1
|
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.
Collapse
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
| |
Collapse
|
2
|
Ernst M, Klamer B, Thompson N, Alpert S, Dajusta D, Fuchs M, McLeod D, Jayanthi R, Ching C. Caregiver disclosure of common early childhood pediatric urologic surgeries. J Pediatr Urol 2023; 19:522.e1-522.e8. [PMID: 36898864 DOI: 10.1016/j.jpurol.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Certain pediatric urologic diagnoses can have serious long-term adverse health outcomes. As a result, it is important for a child to be aware of their diagnosis and a prior surgery. When children have surgery prior to the age of memory formation, it is incumbent upon their caregiver to disclose this surgery. When and how to disclose this information and even if this occurs, is not clear. OBJECTIVE We developed a survey to assess caregiver plans to disclose early childhood pediatric urologic surgery and evaluate for predictors of disclosure and resources needed. METHODS A questionnaire was distributed to caregivers of male children ≤4 years old undergoing single stage repair of hypospadias, inguinal hernia, chordee, or cryptorchidism as part of an IRB approved research study. These surgeries were chosen due to being outpatient surgeries with potential long-term complications and impact. The age criteria was chosen due to likely being before patient memory formation and thus reliance on caregiver disclosure of prior surgery. Surveys were collected the day of surgery and contained information on caregiver demographics, validated health literacy screening, and plans to disclose surgery. RESULTS 120 survey responses were collected (Summary Table). The majority of caregivers responded affirmatively to planning to disclose their child's surgery (108; 90%). There was no impact of caregiver age, gender, race, marital status, education level, health literacy, or personal surgical history on plans to disclose surgery (p ≥ 0.05). Plan to disclose was also not different across urologic surgery type. Race was significantly associated with being "concerned or nervous about disclosing the surgery to the patient". The median patient age for planned disclosure was 10 years (IQR: 7-13). Only 17 respondents (14%) stated they received any information about how to discuss this surgery with the patient, however 83 (69%) felt this information would be helpful. CONCLUSIONS Our study suggests that most caregivers plan to discuss early childhood urologic surgeries with children, however want further guidance in how to talk to their child. While no specific surgery or demographic factor was found to be significantly associated with plans to disclose surgery, it is concerning that one in ten patients will potentially never learn about impactful surgery they had as a child. There is an opportunity for us to better counsel our patients' families about surgical disclosure and fill this gap with quality improvement efforts.
Collapse
Affiliation(s)
- Michael Ernst
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Brett Klamer
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Nora Thompson
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Seth Alpert
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daniel Dajusta
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Molly Fuchs
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daryl McLeod
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rama Jayanthi
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Christina Ching
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| |
Collapse
|
3
|
Kitetele FN, Dageid W, Lelo GM, Akele CE, Lelo PVM, Nyembo PL, Tylleskär T, Kashala-Abotnes E. HIV Disclosure to Infected Children Involving Peers: A New Take on HIV Disclosure in the Democratic Republic of Congo. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1092. [PMID: 37508590 PMCID: PMC10377987 DOI: 10.3390/children10071092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023]
Abstract
Appropriately informing HIV-infected children of their diagnosis is a real challenge in sub-Saharan Africa. Until now, there is no consensus on who ought to disclose and how to disclose. This paper describes the model for HIV status disclosure in which HIV-positive children/adolescents are informed about their diagnosis in a process conducted by young peers under healthcare worker (HCW) supervision in a hospital in Kinshasa, the Democratic Republic of Congo. This new take on HIV status disclosure involving peers includes four stages that help the trained peer supporters to provide appropriate counseling, taking into account the age and level of maturity of the child/adolescent: the preliminary stage, the partial disclosure stage, the full disclosure stage, and the post-disclosure follow-up stage. Of all children/adolescents whose HIV status disclosure data were documented at Kalembelembe Pediatric Hospital (KLLPH) between 2004 and 2016, we found that disclosure by peers was highly accepted by parents, children/adolescents, and health workers. Compared to children/adolescents disclosed to by HCWs or parents, children/adolescents disclosed to by peers had (a) fewer depressive symptoms reported, (b) better drug adherence resulting in higher viral load suppression, and (c) a higher proportion of survivors on treatment. We found that involving peers in the disclosure process of HIV is an important approach to ensure adherence to treatment, resilience, and mental wellbeing of HIV-infected children/adolescents.
Collapse
Affiliation(s)
- Faustin Nd Kitetele
- Department of Infectious Diseases, Kalembelembe Pediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
- Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Wenche Dageid
- Faculty of Psychology, University of Bergen, 5020 Bergen, Norway
| | - Gilbert M Lelo
- Centre Neuro-Psycho-Pathologique de Kinshasa (CNPP), University of Kinshasa, Kinshasa 012, Democratic Republic of the Congo
| | - Cathy E Akele
- Department of Infectious Diseases, Kalembelembe Pediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
| | - Patricia V M Lelo
- Department of Infectious Diseases, Kalembelembe Pediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
- Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Patricia L Nyembo
- Programme National de Lutte Contre le SIDA, Kinshasa 012, Democratic Republic of the Congo
| | - Thorkild Tylleskär
- Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Espérance Kashala-Abotnes
- Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| |
Collapse
|
4
|
van der Brug M, Wojtkowiak J, Hango VN. Caregiver-child communication on parental loss in the context of the AIDS epidemic in Namibia. DEATH STUDIES 2023; 48:293-302. [PMID: 37296529 DOI: 10.1080/07481187.2023.2219647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Personal grief takes place in a social context, such as the family setting. This study aimed to understand how Namibian caregivers and children/adolescents communicate parental loss, in the context of the HIV/AIDS epidemic. An ethnographic design was used, in which 38 children, adolescents, and their caregivers were interviewed. The results show that caregivers shared few memories and provided minimal information about the deceased parents. However, the majority of adolescents and children wished for information. A relational Sender-Message-Channel-Receiver model was used to map the reasons for this silence. This model is useful for grief interventions that aim to strengthen communication.
Collapse
|
5
|
Kairania R, Onyango-Ouma W, Ondicho TG, Kagaayi J, Kigozi G. 'Mummy told me that I have HIV, that is the only thing she told me': Experiences of HIV status disclosure to children in Masaka Region, Uganda. PLoS One 2023; 18:e0285990. [PMID: 37224132 DOI: 10.1371/journal.pone.0285990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), disclosure of HIV status to children remains low. Few studies have examined how children navigate and come to terms with their HIV status. The aim of this study was to explore experiences of children about disclosure of their HIV status. METHODS Between October 2020 and July 2021, 18 purposively selected children aged between 12-17 whose HIV status had been disclosed to them by their caregivers or healthcare providers (HCPs) were recruited for this study. We conducted 18 in-depth interviews (IDIs) to collect data for this study. Data were analyzed using the semantic thematic analysis approach. RESULTS Primary data obtained through IDIs revealed that disclosure of HIV status to children occurred as a one-time event without pre-disclosure preparatory planning or focused post disclosure follow-up counseling irrespective of the discloser. Post disclosure psycho-social experiences elicited mixed responses. Some children experienced insults and belittlement and stigma and discrimination in the family and community for out-of-school children and at school for school-going children. Positive disclosure experiences involved receiving support to improve ART adherence through constantly being reminded to take their medications timely at the workplace, by supervisors, for working children and by teachers, at school for school-going children. CONCLUSIONS This research contributes to knowledge about children' s experiences of being HIV infected and can specifically be used to improve disclosure strategies.
