, Scanlon M, Hogan J, Vreeman R. Factors associated with caregiver compliance to an HIV disclosure intervention and its effect on HIV and mental health outcomes among children living with HIV: post-hoc instrumental variable-based analysis of a cluster randomized trial in Eldoret, Kenya. Front Public Health 2023; 11:1150744. [PMID: 37213654 PMCID: PMC10196043 DOI: 10.3389/fpubh.2023.1150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
Background The HADITHI study is a cluster-randomized trial of children living with HIV and their caregivers in Kenya that aimed to increase rates of caregiver disclosure of their child's HIV status, encourage earlier status disclosure, and improve pediatric mental health and HIV outcomes. This analysis identified characteristics predicting caregiver non-responsiveness and compared outcomes among children based on disclosure status. Methods A penalized logistic regression model with lasso regularization identified the most important predictors of disclosure. The two-stage least squares instrumental variable approach was used to assess outcomes accounting for non-compliance to disclosure. Results Caregiver non-isolation and shorter time on antiretroviral therapy were predictive of HIV status disclosure. There were no statistically significant differences found in CD4 percentage, depression status, or mental and emotional status based on disclosure status up to 24 months-post intervention. Conclusion These findings have implications for specialists seeking to tailor disclosure interventions to improve caregiver-child dyad responsiveness.
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Affiliation(s)
- Elizabeth B. Magill
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Elizabeth B. Magill
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Aaron Baum
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Center for Global Health, Indiana School of Medicine, Bloomington, IN, United States
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Vreeman
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- *Correspondence: Rachel Vreeman
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Armoon B, Fleury MJ, Higgs P, Bayat AH, Bayani A, Mohammadi R, Ahounbar E. Prevalence, socio-demographics and service use determinants associated with disclosure of HIV/AIDS status to infected children: a systematic review and meta-analysis by 1985-2021. Arch Public Health 2022; 80:154. [PMID: 35681146 PMCID: PMC9178876 DOI: 10.1186/s13690-022-00910-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a public health issue of global importance. To our knowledge, no previous meta-analysis documenting the prevalence, socio-demographic, and service use determinants associated with HIV/AIDS disclosure to infected children has been conducted. The present study aimed to determine the prevalence, socio-demographics and service use determinants associated with the disclosure of HIV/AIDS status to infected children. METHODS Studies in English published between 01 January 1985 and 01 November 2021, and available on PubMed, Scopus, Web of Science, and Cochrane electronic databases were searched. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. RESULTS After article duplicates were excluded, assessments of abstracts were completed, and full-text papers evaluated, 37 studies were included in this meta-analysis. The prevalence of the disclosure of HIV status to children was measured to be 41% in this research. The odds that a child of 10 years and older is informed that they are HIV-positive is 3.01 time the odds that younger children are informed. Those children who had primary or lower schooling level were 2.41 times more likely to be informed of their HIV-positive status than children with higher levels of schooling. Children who had a non-biological parents were 3.17 times more likely to have been disclose being HIV-positive; social support (OR = 8.29, 95%CI = 2.34, 29.42), children who had higher levels of social supports were 8.29 times more likely to disclose HIV-positive; the primary educational level of caregivers (OR = 2.03, 95%CI = 1.43, 2.89), respondents who had caregivers with primary education level were 2.03 times more likely to disclose HIV-positive; antiretroviral treatment (ART) adherence (OR = 2.59, 95%CI = 1.96, 3.42), participants who adhered to ART were 2.59 times more likely to disclose HIV-positive and hospital follow-up (OR = 2.82, 95%CI = 1.85, 4.29), those who had hospital follow-up were 2.82 times more likely to disclose HIV-positive; were all significantly associated with the disclosure of HIV/AIDS status to infected children. CONCLUSION Such data are of importance for healthcare pediatrics HIV care professionals. Facilitating HIV diagnosis and disclosure to the infected children and ensuring access to HIV treatment will likely prevent secondary HIV transmission. Healthcare professionals are expected to provide age-appropriate counseling services to this population.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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März JW. What does the best interests principle of the convention on the rights of the child mean for paediatric healthcare? Eur J Pediatr 2022; 181:3805-3816. [PMID: 36083315 PMCID: PMC9546983 DOI: 10.1007/s00431-022-04609-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022]
Abstract
The present review analyses the implications of the best interests of the child principle, which is one of the most widely discussed principles of medical ethics and human rights, for paediatric healthcare. As a starting point, it presents the interpretation of the best interests principle by the United Nations Committee on the Rights of the Child. On this basis, it points out possible fields of application of the best interests principle with regard to paediatric healthcare and discusses the potential difficulties in the application of the best interests principle. Based on this, it illustrates the implications of the best interests principle for paediatric healthcare through four case studies, which look at ethical dilemmas in paediatric gynaecology, end-of-life care, HIV care and genetic testing. Conclusion: The best interests principle requires action, inter alia, by health policymakers, professional associations, hospital managers and medical teams to ensure children receive the best possible healthcare. Whilst the best interests principle does not provide a conclusive solution to all ethical dilemmas in paediatric healthcare (as illustrated by the case studies), it provides children, medical teams, parents and families, and clinical ethicists with an indispensable framework for health care centred on the rights of the child. What is Known: • The best interests principle is one of the most widely discussed principles of medical ethics and human rights and one of the four general principles of the Convention on the Rights of the Child. What is New: • The present review discusses possible fields of application and potential difficulties of the best interests principle with regard to paediatric healthcare. • Based on this, it illustrates the implications of the best interests principle for paediatric healthcare through four case studies, which look at ethical dilemmas in paediatric gynaecology, end-of-life care, HIV care and genetic testing.
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Affiliation(s)
- Julian W. März
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
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Mominur Rahman M, Islam F, Saidur Rahaman M, Sultana NA, Fahim NF, Ahmed M. Studies on the prevalence of HIV/AIDS in Bangladesh including other developing countries. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-021-00610-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Disclosure, Social Support, and Mental Health are Modifiable Factors Affecting Engagement in Care of Perinatally-HIV Infected Adolescents: A Qualitative Dyadic Analysis. AIDS Behav 2021; 25:237-248. [PMID: 32638220 DOI: 10.1007/s10461-020-02968-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents living with perinatally acquired HIV in South Africa face significant barriers to successful transition from pediatric to adult care. We performed in-depth qualitative interviews with 41 adolescents living with HIV and 18 of their caregivers to investigate modifiable factors to improve engagement in care prior to transition to adult care. Based on dyadic, inductive content analysis, findings suggest that HIV status disclosure, social support, and mental health are targets for improvement in engagement in care. Early disclosure and a sense of belonging facilitated engagement in care, while barriers included delayed or inadequate disclosure, denial, and lack of disclosure to others. Adherence support improved by having a biological mother as a direct supervisor. Barriers to care included changing caregivers, abandonment, undiagnosed mental health problems and learning difficulties. Despite these factors, the majority of adolescents showed resilience and remained engaged in care despite difficult circumstances.
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Clinic-Based Pediatric Disclosure Intervention Trial Improves Pediatric HIV Status Disclosure in Ghana. J Acquir Immune Defic Syndr 2020; 84:122-131. [PMID: 32049772 DOI: 10.1097/qai.0000000000002316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disclosing HIV status to HIV-positive children is a major challenge facing families and health care providers. Despite recommendations for disclosure, rates remain low. We tested whether a pediatric HIV disclosure intervention delivered as an integral component of routine HIV health care in Ghana would improve disclosure to children. METHODS Dyads of HIV-infected children aged 7-18 years and their caregivers were enrolled from 2 HIV clinics in Accra and Kumasi, Ghana. The sites were randomly assigned to one of the 2 intervention arms to avoid treatment contamination between intervention and control participants. Trained interventionist used theory-guided therapeutic communication and personalized interaction to promote disclosure. Disclosure outcomes were measured at 12-week intervals. All analyses were completed using a modified intention-to-treat approach. RESULTS We enrolled 446 child-caregiver dyads (N = 240 intervention group; N = 206 control group); 52% of the children were boys, mean age 9.78 (±2.27) years. For disclosure at 1 year, a better overall treatment effect was observed (P < 0.001). Children in the treatment group had greater disclosure at each time point (P < 0.001) and a higher proportion of them had been disclosed to by 1 year (51.4% vs. 16.2%; P < 0.001; un-adjusted hazard ratio = 3.98: 95% confidence interval: 2.63 to 6.03) and 3 years (71.3% vs. 34.0%; unadjusted hazard ratio = 4.21: 95% confidence interval: 3.09 to 5.72). In the multivariate Cox model, factors associated with disclosure were treatment group (P < 0.001), children <11 years of age (P < 0.001), HIV-infected caregivers (P = 0.015), and caregiver's with greater education (P = 0.022). CONCLUSIONS This practical clinic-based disclosure intervention shows excellent promise as a means of improving HIV pediatric disclosure outcomes.