Collapse
Affiliation(s)
- Robert Kairania
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
- Rakai Heath Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Washington Onyango-Ouma
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Tom G Ondicho
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Joseph Kagaayi
- Rakai Heath Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Godfrey Kigozi
- Rakai Heath Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| |
Collapse
|
6
|
Kairania R, Onyango-Ouma W, Ondicho TG. Socio-Cultural Influencers of Disclosure of HIV Status to Children on Antiretroviral Therapy in the Masaka Region, Uganda: A Qualitative Study. J Int Assoc Provid AIDS Care 2023; 22:23259582231163695. [PMID: 36972496 PMCID: PMC10052469 DOI: 10.1177/23259582231163695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
This study explored sociocultural influencers of disclosure of HIV status to children taking daily antiretroviral therapy (ART) in the Masaka region, Uganda using data collected from 26 key informant interviews with caregivers between October 2020 and July 2021. The findings revealed both positive and negative sociocultural influencers of disclosure. Beliefs that disclosure cultivates responsibility in the child to improve ART adherence and the culture of routine sexual health education conversations with children were positive socio-cultural influencers. Beliefs that disclosure increases children's loss of hope in life and breaks confidentiality with children inadvertently disclosing their HIV status to others leading to discrimination and social rejection, were key negative sociocultural influencers. These findings suggest a need for socio-culturally informed interventions that target caregiver negative socio-cultural disclosure influencers in this setting through contextualized sensitization and training to prepare children taking daily ART to receive disclosure progressively.
Collapse
Affiliation(s)
- Robert Kairania
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
- Uganda Virus Research Institute, 561068Rakai Health Sciences Program, Entebbe, Uganda
| | - Washington Onyango-Ouma
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
| | - Tom G Ondicho
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
| |
Collapse
|
7
|
Kitetele FN, Lelo GM, Akele CE, Lelo PVM, Mafuta EM, Tylleskär T, Kashala-Abotnes E. “The Peer Educator Is the Game-Changer of My Life”: Perceptions of Adolescents Living with HIV in DR Congo on Involving Peer Educators in the Process of HIV Disclosure. CHILDREN 2022; 9:children9081239. [PMID: 36010129 PMCID: PMC9406301 DOI: 10.3390/children9081239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022]
Abstract
Several approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the possible roles that other individuals might play in the process of disclosure. This article assesses the perceptions of adolescents living with HIV (ALHIV) about disclosure done by parents, guardians, HCWs, peer educators in the role of peer supporters, accidentally or by self-discovery, and the subsequent effects of disclosure method on their mental health. We used a qualitative study to conduct semi-structured interviews with 73 ALHIV at the Kalembelembe Paediatric Hospital, in DR Congo disclosed to by parents, guardians, HCWs, and/or peer educators, respectively, or disclosed to accidentally or by self-discovery. Microsoft Excel analysis matrix was used to organize the qualitative data. The majority of ALHIV whose disclosure involved a peer educator unanimously acknowledged the important role of the peer in accepting their HIV status, in their ART adherence, and their development of self-esteem. However, most ALHIV disclosed without involving peers declared that they had accepted their situation after a relatively long period followed by contact with the peer and integration in the self-support group. We found that the peer approach is the game-changer of the HIV status disclosure process that would allow ALHIV to accept their HIV status with minimum distress, it builds resilience, and allows them to adhere to treatment.
Collapse
Affiliation(s)
- Faustin Nd. Kitetele
- Department of Infectious Diseases, Kalembelembe Paediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
- Centre for International Health (CIH), University of Bergen, 5020 Bergen, Norway
- Correspondence: ; Tel.: +243-819936833
| | - Gilbert M. Lelo
- Centre Neuro-Psycho-Pathologique de Kinshasa (CNPP), University of Kinshasa, Kinshasa 012, Democratic Republic of the Congo
| | - Cathy E. Akele
- Department of Infectious Diseases, Kalembelembe Paediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
| | - Patricia V. M. Lelo
- Department of Infectious Diseases, Kalembelembe Paediatric Hospital, Kinshasa 012, Democratic Republic of the Congo
- Centre for International Health (CIH), University of Bergen, 5020 Bergen, Norway
| | - Eric M. Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 012, Democratic Republic of the Congo
| | - Thorkild Tylleskär
- Centre for International Health (CIH), University of Bergen, 5020 Bergen, Norway
| | | |
Collapse
|
8
|
Blankstein U, McGrath M, Randhawa H, Braga LH. A survey of parental perceptions and attitudes related to disclosure in hypospadias repair. J Pediatr Urol 2022; 18:178.e1-178.e7. [PMID: 35181223 DOI: 10.1016/j.jpurol.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Boys with hypospadias often undergo reconstructive surgery to improve cosmetic appearance and functional outcomes. While the ethics of physician-patient disclosure of illness are clear, parent-child disclosure is more ambiguous. There is a paucity of research regarding the parental disclosure of past urological procedures, specifically hypospadias repair. Our objective was to determine the rate of parental disclosure in boys undergoing hypospadias repair, and to evaluate the parental perspectives regarding concerns and amount of support in relation. METHODS A web-based questionnaire was distributed to parents of 240 hypospadias patients at our pediatric urology outpatient clinic over 12 months. The questionnaire assessed intent to disclose, decisional regret, and cosmetic perception. Data was analyzed using descriptive statistics and chi-square analyses. RESULTS Two hundred and twenty-three survey responses were collected. The majority of respondents were urban dwellers (72.2%), and the mothers of the child (80.9%). Distal hypospadias was the most common variant of condition (62.7%). When asked if they plan to disclose the repair to their child, 93% said "yes", and of those, the optimal mean age of disclosure was 7.49 ± 4.30 years. Ninety percent reported that they were not offered guidance on how/when to disclose, and 43% thought they would benefit from support on this. There was a significant difference in nervousness to disclose if the condition was distal versus proximal (χ2 = 15.19, p=<0.01), with proximal being more nervous. A significant difference was also observed regarding disclosure support with proximal being more likely to want formal support (χ2 = 4.55, p = 0.03). DISCUSSION AND CONCLUSIONS As hypothesized, the majority of parents intended to disclose their son's surgery to them, but no statistically significant difference was seen between those with a distal vs. proximal repair. Additionally, demographic characteristics which were hypothesized to influence this decision (e.g., parents' level of education and relationship to the child) did not discriminate parental intent to disclose. To our knowledge, this is the first study to evaluate perceptions and attitudes around disclosure in patients with hypospadias and their families. The majority of respondents were planning to disclose the operation to their child, and were not offered any guidance or support as to the optimal way to disclose. Half of those parents thought they could benefit from resources to help them with this process. Further research is required to understand the impact of disclosure and to create tools to help caregivers with this responsibility.
Collapse
Affiliation(s)
- Udi Blankstein
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Deparment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
9
|
Ramsammy CW, Galvin L, Joyce C, Leshabane G, Buckley J, Otwombe K, Liberty A, Violari A. Children's Positive and Negative Emotional Responses to an HIV Disclosure Study in South Africa. Front Pediatr 2022; 10:857336. [PMID: 35712628 PMCID: PMC9192950 DOI: 10.3389/fped.2022.857336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
The benefits of HIV status disclosure to children is widely cited. However, few studies have reported how children respond to the process in a longitudinal fashion. This paper describes children's responses, as documented by healthcare providers (HCPs), during a longitudinal disclosure study conducted at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Two HCPs facilitating disclosure recorded observations of 30 participating children (60% female), aged 7-13 years. Participants attended an average of six disclosure counseling sessions over 78 weeks. Observations documented by HCPs included the child's behavior and expressed emotions during the disclosure counseling sessions. The data was analyzed using content analysis. Mixed responses were observed in children who received full disclosure (27/30), with more children responding with strong negative emotions (16/27). However, 10 of those responded well to reassurance, and emotionally improved over subsequent sessions. Improvements were also observed in the communication and relationship between caregivers and children (17/30). Although most children understood the disclosure content (17/30), many were avoidant of the topic of HIV (16/30). With the understanding of the complex range of emotions elicited by HIV disclosure, we can better prepare HCPs on what to anticipate and train caregivers to further manage negative responses post-disclosure. This in turn may lead to more positive experiences of disclosure and the child's healthy acceptance of their HIV status.
Collapse
Affiliation(s)
- Candice W Ramsammy
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Galvin
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Leshabane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Buckley
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
10
|
Wanjala SW, Ssewanyana D, Mwangala PN, Nasambu C, Chongwo E, Luchters S, Newton CRJC, Abubakar A. Validity, reliability, and measurement invariance of an adapted short version of the HIV stigma scale among perinatally HIV infected adolescents at the Kenyan coast. Glob Health Res Policy 2021; 6:49. [PMID: 34893093 PMCID: PMC8662883 DOI: 10.1186/s41256-021-00229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a dearth of instruments that have been developed and validated for use with children living with HIV under the age of 17 years in the Kenyan context. We examined the psychometric properties and measurement invariance of a short version of the Berger HIV stigma scale administered to perinatally HIV-infected adolescents in a rural setting on the Kenyan coast. METHODS A cross-sectional study was conducted among 201 perinatally HIV-infected adolescents aged 12-17 years between November 2017 and October 2018. A short version of the Berger HIV stigma scale (HSS-40) containing twelve items (HSS-12) covering the four dimensions of stigma was evaluated. The psychometric assessment included exploratory factor analysis, confirmatory factor analysis (CFA), and multi-group CFA. Additionally, scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. RESULTS Evaluation of the reliability and construct validity of the HSS-12 indicated insufficient reliability on three of the four subscales. Consequently, Exploratory Factor Analysis (EFA) was conducted to identify problematic items and determine ways to enhance the scale's reliability. Based on the EFA results, two items were dropped. The Swahili version of this new 10-item HIV stigma scale (HSS-10) demonstrated excellent internal consistency with a Cronbach alpha of 0.86 (95% confidence interval (CI) 0.84-0.89). Confirmatory Factor Analysis indicated that a unidimensional model best fitted the data. The HSS-10 presented a good fit (overall Comparative Fit Index = 0.976, Tucker Lewis Index = 0.969, Root Mean Square Error of Approximation = 0.040, Standardised Root Mean Residual = 0.045). Additionally, multi-group CFA indicated measurement invariance across gender and age groups at the strict invariance level as ΔCFI was ≤ 0.01. CONCLUSION Our findings indicate that the HSS-10 has good psychometric properties and is appropriate for evaluating HIV stigma among perinatally HIV-infected adolescents on the Kenyan coast. Further, study results support the unidimensional model and measurement invariance across gender and age groups of the HSS-10 measure.
Collapse
Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Social Sciences, Pwani University, Box 195, Kilifi, Kenya
| | - Derrick Ssewanyana
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Patrick N. Mwangala
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Carophine Nasambu
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Esther Chongwo
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Settergren SK, Philippe R, St Louis J, Segaren N, Boisson S, Lewis T, Désinor O, François K. Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti. BMC Health Serv Res 2021; 21:236. [PMID: 33726734 PMCID: PMC7967958 DOI: 10.1186/s12913-021-06242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although access to antiretroviral therapy (ART) among children and young people living with HIV has increased in recent years, adherence to medication and viral suppression remain challenges. Evidence of benefits of support groups is growing and reflects a range of models and approaches. Since 2014, hospital-linked psychosocial support groups for children and young people living with HIV, known as Kids Clubs, have been established throughout Haiti. The program provides safe spaces for them to meet with peers, supports medication adherence, delivers health and life skills education, and facilitates linkages with clinic visits and social services. This study describes program enrollment and participant engagement, ART adherence and viral suppression among participants, and other outcomes attributed to the program by participants, caregivers, and program implementers. METHODS Our mixed methods study included quantitative analysis of program monitoring data on rollout and attendance, and medication adherence and viral load results extracted from medical records. We collected qualitative data from club members, caregivers, and implementers about their experiences with the clubs and the impact of participation. RESULTS From January 2014-December 2018, 1330 individuals aged 8-29 were enrolled in the program; over three-quarters participated for at least 12 months. In 2018, 1038 members attended at least one club meeting; more than half missed three or fewer monthly meetings. Three-quarters of ever-enrolled members reported consistent medication use at their most recent clinic visit; 64.2% (600/935) of those with a recent viral load test were virally suppressed. Level of club attendance was positively associated with ART adherence (p < 0.01) and viral suppression (p < 0.05). Club members, caregivers, and implementers noted the value of the clubs to participants' retention in care and medication adherence, health knowledge, and capacity to deal with peer pressure, stigma, shyness, and depression. CONCLUSIONS The Kids Club program has been successful in scaling HIV support services to highly vulnerable children and young people through peer-based groups, and program participation has led to a range of benefits. Efforts to innovate, evaluate, and scale support strategies for vulnerable young populations must be accelerated in order to ensure that they survive, thrive, and reach their full potential.
Collapse
Affiliation(s)
- Susan K Settergren
- Palladium, 1331 Pennsylvania Avenue NW, Suite 600, Washington, DC, 20004, USA.
| | - Robert Philippe
- Société d'Études et de Formation en Information Stratégique, Port-au-Prince, Haiti
| | - Joanne St Louis
- Société d'Études et de Formation en Information Stratégique, Port-au-Prince, Haiti
| | | | | | | | - Olbeg Désinor
- United States Agency for International Development, Port-au-Prince, Haiti
| | - Kesner François
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| |
Collapse
|
12
|
Sumbi EM, Venables E, Harrison R, Garcia M, Iakovidi K, van Cutsem G, Chalachala JL. "It's a secret between us": a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo. BMC Public Health 2021; 21:313. [PMID: 33549066 PMCID: PMC7866707 DOI: 10.1186/s12889-021-10327-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure – in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child’s HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay. Methods A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees. Results At the time of interview, the mean age of children and care-givers was 17 (15–19) and 47 (21–70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them. Conclusions Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10327-5.