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Budhwani H, Mills L, Marefka LEB, Eady S, Nghiem VT, Simpson T. Preliminary study on HIV status disclosure to perinatal infected children: retrospective analysis of administrative records from a pediatric HIV clinic in the southern United States. BMC Res Notes 2020; 13:253. [PMID: 32448309 PMCID: PMC7247121 DOI: 10.1186/s13104-020-05097-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/19/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The World Health Organization recommends disclosing HIV-status between 6 and 12 years; American Academy of Pediatrics recommends that children are informed at “school age.” Neither suggests an optimal age when children should learn of their status to improve viral load suppression. Considering that virally suppressed people do not transmit HIV and that interrupting the transmission cycle is critical to ending the HIV epidemic, our objective is to examine the relationship between age of disclosure and viral load suppression by evaluating data from a pediatric HIV clinic in the southern United States. Records from perinatal infected patients seen between 2008 and 2018 were analyzed (N = 61). Results Longitudinal suppression was low across all groups when benchmarked against the UNAIDS 90% global target; black patients were less likely to achieve suppression compared to white patients (41% vs. 75%, p = 0.04). Adopted children were more likely to achieve suppression than children living with biological family (71% vs. 44%, p < 0.05). Children who learned of their status between 10 and 12 had the highest rate of suppression (65%) compared to peers who learned of their status younger (56%) or older (38%). Our preliminary study is designed to spark research on refining the current recommendations on HIV-status disclosure to perinatal infected children.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA.
| | - Lori Mills
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - Lauren E B Marefka
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - Sequoya Eady
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - Van T Nghiem
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - Tina Simpson
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
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Wariri O, Ajani A, Raymond MP, Iliya A, Lukman O, Okpo E, Isaac E. "What will my child think of me if he hears I gave him HIV?": a sequential, explanatory, mixed-methods approach on the predictors and experience of caregivers on disclosure of HIV status to infected children in Gombe, Northeast Nigeria. BMC Public Health 2020; 20:373. [PMID: 32197648 PMCID: PMC7085175 DOI: 10.1186/s12889-020-08506-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background With increasing access to effective Anti-Retroviral Therapy (ART), the proportion of children who survive into later childhood with HIV has increased. Consequently, caregivers are constantly being confronted with the dilemma of ‘if’, ‘when’, and ‘how’ to tell their children living with HIV their status. We aimed to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to children living with HIV in Gombe, northeast Nigeria. Methods We conducted a sequential, explanatory, mixed-methods study at the specialist Paediatric HIV clinic of the Federal Teaching Hospital Gombe, northeast Nigeria. The quantitative component was a cross sectional, questionnaire-based study that consecutively recruited 120 eligible primary caregivers of children (6–17 years) living with HIV. The qualitative component adopted an in-depth one-on-one interview approach with 17 primary caregivers. Primary caregivers were purposively selected to include views of those who had made disclosure and those who have not done so to gain an enhanced understanding of the quantitative findings. We examined the predictors of HIV status disclosure to infected children using binary logistic regression. The qualitative data was analysed using a combined deductive and inductive thematic analysis approach. Results The mean age of the index child living with HIV was 12.2 ± 3.2 years. The prevalence of disclosure to children living with HIV was 35.8%. Children living with HIV were 10 times more likely to have been told their status if their caregivers believed that disclosure had benefits [AOR = 9.9 (95% CI = 3.2–15.1)], while HIV-negative compared to HIV-positive caregivers were twice more likely to make disclosures [AOR = 1.8 (95%CI = 0.7–4.9)]. Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables [AOR = 1.45 (95% CI = 0.6–3.5)]. Caregivers expressed deep-seated feeling of guilt and self-blame, HIV-related stigma, cultural sensitivity around HIV, and fears that the child might not cope as barriers to non-disclosure. These feeling were more prominent among HIV-positive caregivers. Conclusion The process of disclosure is a complex one and caregivers of HIV positive children should be supported emotionally and psychologically to facilitate disclosure of HIV status to their children. This study further emphasises the need to address HIV-related stigma in resource constrained settings.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Ayomikun Ajani
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | | | - Asabe Iliya
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Olatoke Lukman
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria
| | - Emmanuel Okpo
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.,Department of Public Health Medicine, NHS Grampian, Aberdeen, UK
| | - Elon Isaac
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria.,Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
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Important Roles of Health Professionals in Maternal HIV Disclosure Among HIV-Infected Women in China. AIDS Behav 2019; 23:2829-2836. [PMID: 31228027 DOI: 10.1007/s10461-019-02566-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal HIV disclosure to children is beneficial for both mothers and children. A cross-sectional survey was conducted to investigate the prevalence of maternal HIV disclosure to at least one living child aged > 5 years among 292 HIV-infected mothers in Guangxi Province, China. Among all participants, 45.2% had self-disclosed their HIV positive sero-status to at least one living child aged > 5 years. After adjusting for the significant background variables, participants self-reported health professionals in governmental antenatal care clinics had discussed with them about maternal HIV disclosure (adjusted odds ratios, aOR: 5.85), had received counseling services (aOR: 7.84) or support (aOR: 8.75) from these health professionals when making decision on maternal HIV, and perceived higher empathy of these health professionals (aOR: 1.09) were more likely to have reported maternal HIV disclosure. Instrumental and affective interactions between health professionals and HIV-infected mothers were important facilitators of maternal HIV disclosure.
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Baker AN, Bayer AM, Kolevic L, Najarro L, Viani RM, Deville JG. Child, Caregiver, and Health Care Provider Perspectives and Experiences Regarding Disclosure of HIV Status to Perinatally Infected Children in Lima, Peru. J Int Assoc Provid AIDS Care 2019; 17:2325957417752257. [PMID: 29347903 PMCID: PMC6748514 DOI: 10.1177/2325957417752257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite recommendations for disclosure of HIV status to children living with HIV (CLHIV), fewer than half of CLHIV at the Instituto Nacional de Salud del Niño (INSN) in Lima, Peru, have had disclosure. How and when the disclosure process for CLHIV should take place in Peru has not been studied. METHODS We conducted a qualitative study at INSN to explore perceptions and experiences of 6 health care providers (HCPs), 14 disclosed and nondisclosed CLHIV (8-17 years), and their 14 caregivers regarding knowledge of illness, disclosure of HIV status, and appropriate disclosure approaches. RESULTS Disclosed children wanted to be told their diagnosis earlier. Nondisclosed children expressed frustration taking medications. Caregivers and HCPs discussed motivations to disclose, including educating, honesty, improving medication adherence, and preventing secondary transmission. CONCLUSION Culturally appropriate guidelines and training for HCPs and caregivers are needed to support disclosure of children's HIV status and ongoing support for CLHIV.
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Affiliation(s)
- Amira Noori Baker
- 1 Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA
| | - Angela Marie Bayer
- 2 Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA.,3 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lenka Kolevic
- 4 Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Lizzete Najarro
- 3 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rolando Mario Viani
- 5 Department of Pediatrics, Division of Infectious Diseases, University of California, San Diego, CA, USA.,6 Rady Children's Hospital San Diego, La Jolla, CA, USA.,7 AbbVie, Inc, North Chicago, IL, USA
| | - Jaime Gerardo Deville
- 1 Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Trejos-Herrera AM, Alarcón-Vásquez Y, Pino-Melgarejo M, Mebarak-Chams M. Validación de una herramienta para revelar diagnóstico de VIH a niños y adolescentes. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.65645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La revelación del diagnóstico de VIH/Sida a niños y adolescentes ha tenido beneficios y desafíos para las familias afectadas.Objetivo. Validar la herramienta “Mi Dragón Dormido” para el proceso de revelación del diagnóstico de VIH/Sida a menores de 15 años.Materiales y métodos. Se seleccionaron 10 jueces expertos y 40 cuidadores de niños seropositivos y seronegativos para VIH mediante muestreo no probabilístico intencional. Se administraron cuestionarios estructurados para evaluar cinco componentes de eficacia y se realizó análisis descriptivo de los datos y tabulación mediante el programa IBM SPSS Versión 24.Resultados. Jueces expertos y cuidadores determinaron que el formato y los mensajes fueron claros y favorecieron la identificación y aceptación. También indicaron que la herramienta permitió un cambio de comportamiento en el público objetivo.Conclusión. La herramienta es válida para apoyar el proceso de revelación de diagnóstico a niños con VIH y demostró aceptación en población seronegativa, lo que sugiere que puede ser utilizada en hogares y contextos educativos para promover comportamientos que respalden la salud, el bienestar general y la reducción de prácticas discriminatorias hacia las personas con VIH.