Collapse
Affiliation(s)
| | - Emilie Venables
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa. .,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca Harrison
- Médecins Sans Frontières, Kinshasa, Democratic Republic of Congo
| | - Mariana Garcia
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Kleio Iakovidi
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Gilles van Cutsem
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Jean Lambert Chalachala
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania. AIDS Res Treat 2021; 2020:6663596. [PMID: 33425383 PMCID: PMC7781714 DOI: 10.1155/2020/6663596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age (p < 0.001), school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers' higher education level (p < 0.001), and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.
Collapse
|
14
|
Dlamini CP, Matlakala MC. Disclosure of human immunodeficiency virus status to children: Pattern followed by parents and caregivers. Afr J Prim Health Care Fam Med 2020; 12:e1-e6. [PMID: 33354985 PMCID: PMC7736658 DOI: 10.4102/phcfm.v12i1.2230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 06/15/2020] [Accepted: 07/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background Disclosure of human immunodeficiency virus (HIV) status may be perceived as simply the process of revealing a person’s HIV status, whether positive or negative. Despite the emerging evidence of the benefits of disclosure, who, when and what to disclose to a HIV-infected child remains a challenge. Aim This article reports on the patterns of HIV status disclosure to the infected children by their parents and caregivers. Setting The study was conducted in the outpatient clinic of one referral hospital offering comprehensive HIV care in the Lubombo region, eSwatini. Methods A qualitative descriptive design was followed. Data were collected through semi-structured individual interviews with a purposive sample of 13 parents and caregivers whose children were on antiretroviral treatment and collecting treatment from the specific outpatient clinic. Audio recorded data were transcribed verbatim, thematic content analysis was done and used to organise and present the findings. Results Four themes that emerged in relation to the topic of patterns of disclosure were disclosure of HIV status as a process rather than an event, a proposed person to disclose the HIV status to the child, the appropriate age to disclose HIV status to a child and type and amount of information to give in relation to the HIV status. The proposed person to disclose the HIV status to the infected child was the parent or caregiver involved as the primary carer of the child. There was no agreeable appropriate age to disclose HIV status to an infected child and the type and amount of information to disclose varied with the individuals depending on what prompted disclosure. Conclusion Human immunodeficiency virus disclosure to children demands parents’ and caregivers’ participation and their knowledge of child development.
Collapse
Affiliation(s)
- Cebsile P Dlamini
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria.
| | | |
Collapse
|
15
|
Farthing H, Reynolds NR, Antwi S, Alhassan A, Ofori IP, Renner L, Amissah KA, Kusah JT, Lartey M, Paintsil E. Illness Narratives of Children Living with HIV Who Do Not Know Their HIV Status in Ghana: I'm Sick, But I Don't Know the Sickness-A Qualitative Study. AIDS Behav 2020; 24:3225-3231. [PMID: 32333207 PMCID: PMC7508830 DOI: 10.1007/s10461-020-02884-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite available guidelines for disclosure of HIV status to children, most children living with HIV are unaware of their diagnosis. We sought to characterize the concepts of illness and treatment among children living with HIV who do not know their status. As part of the Sankofa trial we interviewed 435 children aged 6-18 enrolled in clinical care at pediatric HIV clinics at two teaching hospitals in Ghana. Theoretic thematic analysis generated themes among responses. The children believe they come to the clinic to collect medication, to address specific symptoms, to prevent and treat 'sickness', or as part of their routine. Most children learned of their 'illness' from a family member. A majority (73.5%) of children had never talked about their 'illness' with anyone else; many feared consequences. Children living with HIV who do not know their status exhibit signs of anticipated and internalized stigma regarding their unknown 'illness.' An understanding of the way children conceptualize their illness has implications for health promotion and the provision of appropriate information to children living with HIV.ClinicalTrials.gov Identifier NCT01701635.
Collapse
Affiliation(s)
- Heather Farthing
- Department of Pediatrics, Yale School of Medicine, 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
| | - Amina Alhassan
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Irene Pokuaa Ofori
- 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 School of Medicine and Dentistry and Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kofi Aikins 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 School of Medicine and Dentistry and Korle-Bu Teaching Hospital, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital, Accra, Ghana
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
- Departments of Pharmacology & Public Health, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
16
|
Okatch H, Morales K, Rogers R, Chapman J, Marukutira T, Tshume O, Matshaba M, Gross R, Lowenthal ED. Trends in HIV Treatment Adherence Before and After HIV Status Disclosure to Adolescents in Botswana. J Adolesc Health 2020; 67:502-508. [PMID: 32340848 PMCID: PMC8594633 DOI: 10.1016/j.jadohealth.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to determine if disclosure of HIV status to adolescents impacted their medication adherence and how medication autonomy might explain observed effects. METHODS Three hundred adolescents on HIV treatment using electronic medication monitors were followed for 24 months while undergoing routine care. One hundred six of the adolescents were HIV disclosure-naïve and HIV status disclosure in this group was assessed quarterly. Analyses included data from the 75 adolescents who experienced disclosure during the study providing adherence and autonomy data both predisclosure and postdisclosure. Segmented generalized estimating equations were used to examine the trend of adherence and autonomy predisclosure and postdisclosure. Covariates assessed include age at disclosure, sex, and orphan status. RESULTS Median age at study entry was 12.2 years (interquartile range 11.6-12.9). Incident disclosure occurred in 75 (71%) of the adolescents at a median age of 13.1 years (interquartile range 12.5-13.9). Adherence decreased by 11% (95% confidence interval [CI] 7-15, p < .001) during the predisclosure period and by 22% (95% CI 9-36, p = .001) during the postdisclosure period. Adolescents' autonomy over their medication-taking increased over time, but disclosure did not impact the rate of increase in measured medication-taking autonomy. On a scale of 1-4 assessing autonomy (1 = receiving directly observed therapy and 4 = taking medicines mostly without supervision), autonomy increased by an average of .03 units/month (95% CI .02-.03, p < .001) predisclosure and by .05 units/month (95% CI -.01 to .11, p = .42) postdisclosure. CONCLUSIONS The findings suggest that, among perinatally HIV infected adolescents, HIV status disclosure may adversely impact treatment adherence. Postdisclosure support to HIV infected adolescents should be intensified.
Collapse
Affiliation(s)
- Harriet Okatch
- Biology Department, Franklin & Marshall College, Lancaster, Pennsylvania; University of Pennsylvania, Center for Public Health Initiatives, Philadelphia, Pennsylvania.
| | - Knashawn Morales
- University of Pennsylvania, Center of Clinical Epidemiology and Biostatistics 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Rachel Rogers
- Children’s Hospital of Philadelphia, 2714 South St, Philadelphia, PA, USA
| | - Jennifer Chapman
- Children’s Hospital of Philadelphia, 2714 South St, Philadelphia, PA, USA
| | - Tafireyi Marukutira
- Botswana-Baylor Children’s Clinical Centre of Excellence, 1836 Hospital Way, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children’s Clinical Centre of Excellence, 1836 Hospital Way, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children’s Clinical Centre of Excellence, 1836 Hospital Way, Gaborone, Botswana,Baylor College of Medicine, 1 Baylor Plaza, 77030, Houston, TX, USA
| | - Robert Gross
- University of Pennsylvania, Center of Clinical Epidemiology and Biostatistics 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Elizabeth D. Lowenthal
- University of Pennsylvania, Center of Clinical Epidemiology and Biostatistics 423 Guardian Dr, Philadelphia, PA, 19104, USA,Children’s Hospital of Philadelphia, 2714 South St, Philadelphia, PA, USA
| |
Collapse
|
17
|
Zanon BP, Cremonese L, Ribeiro AC, Padoin SMDM, Paula CCD. Communication of bad news in pediatrics: integrative review. Rev Bras Enferm 2020; 73 Suppl 4:e20190059. [PMID: 32785469 DOI: 10.1590/0034-7167-2019-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. METHODS integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. RESULTS the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). CONCLUSIONS there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.
Collapse
Affiliation(s)
- Bruna Pase Zanon
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Luiza Cremonese
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | | | | |
Collapse
|
18
|
Mutambo C, Shumba K, Hlongwana KW. Post-training and mentorship experiences of KidzAlive-trained healthcare workers at primary healthcare facilities in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e11. [PMID: 32634017 PMCID: PMC7343958 DOI: 10.4102/phcfm.v12i1.2109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background KidzAlive, a multicomponent, child-centred capacity building model was adopted by South Africa’s National Department of Health to address the challenges of quality of care among HIV+ children. This model involves training and mentoring healthcare workers (HCWs) on a child-centred care approach of communicating with children and their primary caregivers (PCGs). This study explored HCWs’ post-training experiences after a 6-months implementation period. Aim To evaluate the KidzAlive model as a healthcare approach that seeks to improve the quality of HIV care among children. Setting The study was conducted in 20 PHC rural and urban facilities across four districts in KwaZulu-Natal. Methods Interviews were conducted by trained interviewers who followed a structured interview guide. These were audio-recorded, transcribed, and imported into NVivo 10 software for thematic analysis. Thematic analysis was used to develop a coding framework from the participant’s responses. Results Five themes, namely: (1) increased healthcare worker knowledge, skills and confidence to provide child-friendly HIV services to children; (2) increased involvement of HIV + children in own healthcare journey; (3) the involvement of primary caregivers in children’s healthcare journey; (4) improved health outcomes for HIV + children; and e) transformation of the PHC environment towards being more child-friendly. Conclusion The findings present preliminary evidence of successful KidzAlive trained HCWs’ buy-in of KidzAlive intervention. KidzAlive has been well integrated into current service delivery processes in PHC facilities. However, more rigorous research is warranted to fully understand the impact of this intervention on children and their primary caregivers.
Collapse
Affiliation(s)
- Chipo Mutambo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
| | | | | |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Ekop E, Okechukwu A. Disclosure of status among Human Immunodeficiency Virus-infected adolescents. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_66_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Stein A, Dalton L, Rapa E, Bluebond-Langner M, Hanington L, Stein KF, Ziebland S, Rochat T, Harrop E, Kelly B, Bland R. Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet 2019; 393:1150-1163. [PMID: 30894271 DOI: 10.1016/s0140-6736(18)33201-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.
Collapse
Affiliation(s)
- Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Myra Bluebond-Langner
- The Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Emily Harrop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Helen & Douglas House, Oxford, UK
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
| |
Collapse
|
22
|
Vreeman RC, Scanlon ML, Tu W, Slaven J, McAteer C, Aluoch J, Ayaya S, Nyandiko WM. Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families. J Int Assoc Provid AIDS Care 2019; 18:2325958219880570. [PMID: 31581890 PMCID: PMC6900619 DOI: 10.1177/2325958219880570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There are few validated tools to measure stigma, particularly among children living with HIV and their families. METHODS This study was nested within a larger study that followed 240 child-caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child-caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. RESULTS Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. CONCLUSIONS The stigma instrument showed high validity when compared to emotional and behavioral outcomes.
Collapse
Affiliation(s)
- Rachel Christine Vreeman
- Department of Health Systems Design and Global Health, Icahn School of
Medicine at Mount Sinai, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
| | - Michael Lawrence Scanlon
- Department of Health Systems Design and Global Health, Icahn School of
Medicine at Mount Sinai, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- John W. McCormack Graduate School of Policy and Global Studies, University
of Massachusetts, Boston, MA, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine,
Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine,
Indianapolis, IN, USA
| | - Carole McAteer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Zgambo M, Kalembo FW, Mbakaya BC. Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review. Reprod Health 2018; 15:180. [PMID: 30355344 PMCID: PMC6201550 DOI: 10.1186/s12978-018-0614-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adolescents living with HIV (ALWHIV) in sub-Saharan Africa encounter multiple health problems that are often unrecognised by the public and the healthcare workforce. The aim of this systematic review was to identify risky health behaviours and their associated factors among ALWHIV in sub-Saharan Africa. METHODS We systematically searched for articles in Medline, SCOPUS, Directory of Open Access Journals, Science Direct, ProQuest, Psych-info, Web of science, WHO Global Index Medicus library, Cochrane, and Google Scholar. Studies were included in this review if: they were original studies; participants were aged from 10 to 19 years; participants were ALWHIV or they had data from different key informants focusing on ALWHIV within the age group; they had health behaviours as an outcome; they were conducted in sub-Saharan Africa and were published before December 2016. Data were extracted and the quality of the studies was appraised using the Mixed Method Appraisal Tool (MMAT). RESULTS Thirty-six studies met the eligibility criteria. Nineteen studies scored 100% (indicating high quality), sixteen studies scored 75% (indicating moderate quality) and one study scored 50% (indicating low quality) on the MMAT scale. Adherence to antiretroviral therapy among ALWHIV was suboptimal and was negatively affected by forgetfulness, opportunistic infection, long distance to clinics, and fear of unplanned disclosure. Many adolescents were sexually active, but the majority did not disclose their HIV status to sexual partners, despite knowing their diagnosis (range 76-100% across available studies) and some did not use protection (condoms) to prevent transmission of HIV and other sexually transmitted diseases (range 35-55%). Disclosure to and from adolescents was low across the studies and was associated with fear of disclosure aftermaths including stigma and discrimination (range 40-57%). CONCLUSION A considerable proportion of ALWHIV in sub-Saharan Africa engage in multiple risky health behaviours, which have a substantial negative impact on their wellbeing and cause significant risk and burden to their families, sexual partners and societies.