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Hayfron-Benjamin A, Obiri-Yeboah D, Ayisi-Addo S, Siakwa PM, Mupepi S. HIV diagnosis disclosure to infected children and adolescents; challenges of family caregivers in the Central Region of Ghana. BMC Pediatr 2018; 18:365. [PMID: 30466425 PMCID: PMC6251211 DOI: 10.1186/s12887-018-1330-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/29/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Disclosure of Human Immunodeficiency Virus (HIV) to infected older children and adolescents is essential for both personal health maintenance and HIV prevention within the larger population. Non-disclosure of HIV status has been identified as one of the potential barriers to optimum adherence especially in children and adolescents. Like many other countries in the SSA region, Ghana has significant number of children and adolescents infected by HIV, who have increased survival times, due to increased access to ART. However, both family caregivers and healthcare workers face an array of challenges with the disclosure process, including the timing, what information about the child's HIV status should be shared with him/her and how to go about it. The aim of the study was to identify family caregiver factors associated with non-disclosure of HIV status to infected children and adolescents accessing Antiretroviral Therapy (ART) at the three main ART sites within the Central Region of Ghana. METHODS A quantitative analytical survey was conducted among 103 family caregivers of HIV infected children (aged 6-17 years) assessing ART services in the Central Region of Ghana. Data were analyzed using SSPS version 21. RESULTS The age range of caregivers was 20-69 years. The study found a low disclosure rate (23.3%) among caregivers. Majority of the caregivers (80.6%) lacked knowledge on the process of disclosure (how and what to tell child), and majority (64%) also had never received guidance about the disclosure process from their healthcare providers. The main barriers to disclosure were caregiver lack of knowledge regarding the disclosure process and when to disclose, the fear of child's reaction, and fear of stigmatization and associated negative social consequences. CONCLUSION These findings suggest a lesser involvement of health care providers in preparing caregivers for the disclosure process. This therefore highlight the need for the National HIV/AIDS/STI Control Program to strengthen the involvement and training of healthcare providers in HIV diagnosis disclosure to infected children, based on context-specific policy guidelines informed by the WHO recommendations.
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Affiliation(s)
- Anna Hayfron-Benjamin
- Department of Maternal and Child Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ayisi-Addo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Peter Mate Siakwa
- Department of Basic Life Sciences, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Sylvia Mupepi
- Kirkhoff School of Nursing, Grand Valley State University, Michigan, USA
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McHenry MS, Apondi E, McAteer CI, Nyandiko WM, Fischer LJ, Ombitsa AR, Aluoch J, Scanlon ML, Vreeman RC. Tablet-based disclosure counselling for HIV-infected children, adolescents, and their caregivers: a pilot study. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:249-258. [PMID: 30319030 DOI: 10.2989/16085906.2018.1509101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Overwhelmed, under-trained medical staff working in resource-limited settings need efficient resources for HIV disclosure counselling. The objective of this study was to describe providers' experiences using tablet computers for disclosure-related counselling with HIV-infected children and their caregivers in western Kenya, with additional perspectives from adolescents. METHODS A qualitative study design was implemented at three HIV clinics in western Kenya (Bumala, Busia and Port Victoria) within the Academic Model Providing Access to Healthcare (AMPATH) partnership. Twenty-one healthcare providers involved with paediatric disclosure were recruited and enrolled in the study. Initial interviews focused on understanding current disclosure practices and barriers. Tablets containing disclosure-related resources were distributed. Resources included short narrative videos created in this context to highlight issues relevant to child HIV disclosure. RESULTS Providers reported tablets improved disclosure, child participation, and medication adherence. All reported that reviewing materials increased their knowledge and comfort with disclosure. The most frequently used materials were the narrative videos and an animated video explaining the importance of medication adherence. Time was a major barrier for using the tablet. Clinician self-education persisted at one-year follow-up. Adolescents expressed enjoyment from viewing the tablet resources and had a better understanding of the importance of medication adherence. CONCLUSIONS Tablet computers containing resources for disclosure are an acceptable and potentially effective resource to help providers support families with disclosure. Further work is needed to train the clinical providers in using the resources in a developmentally appropriate manner, and to develop new resources on adolescent-specific and HIV-related topics.
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Affiliation(s)
- Megan S McHenry
- a Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Edith Apondi
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics, College of Health Sciences , School of Medicine, Moi University , Eldoret , Kenya
| | - Carole I McAteer
- a Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Winstone M Nyandiko
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics, College of Health Sciences , School of Medicine, Moi University , Eldoret , Kenya
| | - Lydia J Fischer
- a Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Ananda R Ombitsa
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Josephine Aluoch
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Michael L Scanlon
- a Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Rachel C Vreeman
- a Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics, College of Health Sciences , School of Medicine, Moi University , Eldoret , Kenya
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Kalembo FW, Kendall GE, Ali M, Chimwaza AF. Healthcare workers' perspectives and practices regarding the disclosure of HIV status to children in Malawi: a cross-sectional study. BMC Health Serv Res 2018; 18:540. [PMID: 29996825 PMCID: PMC6042360 DOI: 10.1186/s12913-018-3354-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/04/2018] [Indexed: 11/22/2022] Open
Abstract
Background In 2011 the World Health Organisation recommended that children with a diagnosis of HIV be gradually informed about their HIV status between the ages of 6 and 12 years. However, to date, literature has focused mainly on primary caregiver and child experiences with HIV disclosure, little is known about healthcare workers’ perspectives and practices of HIV status disclosure to children. The aim of this study was to assess healthcare workers’ perspectives and practices regarding the disclosure of HIV status to children aged between 6 and 12 years in Malawi. Methods A cross-sectional survey was used to collect data from 168 healthcare providers working in antiretroviral clinics in all government District and Tertiary Hospitals in Malawi. Participants were asked questions regarding their knowledge, practice, and barriers to HIV disclosure. Data were analysed using binary logistic regression. Results Almost all healthcare workers (98%) reported that it was important to disclose HIV status to children. A significant proportion (37%) reported that they had never disclosed HIV status to a child and about half estimated that the rate of HIV disclosure at their facility was 25% or less. The main barriers to disclosure were lack of training on disclosure (85%) and lack of a standard tool for disclosure (84%). Female healthcare workers (aOR) 2.4; 95% CI: 1.1–5.5) and lack of training on disclosure (aOR 7.7; 95% CI: 3.4–10.7) were independently associated with never having disclosed HIV status to a child. Conclusions This study highlights the need for providing appropriate training in HIV disclosure for healthcare workers and the provision of standardised disclosure materials. Electronic supplementary material The online version of this article (10.1186/s12913-018-3354-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fatch W Kalembo
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia. .,Mzuzu University, Mzuzu, Malawi.
| | - Garth E Kendall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mohammed Ali
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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DeSilva MB, Penwill N, Sabin L, Gifford AL, Li Z, Fujie Z, Weiwei M, Yongzhen L, Hongyan L, Xuemei Z, Barnoon Y, Gill CJ, Bonawitz R. We don't dare to tell her … we don't know where to begin: Disclosure experiences and challenges among adolescents living with HIV and their caregivers in China. Int J Pediatr Adolesc Med 2018; 5:5-12. [PMID: 30805525 PMCID: PMC6363272 DOI: 10.1016/j.ijpam.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
Background and Objectives With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China. To help address this gap, we explored practices for disclosure to adolescents living with HIV (ALHIV) among Chinese caregivers and clinicians, and the disclosure experiences of the adolescents themselves using qualitative methods. Design and Setting The study was conducted in 2014 at the Guangxi Center for Disease Control and Prevention ART (CDC-ART) clinic in Nanning, China. We used a qualitative design, incorporating in-depth interviews (IDIs) and focus group discussions (FGDs). Patients and Methods We conducted IDIs with 19 adolescent/caregiver dyads and five FGDs with adolescents and clinicians. Adolescent participants were aged 10–15 years, and had contracted HIV perinatally. Using NVivoTM software, we summarized major themes. Results Only 6/19 caregivers reported disclosing to their child; matched adolescents' statements indicate that 9/19 children knew their HIV status. Caregivers planned to disclose when children were 14 years or older. Concerns about stigma toward children and families were associated with reluctance to disclose. Conclusion Disclosure to adolescents living with HIV in China was delayed compared with recommended guidelines. Culturally appropriate disclosure strategies should be developed, focused on supporting caregivers and de-stigmatizing HIV.
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Affiliation(s)
- Mary Bachman DeSilva
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States.,Department of Global Health, Boston University School of Public Health, Boston, MA, United States.,Westbrook College of Health Professions, University of New England, Portland, ME, United States
| | - Nicole Penwill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
| | - Lora Sabin
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States.,Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Allen L Gifford
- Departments of Health Policy and Management, Boston University Schools of Public Health and Medicine, Boston University, Boston, MA, United States.,Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | | | - Zhang Fujie
- Division of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mu Weiwei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, Beijing, China
| | - Li Yongzhen
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Lu Hongyan
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Zeng Xuemei
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Yiyao Barnoon
- Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
| | - Christopher J Gill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States.,Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Rachael Bonawitz
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States.,Department of Global Health, Boston University School of Public Health, Boston, MA, United States
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Ramos JV, Mmbaga BT, Turner EL, Rugalabamu LL, Luhanga S, Cunningham CK, Dow DE. Modality of Primary HIV Disclosure and Association with Mental Health, Stigma, and Antiretroviral Therapy Adherence in Tanzanian Youth Living with HIV. AIDS Patient Care STDS 2018; 32:31-37. [PMID: 29323556 DOI: 10.1089/apc.2017.0196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Disclosing HIV status to children before adolescence is a major challenge facing families and healthcare providers. This study used a mixed methods approach to explore the youth perspective of how youth living with HIV (YLHIV) found out their status and to quantify the association of disclosure modality with mental health, stigma, adherence, and HIV outcomes in adolescence. Youth 11-24 years of age attending adolescent HIV clinic in Moshi, Tanzania were included. Adolescents answered questions, including when and how they found out they had HIV, mental health surveys (nine-item Patient Health Questionnaire, Strengths and Difficulties Questionnaire, and modified University of California Los Angeles trauma screen), modified Berger's stigma scale, and self-reported adherence. HIV-1 RNA and latest CD4 were obtained. In-depth interviews were conducted using a convenience sample. The majority of youth reported that they found out their HIV status on their own (80%). Youth attending the government site were less likely to be purposefully told their HIV status compared with those attending the referral site (p < 0.01). Depressive and emotional/behavioral symptoms, internal stigma, and incomplete adherence were significantly more likely among those who figured out their HIV status on their own as compared with those who were purposefully told. Youth discussed how they figured out their HIV status on their own during in-depth interviews. These findings demonstrated that youth who figured out their HIV status on their own had increased mental health symptoms and worse adherence to antiretroviral therapy (ART). It is imperative to implement disclosure protocols in early childhood to reduce mental health difficulties, internal stigma, and promote ART adherence in YLHIV.