Collapse
Affiliation(s)
- Maggie Zgambo
- St John’s College of Nursing and Midwifery, P.O Box 18, Mzuzu, Malawi
| | - Fatch Welcome Kalembo
- Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Malawi
| | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
MacCarthy S, Saya U, Samba C, Birungi J, Okoboi S, Linnemayr S. "How am I going to live?": exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda. BMC Public Health 2018; 18:1158. [PMID: 30286746 PMCID: PMC6172755 DOI: 10.1186/s12889-018-6048-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies from sub-Saharan Africa (SSA) document how barriers to ART adherence present additional complications among adolescents and young adults living with HIV. We qualitatively explored barriers to ART adherence in Uganda among individuals age 14–24 to understand the unique challenges faced by this age group. Methods We conducted focus group (FG) discussions with Community Advisory Board members (n = 1), health care providers (n = 2), and male and female groups of adolescents age 14–17 (n = 2) and youth age 18–24 (n = 2) in Kampala, Uganda. FGs were transcribed verbatim and translated from Luganda into English. Two investigators independently reviewed all transcripts, developed a detailed codebook, achieved a pooled Cohen’s Kappa of 0.79 and 0.80, and used a directed content analysis to identify key themes. Results Four barriers to ART adherence emerged: 1) poverty limited adolescents’ ability to buy food and undercut efforts to become economically independent in their transition from adolescence to adulthood; 2) school attendance limited their privacy, further disrupting ART adherence; 3) family support was unreliable, and youth often struggled with a constant change in guardianship because they had lost their biological parents to HIV. In contrast peer influence, especially among HIV-positive youth, was strong and created an important network to support ART adherence; 4) the burden of taking multiple medications daily frustrated youth, often leading to so-called ‘drug holidays.’ Adolescent and youth-specific issues around disclosure emerged across three of the four barriers. Conclusions To be effective, programs and policies to improve ART adherence among youth in Uganda must address the special challenges that adolescents and young adults confront in achieving optimal adherence. For example, training on budgeting and savings practices could help promote their transition to financial independence. School staff could develop strategies to help students take their medications consistently and confidentially. While challenging to extend the range of services provided by HIV clinics, successful efforts will require engaging the family, peers, and larger community of health and educational providers to support adolescents and young adults living with HIV to live longer and healthier lives. Trial registration ClinicalTrials.gov Identifier: NCT02514356. Registered August 3, 2015.
Collapse
Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA.
| | - Uzaib Saya
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, USA
| | - Clare Samba
- TASO Uganda, Old Mulago Complex, Kampala, P.O.Box 10443, Kampala, Uganda
| | - Josephine Birungi
- TASO Uganda, Old Mulago Complex, Kampala, P.O.Box 10443, Kampala, Uganda.,Old Mulago Complex, Kampala P.O.Box 10443, Kampala, Uganda
| | - Stephen Okoboi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
| |
Collapse
|
27
|
Whembolua GL, Conserve DF, Thomas K, Tshiswaka DI, Handler L. HIV serostatus disclosure in the Democratic Republic of the Congo: a systematic review. AIDS Care 2018; 31:489-493. [PMID: 30111174 DOI: 10.1080/09540121.2018.1510103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV status disclosure among people living with HIV/AIDS has been shown to have a number of both personal and public health benefits, but rates of HIV status disclosure remain low in many African countries, including the Democratic Republic of the Congo (DRC). This systematic review uses the Disclosure Process Model to examine the factors involved in serostatus disclosure and nondisclosure to various persons in the lives of people living with HIV/AIDS (PLWHA) in the DRC, as well as the specific outcomes of their disclosure or nondisclosure. MEDLINE/PubMed, Embase, Web of Science, Global Health, and PsycINFO were searched and research studies were included if: (i) the study discussed disclosure of HIV status; (ii) the study population included HIV-infected people in DRC; and (iii) the study was published in English. Fourteen articles met the inclusion criteria and were included in the study. Factors contributing to nondisclosure were generally associated with high stigma of HIV in adults and concern for emotional wellbeing when disclosing to HIV positive minors. Factors contributing to disclosure among adults were increased social support and religion. In disclosing to HIV positive minors, increasing age and health benefits were identified as approach goals that supported disclosure. The findings highlight the importance of understanding the avoidance and approach goals involved in HIV status disclosure among populations living in the DRC. Interventions and future research directed at increasing HIV disclosure among Congolese PLWHA should move beyond individual-level to consider multilevel factors including circumstantial social behaviors.
Collapse
Affiliation(s)
- Guy-Lucien Whembolua
- a Department of Africana Studies , University of Cincinnati , Cincinnati , OH , USA
| | - Donaldson F Conserve
- b Arnold School of Public Health , University of South Carolina , Charleston , SC , USA
| | - Kirstyn Thomas
- a Department of Africana Studies , University of Cincinnati , Cincinnati , OH , USA
| | - Daudet Ilunga Tshiswaka
- c Department of Public Health , University of West Florida , 11000 University Parkway, Pensacola , FL , USA
| | - Lara Handler
- d Health Sciences Library , UNC Chapel Hill , CB 7585, Chapel Hill , NC , USA
| |
Collapse
|
28
|
Evangeli M. The Adolescent HIV Communication Belief Scale: Preliminary Reliability and Validity. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:2404-2410. [PMID: 30100696 PMCID: PMC6061023 DOI: 10.1007/s10826-018-1075-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Globally, there are nearly 2 million HIV positive children, many of whom are adolescents. The majority have perinatally acquired HIV. A key challenge for this population is communicating about HIV to meet emotional and practical needs. Despite evidence of its benefits, HIV communication in adolescents with HIV is rare. To enhance HIV communication, individuals' beliefs may need to be taken into account. There is no measure of beliefs about HIV communication for adolescents living with HIV. A seven-item measure of HIV communication beliefs was developed and administered to 66 adolescents with HIV in the UK (39 female; aged 12-16 years). Data were explored using principal component analysis. Preliminary criterion-related validity was assessed by examining relationships between the measure and communication occurrence, frequency and intention. Preliminary construct validity was assessed by examining relationships between the measure and HIV stigma, HIV disclosure cognition and affect, quality of life and self-perception. Two factors were revealed: communication self-efficacy and normative beliefs; and communication attitudes. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV communication intention, HIV disclosure cognitions and affect, and HIV stigma but not with other variables. Preliminary evidence of the measure's good psychometric properties suggests it may be helpful in outlining relationships between HIV communication beliefs and other constructs. It may also be useful in testing interventions that aim to enhance HIV communication in this population. Further work needs to be done to establish the scale's psychometric properties.
Collapse
Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, UK
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Gibbs C, Melvin D, Foster C, Evangeli M. 'I don't even know how to start that kind of conversation': HIV communication between mothers and adolescents with perinatally acquired HIV. J Health Psychol 2018; 25:1341-1354. [PMID: 29402139 DOI: 10.1177/1359105318755544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Young people with perinatally acquired HIV are now surviving into late adolescence and adulthood. We explored HIV communication within mother/adolescent dyads following naming of the adolescents' HIV. Five adolescents with perinatally acquired HIV (14-16 years) and their biological mothers were interviewed separately. HIV communication between mothers and children was rare. Discussion most commonly related to biomedical aspects of HIV. Onward HIV disclosure was discouraged by mothers, which often contrasted with adolescents' beliefs. Discussing emotional and sexual aspects of HIV was mutually avoided. Culturally sensitive support and guidance should be offered to families about discussing HIV, considering potentially differing perspectives.
Collapse
|
31
|
Lee S, Siberry GK, Alarcón JO, Vega MR, Roca LK, Gutierrez C, Celia de Menezes Succi R, Ferreira Peixoto M, Stoszek SK, Hazra R, Harris DR. Prevalence and Associated Characteristics of HIV-Infected Children in Latin America Who Know Their HIV Status. J Pediatric Infect Dis Soc 2018; 7:78-81. [PMID: 28204558 PMCID: PMC5907867 DOI: 10.1093/jpids/pix001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022]
Abstract
We estimated the prevalence of human immunodeficiency virus (HIV) disclosure in children from a prospective observational cohort study conducted at clinical sites in Brazil, Mexico, and Peru. Fewer than half of the children in this study knew their HIV status, which highlights the need for better strategies for disclosure that are age and culturally appropriate.
Collapse
Affiliation(s)
- Sonia Lee
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland,Correspondence: S. Lee, PhD, Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr., Room 2159D, MSC 7002, Bethesda, MD 20892 ()
| | - George K Siberry
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jorge O Alarcón
- Instituto de Medicina Tropical “Daniel A. Carrión,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Mary Reyes Vega
- Instituto de Medicina Tropical “Daniel A. Carrión,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Lenka Kolevic Roca
- Instituto de Medicina Tropical “Daniel A. Carrión,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - César Gutierrez
- Instituto de Medicina Tropical “Daniel A. Carrión,” Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | | | | | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | |
Collapse
|
32
|
Okawa S, Mwanza-Kabaghe S, Mwiya M, Kikuchi K, Jimba M, Kankasa C, Ishikawa N. Adolescents' Experiences and Their Suggestions for HIV Serostatus Disclosure in Zambia: A Mixed-Methods Study. Front Public Health 2017; 5:326. [PMID: 29326914 PMCID: PMC5736526 DOI: 10.3389/fpubh.2017.00326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background HIV serostatus disclosure is an immense challenge for adolescents living with HIV, their caregivers, and health workers. In Zambia, however, little guidance is available from the adolescents’ point of view on the HIV disclosure process. Objective This study aimed to examine the setting of HIV serostatus disclosure for adolescents, its impacts on them, and their suggestions on the best practice of HIV disclosure. Methods We conducted a mixed-methods study at the University Teaching Hospital in Zambia from April to July 2014. We recruited 200 adolescents living with HIV, aged 15–19 years. We collected data using a structured questionnaire including two open-ended questions. We excluded two adolescents due to withdrawal during the survey, and eight from the data set due to out-of-eligibility criteria in age. Eventually, we included 190 in the analysis. We performed descriptive analysis to calculate the distributions of basic characteristics of the adolescents, their experience and preference on HIV serostatus disclosure, its emotional and behavioral impacts, and health education topics they had ever learned at hospital. We performed thematic analysis with open-ended data to explain first impressions upon disclosure in detail and to determine perceived advantages of HIV serostatus disclosure. Results The majority of adolescents recommended the age of 12 as appropriate for adolescents to learn about their HIV serostatus and preferred disclosure by both parents. Out of 190 adolescents, 73.2% had negative or mixed feelings about HIV serostatus disclosure, while 86.2% reported that disclosure was beneficial. Thematic analyses showed that the adolescents reacted emotionally due to an unexpected disclosure and a belief of imminent death from HIV. However, they improved adherence to treatment (84.7%), limited self-disclosure of their HIV serostatus to others (81.1%), and felt more comfortable in talking about HIV with their caregivers (54.2%). Thematic analysis identified perceived benefits of disclosure as follows: better understanding of their sickness and treatment, and improved self-care and treatment adherence. Lower percentage of the adolescents have learned about psychosocial well-being, compared to facts about HIV and treatment. Conclusion Despite initial emotional distress experienced after the disclosure, knowing one’s own HIV serostatus was found to be a crucial turning point for adolescents to improve motivation for self-care. HIV serostatus disclosure to adolescents requires follow-up support involving parents/primary caregivers, health workers, and peers.
Collapse
Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sylvia Mwanza-Kabaghe
- Department of Educational Psychology, Sociology, and Special Education, School of Education, University of Zambia, Lusaka, Zambia.,Pediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Mwiya Mwiya
- Pediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Kimiyo Kikuchi
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chipepo Kankasa
- Pediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Naoko Ishikawa
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
33
|
Namukwaya S, Paparini S, Seeley J, Bernays S. "How Do We Start? And How Will They React?" Disclosing to Young People with Perinatally Acquired HIV in Uganda. Front Public Health 2017; 5:343. [PMID: 29326918 PMCID: PMC5733349 DOI: 10.3389/fpubh.2017.00343] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Abstract
Despite great advances in pediatric HIV care, rates and the extent of full disclosure of HIV status to infected children remain low especially in resource-constrained setting. The World Health Organisation recommends that, by the age of 10–12 years old, children should be made fully aware of their HIV-positive status. However, this awareness is often delayed until much later in their adolescence. Few studies have been conducted to investigate what influences caregivers’ decision-making process in this regard in low-income settings. In this article, we present an analysis of care dyads of caregivers and HIV-positive young people in Kampala, Uganda, as part of the findings of a longitudinal qualitative study about young people’s adherence to antiretroviral therapy embedded in an international clinical trial (BREATHER). Repeat in-depth interviews were conducted with 26 young people living with HIV throughout the course of the trial, and once-off interviews with 16 of their caregivers were also carried out toward the end of the trial. In this article, we examine why and how caregivers decide to disclose a young person’s HIV status to them and explore their feelings and dilemmas toward disclosure, as well as how young people reacted and the influence it had on their relationships with and attitudes toward their caregivers. Caregivers feared the consequences of disclosing the young person’s positive status to them and disclosure commonly occurred hurriedly in response to a crisis, rather than as part of an anticipated and planned process. A key impediment to disclosure was that caregivers feared that disclosing would damage their relationships with the young people and commonly used this as a reason to continue to postpone disclosure. However, young people did not report prolonged feelings of blame or anger toward their caregivers about their own infection, but they did express frustration at the delay and obfuscation surrounding the disclosure process. Our findings can inform the ways in which mainstream HIV services support caregivers through the disclosure process. This includes providing positive encouragement to disclose fully and to be more confident in initiating and sustaining the timely process of disclosure.
Collapse
Affiliation(s)
- Stella Namukwaya
- Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda
| | - Sara Paparini
- Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Janet Seeley
- Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda.,Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Bernays
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
34
|
Montalto GJ, Sawe FK, Miruka A, Maswai J, Kiptoo I, Aoko A, Oreyo C, Obiero E, Korir S, Bii SK, Song KX, Kunz AN. Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study. PLoS One 2017; 12:e0183180. [PMID: 28991913 PMCID: PMC5633147 DOI: 10.1371/journal.pone.0183180] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background & aims Emphasis on adolescent HIV has increased worldwide as antiretroviral treatment has greatly extended life expectancies of HIV-positive children. Few evidence-based guidelines exist on the optimal time to disclose to an adolescent living with HIV (ALHIV); little is known about the medical effects of disclosure. This study looked to determine whether disclosure is associated with improved medical outcomes in ALHIV. Prior work has tended to be qualitative, cross-sectional, and with an emphasis on psychosocial outcomes. This paper addresses the adolescent cohort retrospectively (longitudinally), building upon what is already known about disclosure. Methods Retrospective, longitudinal clinical record reviews of ALHIV seen at Kericho District Hospital between April 2004 and November 2012 were performed. Patient demographics and clinical outcomes were systematically extracted. The student’s t-test was used to calculate changes in mean CD4 count, antiretroviral therapy (ART), and cotrimoxazole adherence pre- vs. post-disclosure. Linear regression modelling assessed for trends in those clinical outcomes associated with age of disclosure. Results Ninety-six ALHIV (54 female, 42 male) were included; most (73%) entered care through the outpatient department. Nearly half were cared for by parents, and 20% experienced a change in their primary caregiver. The mean time in the study was 2.47 years; mean number of visits 10.97 per patient over the mean time in the study. Mean disclosure age was 12.34 years. An increase in mean ART adherence percentage was found with disclosure (0.802 vs. 0.917; p = 0.0015). Younger disclosure age was associated with significantly higher mean CD4 counts over the course of the study (p = 0.001), and a nonsignificant trend toward a higher mean ART adherence percentage (p = 0.055). Conclusion ART adherence and improved immunologic status are both associated with disclosure of HIV infection to adolescent patients. Disclosure of an HIV diagnosis to an adolescent is an important means to improve HIV care.