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Affiliation(s)
- Julia V. Ramos
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | - Severa Luhanga
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
| | - Coleen K. Cunningham
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Pediatrics, Infectious Diseases, Duke University, Durham, North Carolina
| | - Dorothy E. Dow
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Pediatrics, Infectious Diseases, Duke University, Durham, North Carolina
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Silva-Suárez G, Rabionet SE, Zorrilla CD. HIV normalization message and its implication on the lives of perinatally HIV-infected youth in Puerto Rico. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017; 8:241-246. [PMID: 33042232 DOI: 10.1111/jphs.12194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To examine the impact of the HIV normalization discourse on the life of a group of perinatally HIV-infected (pHIV-I) youth in Puerto Rico. Methods A qualitative research study was conducted to explore the life experiences of pHIV-I youth in Puerto Rico. Twenty in-depth interviews were carried out among 12 women and eight men aged 18 to 30 years. Questions focused primarily on their life experiences and the meaning they ascribe to HIV. Interviews were analyzed and interrelationships, connections and patterns were assessed. Findings Normalization messages were present in most of the participants' narratives. The majority considered their HIV diagnosis like "any other health condition" and most of them had a positive attitude towards life. When study participants positioned themselves from a social perspective, contradictions of normalization messages emerged. Some participants reported that because HIV is highly stigmatized, their rejections, discrimination and stigma experiences are different from those of patients with other chronic conditions. Those with HIV also face unique and difficult situations such as losing family members, dealing with a potentially fatal illness, and maintaining secrecy about their health conditions. Conclusion While the normalization discourse is very common in the medical field, it does not necessarily translate into the personal and social spheres of HIV-positive youth. Interventions to assist patients in dealing with the social implications of the HIV condition are still needed.
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Affiliation(s)
- Georgina Silva-Suárez
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, 00926 San Juan, Puerto Rico
| | - Silvia E Rabionet
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, 33314, Fort Lauderdale, FL & Department of Social Science, School of Public Health, University of Puerto Rico, Medical Sciences Campus, 00921 San Juan, Puerto Rico;
| | - Carmen D Zorrilla
- Department of Obstetrics and Gynecology, University of Puerto Rico, Medical Sciences Campus, 00921 San Juan, Puerto Rico;
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Pediatric HIV Disclosure Intervention Improves Knowledge and Clinical Outcomes in HIV-Infected Children in Namibia. J Acquir Immune Defic Syndr 2017; 75:18-26. [PMID: 28114186 PMCID: PMC5388570 DOI: 10.1097/qai.0000000000001290] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: Using routinely collected data, we evaluated a nationally implemented intervention to assist health care workers and caregivers with HIV disclosure to children. We assessed the impact of the intervention on child's knowledge and health outcomes. Methods: Data were abstracted from national databases and patient charts for HIV-infected children aged 7–15 years attending 4 high-volume HIV clinics in Namibia. Disclosure rates, time to disclosure, and HIV knowledge in 314 children participating in the intervention were analyzed. Logistic regression was used to identify correlates of partial vs. full disclosure. Paired t-tests and McNemar tests were used to compare adherence and viral load (VL) before versus after intervention enrollment. Results: Among children who participated in the disclosure intervention, 11% knew their HIV status at enrollment and an additional 38% reached full disclosure after enrollment. The average time to full disclosure was 2.5 years (interquartile range: 1.2–3 years). Children who achieved full disclosure were more likely to be older, have lower VLs, and have been enrolled in the intervention longer. Among children who reported incorrect knowledge regarding why they take their medicine, 83% showed improved knowledge after the intervention, defined as knowledge of HIV status or adopting intervention-specific language. On comparing 0–12 months before vs. 12–24 months after enrollment in the intervention, VL decreased by 0.5 log10 copies per milliliter (N = 42, P = 0.004), whereas mean adherence scores increased by 10% (N = 88, P value < 0.001). Conclusions: This HIV disclosure intervention demonstrated improved viral suppression, adherence, and HIV knowledge and should be considered for translation to other settings.
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Rochat TJ, Mitchell J, Lubbe AM, Stein A, Tomlinson M, Bland RM. Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa. Soc Sci Med 2017; 172:124-134. [PMID: 27881248 PMCID: PMC5224234 DOI: 10.1016/j.socscimed.2016.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/18/2016] [Accepted: 10/29/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Children's understanding of HIV and death in epidemic regions is under-researched. We investigated children's death-related questions post maternal HIV-disclosure. Secondary aims examined characteristics associated with death-related questions and consequences for children's mental health. METHODS HIV-infected mothers (N = 281) were supported to disclose their HIV status to their children (6-10 years) in an uncontrolled pre-post intervention evaluation. Children's questions post-disclosure were collected by maternal report, 1-2 weeks post-disclosure. 61/281 children asked 88 death-related questions, which were analysed qualitatively. Logistic regression analyses examined characteristics associated with death-related questions. Using the parent-report Child Behaviour Checklist (CBCL), linear regression analysis examined differences in total CBCL problems by group, controlling for baseline. RESULTS Children's questions were grouped into three themes: 'threats'; 'implications' and 'clarifications'. Children were most concerned about the threat of death, mother's survival, and prior family deaths. In multivariate analysis variables significantly associated with asking death-related questions included an absence of regular remittance to the mother (AOR 0.25 [CI 0.10, 0.59] p = 0.002), mother reporting the child's initial reaction to disclosure being "frightened" (AOR 6.57 [CI 2.75, 15.70] p=<0.001) and level of disclosure (full/partial) to the child (AOR 2.55 [CI 1.28, 5.06] p = 0.008). Controlling for significant variables and baseline, all children showed improvements on the CBCL post-intervention; with no significant differences on total problems scores post-intervention (β -0.096 SE1.366 t = -0.07 p = 0.944). DISCUSSION The content of questions children asked following disclosure indicate some understanding of HIV and, for almost a third of children, its potential consequence for parental death. Level of maternal disclosure and stability of financial support to the family may facilitate or inhibit discussions about death post-disclosure. Communication about death did not have immediate negative consequences on child behaviour according to maternal report. CONCLUSION In sub-Saharan Africa, given exposure to death at young ages, meeting children's informational needs could increase their resilience.
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Affiliation(s)
- Tamsen J Rochat
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa; Human and Social Development Research Programme, Human Sciences Research Council, South Africa; MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, South Africa; Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, United Kingdom.
| | - Joanie Mitchell
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
| | - Anina M Lubbe
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, United Kingdom; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ruth M Bland
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Royal Hospital for Sick Children, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Abdulrahman R, Stuard E, Vachon ME, Nicholas C, Neugebauer R, Hagmann SHF, Purswani MU. Predictors of Disclosure of Maternal HIV Status by Caregivers to their Children in an Inner-City Community in the United States. AIDS Behav 2017; 21:141-151. [PMID: 27011379 DOI: 10.1007/s10461-016-1372-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disclosure of HIV status to children is a challenge parents living with HIV face. To evaluate predictors of maternal HIV disclosure in a low-income clinic in the U.S. that serves an African American, Hispanic and immigrant population with high HIV prevalence, 172 caregivers with 608 children completed a standardized survey. Caregivers were 93 % female, 84 % biological mothers, and 34 % foreign born. Sixty-two (36 %) caregivers had at least one disclosed child, 42 of whom also had other nondisclosed children. Of all children, 581 (96 %) were uninfected and 181 (30 %) were disclosed. Caregiver's U.S. birth (OR: 2.32, 95 % CI 1.20-4.52), child's age (OR: 1.2/year, 95 % CI 1.16-1.24), and increased HIV-stigma perception by caregiver (1.06/point increase, 95 % CI 1.04-1.09) predicted disclosure. Children were more often disclosed if their caregiver was born in the U.S. or reported higher HIV-related stigma. These findings suggest that complex family context may complicate disclosure, particularly among immigrants.
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Affiliation(s)
- Rozan Abdulrahman
- Columbia University, Mailman School of Public Health, Environmental Health Department, New York, NY, USA.
| | - Emma Stuard
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Mary E Vachon
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Cate Nicholas
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
| | - Richard Neugebauer
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | | | - Murli U Purswani
- Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA
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de Vries DH, Koppen L, Lopez AM, Foppen R. The Vicious Cycle of Stigma and Disclosure in "Self-Management": A Study Among the Dutch HIV Population. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:485-498. [PMID: 27925490 DOI: 10.1521/aeap.2016.28.6.485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Though HIV has become a chronic disease, HIV-related stigma has remained. This article reports on a study that asked how Dutch people living with HIV-AIDS (PLWHA) experienced stigmatization and devised self-management strategies. We used qualitative findings from a survey questionnaire conducted among 468 Dutch HIV-positive people (3% of the population), using a stratified research sample. Findings show how respondents experience relatively high public (30%), self- (26%) and structural (15%) stigma. At the same time, results show the importance of selective disclosure as a self-management strategy. About half the respondents disclose selectively, while 16% does not disclose at all. We conclude that many Dutch PLHWA remain caught up in a vicious cycle of stigma and nondisclosure. To break the cycle, respondents point at the importance of stigma reduction campaigns using actual PLWHA. We highlight the importance of workplace programs and training of medical professionals.
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Affiliation(s)
- Daniel H de Vries
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands
| | - Luca Koppen
- Graduate School of Social Sciences, University of Amsterdam
| | | | - Reina Foppen
- HIV-Vereniging Nederland, Amsterdam, the Netherlands
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26
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Aderomilehin O, Hanciles-Amu A, Ozoya OO. Perspectives and Practice of HIV Disclosure to Children and Adolescents by Health-Care Providers and Caregivers in sub-Saharan Africa: A Systematic Review. Front Public Health 2016; 4:166. [PMID: 27570762 PMCID: PMC4981616 DOI: 10.3389/fpubh.2016.00166] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest prevalence of HIV globally, and this is due to persistent new HIV infections and decline in HIV/AIDS-related mortality from improved access to antiretroviral (ART) therapy. There is a limited body of work on perspectives of health-care providers (HCPs) concerning disclosing outcomes of HIV investigations to children and adolescents in SSA. Most studies are country-specific, indicating a need for a regional scope. OBJECTIVE To review the current literature on the perspectives of HCPs and caregivers of children and adolescents on age group-specific and culture-sensitive HIV disclosure practice. METHODS Electronic database search in PubMed, Google scholar, and the University of South Florida Library Discovery Tool (January 2006 up to February 2016). Further internet search was conducted using the journal author name estimator search engine and extracting bibliographies of relevant articles. Search terms included "disclosure*," "HIV guidelines," "sub-Saharan Africa," "clinical staff," "ART," "antiretroviral adherence," "people living with HIV," "pediatric HIV," "HIV," "AIDS," "health care provider," (HCP), "caregiver," "adolescent," "primary care physicians," "nurses," and "patients." Only studies related to HIV/AIDS disclosure, HCPs, and caregivers that clearly described perspectives and interactions during disclosure of HIV/AIDS sero-status to affected children and adolescents were included. Independent extraction of articles was conducted by reviewers using predefined criteria. Nineteen articles met inclusion criteria. Most studies were convenience samples consisting of combinations of children, adolescents, HCPs, and caregivers. Key findings were categorized into disclosure types, prevalence, facilitators, timing, process, persons best to disclose, disclosure setting, barriers, and outcomes of disclosure. CONCLUSION Partial disclosure is appropriate for children in SSA up to early adolescence. Caregivers should be directly involved in disclosing to children but they require adequate disclosure support from HCPs. Full disclosure is suitable for adolescents. Adolescents prefer disclosure by HCPs and they favor peer-group support from committed peers and trained facilitators, to reduce stigma. HCPs need continuous training and adequate resources to disclose in a patient-centered manner.
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Affiliation(s)
| | | | - Oluwatobi Ohiole Ozoya
- Department of Global Health, University of South Florida, Tampa, FL, USA
- Emergency and Trauma Center, Tampa General Hospital, Tampa, FL, USA
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van Rooyen H, Essack Z, Rochat T, Wight D, Knight L, Bland R, Celum C. Taking HIV Testing to Families: Designing a Family-Based Intervention to Facilitate HIV Testing, Disclosure, and Intergenerational Communication. Front Public Health 2016; 4:154. [PMID: 27547750 PMCID: PMC4974258 DOI: 10.3389/fpubh.2016.00154] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents, and adults who are not accessing health facilities. While home-based counseling and testing has been successfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated. METHODS The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence, and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention. RESULTS The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed, and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children, and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure, and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored. CONCLUSION This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents, and men could have significant impact, if the pilot is successful and scaled-up.
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Affiliation(s)
- Heidi van Rooyen
- Human and Social Development Program, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Zaynab Essack
- Human and Social Development Program, Human Sciences Research Council, Pietermaritzburg, South Africa
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Tamsen Rochat
- Human and Social Development Program, Human Sciences Research Council, Pietermaritzburg, South Africa
- Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
- Section of Child of Adolescent Psychiatry, Department of Psychiatry, Oxford University, Oxford, UK
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ruth Bland
- Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- University of Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Li H, Li X, Tso LS, Qiao S, Holroyd E, Zhou Y, Shen Z. HIV-negative children's experiences and opinions towards parental HIV disclosure: a qualitative study in China. VULNERABLE CHILDREN AND YOUTH STUDIES 2016; 11:173-179. [PMID: 30828354 PMCID: PMC6396297 DOI: 10.1080/17450128.2016.1159771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In HIV/AIDS research, few studies to date have evaluated ways to improve parental HIV disclosure practices using feedback from HIV negative children who have recently experienced this event. We conducted semi-structured in-depth interviews with 20 children (aged 6-15) who were partially to fully aware of their parents' HIV status in rural Guangxi, China. Of the 20 children, eight children who were of older age (11.38 years in average) endorsed parental HIV disclosure, five discouraged it, and seven expressed uncertainty. Children's different experiences and attitudes towards disclosure were seen to be associated with their family dynamics (especially the parent-child relationship), social support and care, experiences of stigma and discrimination, psychosocial suffering, comprehension of the disease, and the children's age. Our study contributes to building a child centered comprehensive understanding for Chinese parental HIV disclosure. It is imperative that counsellors and community advocates assess and help parents achieve optimal readiness preceding disclosure of their illness to their HIV negative children.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, Jinan,
Shandong, China
- UNC Project-China, Institute for Global Health &
Infectious Diseases, University of North Carolina at Chapel Hill, NC,USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South
Carolina, Columbia, SC, USA
| | - Lai Sze Tso
- UNC Project-China, Institute for Global Health &
Infectious Diseases, University of North Carolina at Chapel Hill, NC,USA
| | - Shan Qiao
- Arnold School of Public Health, University of South
Carolina, Columbia, SC, USA
| | - Eleanor Holroyd
- School of Health Sciences, RMIT University, Melbourne,
Australia
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning,
Guangxi, China
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning,
Guangxi, China
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29
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Van Rooyen HE, Strode AE, Slack CM. HIV testing of children is not simple for health providers and researchers: Legal and policy frameworks guidance in South Africa. S Afr Med J 2016; 106:37-9. [PMID: 27138658 PMCID: PMC5835667 DOI: 10.7196/samj.2016.v106i5.10484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 11/08/2022] Open
Abstract
Antiretroviral treatment coverage for children and adolescents is significantly lower than that for adults. A first step in improving this situation is ensuring increased access to HIV counselling and testing services. Current legal and policy frameworks outline four norms that should inform HIV testing of children in South Africa: limiting HIV testing to defined circumstances, and ensuring that consent is obtained, counselling is provided and confidentiality is maintained. Implementing these norms is not simple. We discuss the challenges and opportunities these norms present for children, their families, health providers and researchers working in this area. Better alignment between evolving public health approaches and the HIV counselling and testing legal/policy frameworks (and the internal coherence of domestic frameworks) would better serve children, their parents and those who work with them.
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Affiliation(s)
- Heidi Eve Van Rooyen
- Human and Social Development Programme, Human Sciences Research Council, Durban, South Africa.
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Prevalence and Correlates of HIV Disclosure Among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review. J Dev Behav Pediatr 2016; 37:496-505. [PMID: 27262128 PMCID: PMC5949066 DOI: 10.1097/dbp.0000000000000303] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Disclosure of HIV status among children and adolescents living with HIV has both beneficial and challenging aspects. To address existing knowledge gaps and update the literature on childhood disclosure, we conducted a systematic review on caregivers' perceptions and practices of HIV disclosure in low- and middle-income countries (LMICs). METHODS Standard databases were searched for studies conducted in LMICs, published in English between 2004 and 2015. Excluded articles were reviews or case reports, and those not reporting childhood disclosure. Data regarding prevalence, correlates and impact of disclosure, were presented as frequencies. RESULTS Two authors independently screened 982 articles. After applying eligibility criteria, 22 articles representing 12 countries and 2,843 children were reviewed. The proportion of fully disclosed children ranged from 1.7% to 41.0%. Up to 49.5% children were provided "deflected" information (use of a non-HIV-related reason for explaining illness and health care visits). Factors associated with full disclosure included antiretroviral treatment initiation and caregivers' felt need for maintaining optimal adherence. Barriers to disclosure included fear of negative psychological reactions and inadvertent disclosure to others. Caregivers perceived a strong need for active participation from health care providers to aid the process of disclosure. CONCLUSIONS Full disclosure of HIV status was not common among children and adolescents in LMICs, while the practice of deflected disclosure was prominent. Caregivers perceived the need for support from health care providers during the disclosure process. Evidence-based guidelines incorporating the developmental status of the child, locally prevalent cultures, and caregiver perceptions are prerequisite to enhancing disclosure in these settings.
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Gyamfi E, Okyere P, Appiah-Brempong E, Adjei RO, Mensah KA. Benefits of Disclosure of HIV Status to Infected Children and Adolescents: Perceptions of Caregivers and Health Care Providers. J Assoc Nurses AIDS Care 2015; 26:770-80. [PMID: 26324523 DOI: 10.1016/j.jana.2015.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/06/2015] [Indexed: 11/29/2022]
Abstract
The rate of disclosure of HIV status to infected children and adolescents remains low in developing countries. We used a mixed-method approach to determine the perceptions of caregivers and health care providers about the benefits of HIV status disclosure to infected children and adolescents and to assess the support needed by caregivers during disclosure. We recruited a convenience sample of 118 caregivers of HIV-infected children and adolescents for the quantitative component of the study and completed in-depth qualitative interviews with 10 purposefully sampled key informants, including health care providers and volunteer workers. The main benefits of disclosure included improved medication adherence and healthier, more responsible adolescent sexual behavior. The main supports required by caregivers during disclosure included biomedical information, emotional and psychological support, and practical guidelines regarding disclosure. We confirmed the importance of disclosure to HIV-infected children and adolescents and the need to develop culturally specific disclosure guidelines.
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Watermeyer J. 'Are we allowed to disclose?': a healthcare team's experiences of talking with children and adolescents about their HIV status. Health Expect 2015; 18:590-600. [PMID: 24112299 PMCID: PMC5060803 DOI: 10.1111/hex.12141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Talking with a child about their HIV status is a complex, emotionally laden and difficult task for caregivers and healthcare providers. Disclosure is an important process which may have psychosocial and health benefits. Despite existing guidelines and materials, disclosure does not always happen for various reasons. OBJECTIVE This qualitative study explored a healthcare team's perspectives and experiences about disclosure practices. METHODS Three focus groups were conducted with a total of 23 healthcare providers at a paediatric clinic in South Africa. The data were analysed using principles of thematic analysis. RESULTS Results confirm the complexity of the disclosure process and highlight confusion, hesitancy and ethical dilemmas regarding disclosure practices. Tensions were noted within the team which seem linked to professional hierarchies. Counsellors and nurses preferred an indirect approach of encouraging caregivers to disclose to their children and providing psychosocial support, while doctors tended to become more directly involved in disclosing to children out of a sense of duty, legal responsibilities and knowledge of the child's rights. DISCUSSION AND CONCLUSIONS This study demonstrates how the complexities of disclosure with children and adolescents bring about additional challenges for healthcare teams. The legal and ethical implications as well as the roles and responsibilities of healthcare providers with disclosure remain unclear. Several recommendations for practice and policy emerge from this study, related particularly to the need for clarification of disclosure guidelines and legal implications. Implications for the healthcare team are also discussed.
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Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research UnitSchool of Human and Community DevelopmentUniversity of the WitwatersrandJohannesburgSouth Africa
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Penn C. 'Too much for one day': a case study of disclosure in the paediatric HIV/AIDS clinic. Health Expect 2015; 18:578-89. [PMID: 24118752 PMCID: PMC5060797 DOI: 10.1111/hex.12140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite acknowledgement of the complexity and challenges of the process of disclosure of HIV status to adolescents, little work has been carried out on the communication features which facilitate or hinder the process. This qualitative case study reflects the interactional dynamics of an interaction between caregiver, physician and counsellor around the topic of disclosure in a South African clinic. METHODS A 40-minute encounter between a doctor, the grandmother of an adolescent with HIV/AIDS and a counsellor around the process of disclosure was transcribed and examined in detail in relation to its structure, topics, timing and sequence as well as its movement towards a collaborative ending. Analysis was based on elements of conversational and thematic analysis. RESULTS The session was characterized by distinct stages and the emergence of multiple voices and perspectives from the participants. The negotiated management of the session sheds light on multiple barriers to care as well as the influence of contextual factors on the process. The important mediating role of the counsellor in the triad emerges. The analysis highlights both unique features of the consultation and common challenges to clinicians when disclosing. DISCUSSION AND CONCLUSIONS The task of disclosure is complex and intricate. Results suggest team processes are critical, as are temporal and contextual factors and the need for an understanding of communication. Implications for the clinic team are discussed and suggestions made for the development of collaborative partnership based on an understanding of roles and responsibilities, time factors and enhancement of features such as trust and communication.
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Affiliation(s)
- Claire Penn
- Health Communication Research UnitSchool of Human and Community DevelopmentUniversity of the WitwatersrandJohannesburgSouth Africa
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Nurse-delivered counselling intervention for parental HIV disclosure: results from a pilot randomized controlled trial in China. AIDS 2015; 29 Suppl 1:S99-S107. [PMID: 26049544 DOI: 10.1097/qad.0000000000000664] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to design and conduct a preliminary evaluation of an intervention to assist parents in decision-making about disclosure of their HIV diagnosis to their children. DESIGN This was a pilot randomized controlled trial (RCT) with blinded assessment. Participants were randomized to intervention or treatment-as-usual (TAU) arms. SETTING The study occurred at an outpatient HIV primary care centre in Shanghai, China. PARTICIPANTS Participants were 20 HIV-positive outpatients with at least one child (13-25 years old) who was unaware of the parent's HIV diagnosis. INTERVENTION The nurse-delivered intervention involved three, hour-long, individual sessions over 4 weeks. Intervention content comprised family assessment, discussion of advantages and disadvantages of disclosure, psycho-education about cognitive, social and emotional abilities of children at different developmental stages, and disclosure planning and practicing via role-plays. MAIN OUTCOME MEASURE(S) Primary study outcomes for intervention versus TAU arms were self-reported disclosure distress, self-efficacy, and behaviours along a continuum from no disclosure to full disclosure and open communication about HIV. RESULTS In all cross-sectional (Wald tests) and longitudinal (general estimating equations) analyses, at both postintervention (4 weeks) and follow-up (13 weeks), effects were in the hypothesized directions. Despite the small sample size, most of these between-arm comparisons were statistically significant, with at least one result for each outcome indicating a 'large' effect size. CONCLUSION Our results suggest that nurses are able to deliver a counselling intervention in a clinic setting with the potential to alleviate parental distress around HIV disclosure to their children. Findings warrant future trials powered for efficacy.
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Abstract
With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this potential, children must navigate normative developmental processes and challenges while living with an unusually complex, stigmatizing, potentially fatal chronic illness and meeting the demands of treatment.Yet many of these children, especially preadolescents, do not know they are HIV-infected. Despite compelling evidence supporting the merits of informing children of their HIV status, there has been little emphasis on equipping the child's caregiver with information and skills to promote disclosure, particularly, when the caregiver faces a variety of sociocultural barriers and is reluctant to do so. In this study, we present the background, process and methods for a first of its kind collaboration that is examining the efficacy of an intervention developed to facilitate the engagement of caregivers in the process of disclosure in a manner suitable to the sociocultural context and developmental age and needs of the child in Ghana. We also report preliminary data that supported the design of the intervention approach and currently available domains of the data system. Finally, we discuss challenges and implications for future research.
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Growing-up just like everyone else: key components of a successful pediatric HIV disclosure intervention in Namibia. AIDS 2015; 29 Suppl 1:S81-9. [PMID: 26049542 DOI: 10.1097/qad.0000000000000667] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To facilitate replication and adaptation of pediatric HIV disclosure interventions, we identified key components of a child-friendly cartoon book used to guide Namibian caregivers and healthcare workers (HCWs) through a gradual, structured disclosure process. DESIGN Qualitative interviews were conducted with caregivers and HCWs from four high-volume pediatric HIV clinics in Namibia. METHODS Semi-structured in-depth interviews with 35 HCWs and 64 caregivers of HIV+ children aged 7-15 were analyzed using constant comparative and modified grounded theory analysis. Major barriers to disclosure were compared to accounts of intervention success, and themes related to key components were identified. RESULTS The disclosure book overcomes barriers to disclosure by reducing caregiver resistance, increasing HIV and disclosure knowledge, and providing a gradual, structured framework for disclosure. The delayed mention of HIV-specific terminology overcomes caregiver fears associated with HIV stigma, thus encouraging earlier uptake of disclosure initiation. Caregivers value the book's focus on staying healthy, keeping the body strong, and having a future 'like other kids', thus capitalizing on evidence of the positive benefits of resilience and hopefulness rather than the negative consequences of HIV. The book's concepts and images resonate with children who readily adopt the language of 'body soldiers' and 'bad guys' in describing how important it is for them to take their medicine. Discussion cues ease communication between HCWs, caregivers, and pediatric patients. CONCLUSION Given the urgent need for available pediatric HIV disclosure interventions, easily implementable tools like the Namibian disclosure book should be evaluated for utility in similar settings.
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'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. AIDS 2015; 29 Suppl 1:S57-65. [PMID: 26049539 DOI: 10.1097/qad.0000000000000695] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve antiretroviral therapy (ART) adherence. However, quantitative evidence remains limited for adolescents. This study examines associations between adolescent knowledge of HIV-positive status and ART-adherence in South Africa. DESIGN A cross-sectional study of the largest known community-traced sample of HIV-positive adolescents. Six hundred and eighty-four ART-initiated adolescents aged 10-19 years (52% female, 79% perinatally infected) were interviewed. METHODS In a low-resource health district, all adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced to 150 communities [n = 1102, 351 excluded, 27 deceased, 40 (5.5%) refusals]. Quantitative interviews used standardized questionnaires and clinic records. Quantitative analyses used multivariate logistic regressions, and qualitative analyses used grounded theory for 18 months of interviews, focus groups and participant observations with 64 adolescents, caregivers and healthcare workers. RESULTS About 36% of adolescents reported past-week ART nonadherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms [odds ratio (OR) 0.55; 95% CI 0.40-0.76]. Adolescent knowledge of HIV-positive status was associated with higher adherence, independently of all cofactors (OR 2.18; 95% CI 1.47-3.24). Among perinatally infected adolescents who knew their status (n = 362/540), disclosure prior to age 12 was associated with higher adherence (OR 2.65; 95% CI 1.34-5.22). Qualitative findings suggested that disclosure was undertaken sensitively in clinical and family settings, but that adults lacked awareness about adolescent understandings of HIV status. CONCLUSION Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission.
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"If I take my medicine, I will be strong: " evaluation of a pediatric HIV disclosure intervention in Namibia. J Acquir Immune Defic Syndr 2015; 68:e1-7. [PMID: 25296096 PMCID: PMC4262649 DOI: 10.1097/qai.0000000000000387] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite known benefits, only a small proportion of HIV-infected children in sub-Saharan Africa know their status and limited disclosure interventions exist. Namibia's Ministry of Health and Social Services developed and implemented a multipronged intervention to support health care workers (HCWs) and caregivers in the disclosure process. METHODS The intervention included a staged disclosure cartoon book, child and caregiver readiness assessment tools, a monitoring form to track progress over visits, and HCW training curriculum. We conducted qualitative interviews with 35 HCWs and 46 caregivers of HIV-positive children at 4 high volume HIV clinics. Interviews elicited detailed information about intervention uptake and impact. HCWs also participated in a self-efficacy survey. RESULTS The intervention improved HCW and caregiver confidence and communication skills in pediatric disclosure. The most valuable intervention component was the disclosure cartoon book, which provided structure, language, and guidance for a gradual disclosure process. HCWs reported it greatly reduced caregiver resistance to disclosure. Both caregivers and HCWs reported improved knowledge and ability to support the pediatric patient, improved child understanding of how HIV medications work, increased child hopefulness for their future, and improved child adherence to care and treatment. HCW self-efficacy surveys found that HCWs who received training felt more confident in their ability to engage in the disclosure process. CONCLUSIONS HCWs and caregivers highly endorsed the intervention. Given the urgency to address pediatric HIV disclosure in Africa, and the utility and low cost of the locally-produced disclosure tool, this approach may be useful in other similar settings.
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Nyogea D, Mtenga S, Henning L, Franzeck FC, Glass TR, Letang E, Tanner M, Geubbels E. Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study. BMC Infect Dis 2015; 15:28. [PMID: 25637106 PMCID: PMC4314748 DOI: 10.1186/s12879-015-0753-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022] Open
Abstract
Background Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania. Methods We applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis. Results Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence. Conclusion The study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.
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Affiliation(s)
- Daniel Nyogea
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Sally Mtenga
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania.
| | - Lars Henning
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University Hospital of Zurich, Zürich, Switzerland.
| | - Fabian C Franzeck
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Emilio Letang
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Marcel Tanner
- Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Li X, Qiao S, de Wit J, Sherr L. What's in the telling? Understanding social, psychological and clinical aspects of HIV disclosure. AIDS Care 2015; 27 Suppl 1:1-5. [PMID: 26616120 PMCID: PMC4685618 DOI: 10.1080/09540121.2015.1102687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaoming Li
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - John de Wit
- Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lorraine Sherr
- Research Department of Infection & Population Health, University College London, London, UK
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Communication between HIV-infected children and their caregivers about HIV medicines: a cross-sectional study in Jinja district, Uganda. J Int AIDS Soc 2014; 17:19012. [PMID: 25005046 PMCID: PMC4087168 DOI: 10.7448/ias.17.1.19012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Knowledge of antiretroviral therapy (ART) among children with HIV depends on open communication with them about their health and medicines. Guidelines assign responsibility for communication to children's home caregivers. Other research suggests that communication is poor and knowledge about ART is low among children on treatment in low-income countries. This study sought to describe communication about medicine for HIV in quantitative terms from the perspectives of both children and caregivers. Thereafter, it established the factors associated with this communication and with children's knowledge about their HIV medicines. Methods We undertook a cross-sectional survey of a random sample of 394 children with HIV on treatment and their caregivers at nine health facilities in Jinja District, Uganda. We assessed reported frequency and content of communication regarding their medicines as well as knowledge of what the medicines were for. Logistic regression analysis was used to determine the factors associated with communication patterns and children's knowledge of HIV medicines. Results Although 79.6% of the caregivers reported that they explained to the children about the medicines, only half (50.8%) of the children said they knew that they were taking medicines for HIV. Older children aged 15–17 years were less likely to communicate with a caregiver about the HIV medicines in the preceding month (OR 0.5, 95% CI 0.3–0.7, p=0.002). Children aged 11–14 years (OR 6.1, 95% CI 2.8–13.7, p<0.001) and 15–17 years (OR 12.6, 95% CI 4.6–34.3, p<0.001) were more likely to know they were taking medicines for HIV compared to the younger ones. The least common reported topic of discussion between children and caregivers was “what the medicines are for” while “the time to take medicines” was by far the most mentioned by children. Conclusions Communication about, and knowledge of, HIV medicines among children with HIV is low. Young age (less than 15 years) was associated with more frequent communication. Caregivers should be supported to communicate diagnosis and treatment to children with HIV. Age-sensitive guidelines about the nature and content of communication should be developed.
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Mumburi LP, Hamel BC, Philemon RN, Kapanda GN, Msuya LJ. Factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Pan Afr Med J 2014; 18:50. [PMID: 25368739 PMCID: PMC4215360 DOI: 10.11604/pamj.2014.18.50.2307] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/02/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION With the introduction of antiretroviral drugs HIV-infected children live longer. Disclosure of HIV diagnosis is increasingly an important and inevitable issue. Both healthcare providers and caregivers face challenges of disclosure to children. The objective of the study was to explore factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC). METHODS A cross-sectional hospital-based study was conducted from October 2011 to April 2012. Study population included HIV-infected children aged 5 to 14 years, their caregivers and healthcare providers. Structured questionnaires were used to collect information. Children were asked the reason for hospital visits. Outcome of interest was HIV disclosure status. Data was processed and analysed using SPSS version 16.0. Multivariate logistic regression at 5% margin error was used to account for confounders. RESULTS A total of 211 children were enrolled with mean age of 9.7 (SD±2.6; range 5-14) years. Only 47 (22.3%) children knew their HIV-status. The mean age of disclosure was 10.6 years. Most of disclosed children were aged above 10 years (p). CONCLUSION Most of children were not disclosed. Ages, self medication, getting other support and parents/caregivers prior discussion were strong predictors of disclosure status.
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Affiliation(s)
- Livin Peter Mumburi
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania
| | | | | | | | - Levina January Msuya
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania
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Sirikum C, Sophonphan J, Chuanjaroen T, Lakonphon S, Srimuan A, Chusut P, Do TC, Prasitsuebsai W, Puthanakit T, Ananworanich J, Bunupuradah T. HIV disclosure and its effect on treatment outcomes in perinatal HIV-infected Thai children. AIDS Care 2014; 26:1144-9. [PMID: 24625136 DOI: 10.1080/09540121.2014.894614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The World Health Organization guideline recommends informing children of their HIV status between the ages of 6-12 years. Primary caregivers of perinatal HIV-infected Thai children ≥6 years were interviewed in order to assess the HIV status disclosure rate. In addition, pill counts of antiretroviral therapy (ART) were performed every three months. CD4 and HIV-RNA were performed every six months. Of the 260 children/adolescents included, the median age of disclosure was 14.8 years. The disclosure rate among those from 6 to 12 years was 21% and for those greater than 12 years of age was 84%. When comparing children aged 6-12 years whose HIV status had been disclosed to them, to children whose HIV had yet to be disclosed, no difference was noted in median ART adherence by pill count, CD4 count, or proportion of HIV-RNA <50 copies/ml (p > 0.05). Factors associated with HIV disclosure were an age of ≥12 years (OR 17.8, 95% CI 8.86-35.79) and a current CD4 ≤ 30% (OR 2.09, 95% CI 1.20-3.62). In conclusion, although the majority of adolescents ≥12 years were aware of their HIV status only one-fifth of children aged 6-12 years were aware. Moreover, the child's/adolescent's disclosure status had no bearing on ART adherence by pill count or immunological and virological outcomes.
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Affiliation(s)
- Chompoonoot Sirikum
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Center , Bangkok , Thailand
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Mburu G, Hodgson I, Kalibala S, Haamujompa C, Cataldo F, Lowenthal ED, Ross D. Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes. J Int AIDS Soc 2014; 17:18866. [PMID: 24629845 PMCID: PMC3956312 DOI: 10.7448/ias.17.1.18866] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/07/2014] [Accepted: 01/20/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS In 2010, we conducted a qualitative study among adolescents aged 10-19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents' disclosure of their status to others; and the impact of both forms of disclosure on adolescents. RESULTS Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents' disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents' sexual relationships, although it did not always lead to rejection. CONCLUSIONS There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.
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Affiliation(s)
- Gitau Mburu
- International HIV/AIDS Alliance, Hove, UK; Division of Health Research, Lancaster University, UK;
| | - Ian Hodgson
- Center for Global Health, Trinity College, Dublin, Ireland, UK
| | | | | | - Fabian Cataldo
- Research Department, Dignitas International, Zomba, Malawi
| | - Elizabeth D Lowenthal
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, PA, USA; Children's Hospital of Philadelphia, PA, USA
| | - David Ross
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Cantrell K, Patel N, Mandrell B, Grissom S. Pediatric HIV disclosure: a process-oriented framework. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:302-314. [PMID: 23837808 DOI: 10.1521/aeap.2013.25.4.302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As children with vertically transmitted human immunodeficiency virus (HIV) infection live into adulthood, caregivers face the stressful process of informing their children about their infection. Although developmentally guided disclosure of HIV status is widely recommended, there are few specific frameworks to guide caregivers, families, and health care providers through the disclosure process. The authors propose a process-oriented framework for the disclosure of HIV in children and adolescents. This educational framework incorporates Piaget's cognitive development theory in an attempt to disclose and assist children and adolescents in understanding their HIV status. The framework is organized into 10 sequential stages of disclosure and three assessment stages in which health care providers discuss HIV health concepts with the child and caregiver, based on the child's developmental readiness. The described framework can be easily replicated by health care providers in disclosing disease status to children with HIV.
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Affiliation(s)
- Kathryn Cantrell
- Child Life Program, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Turissini ML, Nyandiko WM, Ayaya SO, Marete I, Mwangi A, Chemboi V, Warui L, Vreeman RC. The Prevalence of Disclosure of HIV Status to HIV-Infected Children in Western Kenya. J Pediatric Infect Dis Soc 2013; 2:136-43. [PMID: 26619460 DOI: 10.1093/jpids/pit024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 03/14/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND As antiretroviral therapy (ART) allows the world's 2.3 million human immunodeficiency virus (HIV)-infected children to grow and thrive, these children need to be informed of their HIV status. Neither the prevalence of disclosure to children nor its impact has been evaluated in most resource-limited settings. METHODS We conducted a prospective assessment of a random sample of HIV-infected children ages 6-14 years enrolled in HIV care at a large referral clinic in Eldoret, Kenya. Clinicians administered questionnaires to children and caregivers independently at routine clinic visits to assess disclosure status, ART adherence, stigma, and depression. Children's demographic and clinical characteristics were extracted from chart review. We calculated descriptive statistics and performed logistic regression to assess the association between disclosure and other characteristics. RESULTS Two hundred seventy children-caregiver dyads completed questionnaires. The mean child age was 9.3 years (standard deviation 2.6); 49% were male, and 42% were orphans. 11.1% of children had been informed of their HIV status (N = 30). Of those under 10 years, 3.3% knew their status, whereas 9.2% of 10- to 12-year-olds and 39.5% of 13- to 14-year-olds knew they had HIV. Only age was significantly associated with disclosure status in both bivariate analyses (P < .0001) and multiple logistic regression (odds ratio 1.67, 95% confidence interval 1.36-2.05) when considering social demographics, disease stage variables, adherence, stigma measures, and depression. CONCLUSIONS Rates of informing children in western Kenya of their HIV status are low, even among older children. Guiding families through developmentally appropriate disclosure processes should be a key facet of long-term pediatric HIV management.
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Affiliation(s)
- Matthew L Turissini
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership
| | - Winstone M Nyandiko
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Samuel O Ayaya
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Irene Marete
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Ann Mwangi
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Victor Chemboi
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership
| | - Lucy Warui
- United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership
| | - Rachel C Vreeman
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership
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Disclosure of HIV status to children in resource-limited settings: a systematic review. J Int AIDS Soc 2013; 16:18466. [PMID: 23714198 PMCID: PMC3665848 DOI: 10.7448/ias.16.1.18466] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 05/01/2013] [Indexed: 12/04/2022] Open
Abstract
Introduction Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact. Methods MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. Results Thirty-two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one-time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART) improved post-disclosure but the emotional and psychological effects of disclosure were variable. Conclusions Most studies show that a minority of HIV-infected children in resource-limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age- and culture-appropriate disclosure in resource-limited settings.
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Rochat TJ, Mkwanazi N, Bland R. Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention. BMC Public Health 2013; 13:147. [PMID: 23418933 PMCID: PMC3599138 DOI: 10.1186/1471-2458-13-147] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
Abstract
Background As access to treatment increases, large numbers of HIV-positive parents are raising HIV-negative children. Maternal HIV disclosure has been shown to have benefits for mothers and children, however, disclosure rates remain low with between 30-45% of mothers reporting HIV disclosure to their children in both observational and intervention studies. Disclosure of HIV status by parent to an HIV-uninfected child is a complex and challenging psychological and social process. No intervention studies have been designed and tested in Southern Africa to support HIV-positive parents to disclose their status, despite this region being one of the most heavily affected by the HIV epidemic. Method This paper describes the development of a family-centred, structured intervention to support mothers to disclose their HIV status to their HIV-negative school-aged children in rural South Africa, an area with high HIV prevalence. The intervention package includes printed materials, therapeutic tools and child-friendly activities and games to support age-appropriate maternal HIV disclosure, and has three main aims: (1) to benefit family relationships by increasing maternal HIV disclosure; (2) to increase children’s knowledge about HIV and health; (3) to improve the quality of custody planning for children with HIV-positive mothers. We provide the theoretical framework for the intervention design and report the results of a small pilot study undertaken to test its acceptability in the local context. Results The intervention was piloted with 24 Zulu families, all mothers were HIV-positive and had an HIV-negative child aged 6–9 years. Lay counsellors delivered the six session intervention over a six to eight week period. Qualitative data were collected on the acceptability, feasibility and the effectiveness of the intervention in increasing disclosure, health promotion and custody planning. All mothers disclosed something to their children: 11/24 disclosed fully using the words "HIV" while 13/24 disclosed partially using the word "virus". Conclusion The pilot study found the intervention was feasible and acceptable to mothers and counsellors, and provides preliminary evidence that participation in the intervention encouraged disclosure and health promotion. The pilot methodology and small sample size has limitations and further research is required to test the potential of this intervention. A larger demonstration project with 300 families is currently underway.
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Affiliation(s)
- Tamsen J Rochat
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa, and Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
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Hogwood J, Campbell T, Butler S. I wish I could tell you but I can't: adolescents with perinatally acquired HIV and their dilemmas around self-disclosure. Clin Child Psychol Psychiatry 2013; 18:44-60. [PMID: 22287554 DOI: 10.1177/1359104511433195] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many young people growing up with HIV are choosing not to disclose their status to others, yet are likely to face difficult decisions and conversations such as explaining school absence, taking medication, coping with physical changes and for many, parental bereavement. This study aims to describe and explore the attitudes and opinions of adolescents with perinatally acquired HIV towards disclosure. Semi-structured interviews were conducted with nine young people aged 13-19 and analysed using Interpretative Phenomenological Analysis. Four themes emerged to illuminate the young people's attitudes towards disclosure. These were 1) myths and assumptions, 2) the disclosure dilemma, 3) fear and 4) keeping HIV in its place. This study confirms that many young people with HIV are choosing not to disclose. However, it appears that it is a complex decision-making process that changes over time and is influenced by developmental factors and societal attitudes towards HIV. Recommendations are suggested for services to better support adolescents growing up with HIV.
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Affiliation(s)
- Jemma Hogwood
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
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