Collapse
Affiliation(s)
- Gregg Joseph Montalto
- Division of Adolescent Medicine, Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, United States of America
- * E-mail:
| | - Fredrick K. Sawe
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Argwings Miruka
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Jonah Maswai
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Ignatius Kiptoo
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Appolonia Aoko
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Chrispine Oreyo
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Eunice Obiero
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Sheila Korir
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Stephen K. Bii
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Katherine X. Song
- United States Military HIV Research Program, Rockville, Maryland, United States of America
| | - Anjali N. Kunz
- Department of Pediatrics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
| |
Collapse
|
35
|
Odiachi A. The Impact of Disclosure on Health and Related Outcomes in Human Immunodeficiency Virus-Infected Children: A Literature Review. Front Public Health 2017; 5:231. [PMID: 28913332 PMCID: PMC5582203 DOI: 10.3389/fpubh.2017.00231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
This review explores the association between pediatric human immunodeficiency virus (HIV) disclosure and health and related outcomes among children living with HIV. A multi-stage process was used to search for relevant articles on the ISI Web of Knowledge database. Fifteen articles met the inclusion criteria. Five major outcomes emerged from children’s knowledge of their HIV-seropositive status: physical/physiological outcomes; adherence to antiretroviral therapy; psychosocial outcomes; sexual and reproductive health, including HIV prevention outcomes; and disclosure of status by the children. Disclosure of a child’s HIV status to the child has value in terms of positive health outcomes for the child, such as better adherence and slower disease progression—albeit the different studies did not always reach the same conclusions, and some suggest negative health outcomes, such as increased psychiatric hospitalization. Yet, there does not seem to be a systematic or coherent system for child disclosure. One recommendation from this review, therefore, is for government and program policies and guidelines that will promote child HIV disclosure in order to address the current low rates of disclosure in sub-Saharan Africa (SSA). More rigorous and longitudinal studies on the outcomes of disclosure, with larger sample sizes, and in SSA, are also needed.
Collapse
Affiliation(s)
- Angela Odiachi
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
36
|
Woollett N, Black V, Cluver L, Brahmbhatt H. Reticence in disclosure of HIV infection and reasons for bereavement: impact on perinatally infected adolescents' mental health and understanding of HIV treatment and prevention in Johannesburg, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:175-184. [PMID: 28714809 DOI: 10.2989/16085906.2017.1337646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Survival rates of perinatally infected HIV-positive adolescents (PIA) are increasing in sub-Saharan Africa. There is a gap in understanding how disclosure and bereavement have an impact on PIA beliefs and understanding of their HIV infection and its management. In-depth interviews were conducted with 25 purposively selected adolescents aged 13-19 years from 5 public health clinics in Johannesburg, South Africa. Data were analysed using NVivo 10 using a thematic approach. PIA experience incomplete disclosure both of their HIV status and reasons for their bereavements, which limits their understanding of how they became infected, vertical transmission and prevention options like prevention of mother-to-child transmission (PMTCT). Most participants were orphaned and were experiencing complicated grieving (i.e., engaged in unresolved tasks of grieving) which had a negative impact on their mental health, and ability to accept their HIV status and adhere to treatment. PIA need improved communication regarding vertical transmission and how they became HIV-positive, as well as reasons for death of their loved ones to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and truthful engagement in the process of disclosure of HIV status is necessary to reduce stigma and complicated grieving, and improve mental health in this population.
Collapse
Affiliation(s)
- Nataly Woollett
- a Wits Reproductive Health and HIV Institute , University of the Witwatersrand , Johannesburg , South Africa.,b School of Clinical Medicine, Faculty of Medicine , University of the Witwatersrand , Johannesburg , South Africa
| | - Vivian Black
- c Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lucie Cluver
- d Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK
| | - Heena Brahmbhatt
- a Wits Reproductive Health and HIV Institute , University of the Witwatersrand , Johannesburg , South Africa.,e Department of Population, Reproductive and Family Health, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| |
Collapse
|
37
|
Dusabe-Richards E, Rutakumwa R, Zalwango F, Asiimwe A, Kintu E, Ssembajja F, Seeley J. Dealing with disclosure: Perspectives from HIV-positive children and their older carers living in rural south-western Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:387-395. [PMID: 27974016 DOI: 10.2989/16085906.2016.1256330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are limited data on the challenges faced by carers, in particular older carers, in managing the difficult task of status disclosure for HIV-positive children. We report findings from qualitative interviews with 18 care dyads of older people and HIV-positive children living in rural south-western Uganda. Our data provide insights into perceptions and norms influencing communication during and following disclosure among both carers and children, including those shaped by gendered expectations of girls' and boys' sexual behaviour. Young participants reported several advantages of knowing their status and showed considerable resilience in the face of HIV disclosure. Better and more support is needed to help health workers and carers (particularly older carers) manage cross-generational communication around HIV disclosure and other related aspects of sexual and reproductive health as critical aspects of children's psychosocial development and well-being.
Collapse
Affiliation(s)
- Esther Dusabe-Richards
- a Department of International Public Health , Liverpool School of Tropical Medicine , Pembroke Place, Liverpool , United Kingdom
| | - Rwamahe Rutakumwa
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Flavia Zalwango
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Allen Asiimwe
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Elvis Kintu
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Fatuma Ssembajja
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Janet Seeley
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda.,c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , United Kingdom
| |
Collapse
|
38
|
Wright S, Amzel A, Ikoro N, Srivastava M, Leclerc-Madlala S, Bowsky S, Miller H, Phelps BR. Talking to children about their HIV status: a review of available resources, tools, and models for improving and promoting pediatric disclosure. AIDS Care 2017; 29:1019-1025. [PMID: 28081616 DOI: 10.1080/09540121.2016.1273471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As children living with HIV (CLHIV) grow into adolescence and adulthood, caregivers and healthcare providers are faced with the sensitive challenge of when to disclose to a CLHIV his or her HIV status. Despite WHO recommendations for CLHIV to know their status, in countries most affected by HIV, effective resources are often limited, and national guidance on disclosure is often lacking. To address the need for effective resources, gray and scientific literature was searched to identify existing tools and resources that can aid in the disclosure process. From peer-reviewed literature, seven disclosure models from six different countries were identified. From the gray literature, 23 resources were identified including children's books (15), job aides to assist healthcare providers (5), and videos (3). While these existing resources can be tailored to reflect local norms and used to aid in the disclosure process, careful consideration must be taken in order to avoid damaging disclosure practices.
Collapse
Affiliation(s)
- S Wright
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - A Amzel
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - N Ikoro
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - M Srivastava
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - S Leclerc-Madlala
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - S Bowsky
- b Futures Group International , Washington , USA
| | - H Miller
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| | - B R Phelps
- a U.S. Agency for International Development, Office of HIV/AIDS , Washington , DC , USA
| |
Collapse
|
39
|
Chilemba E, Phiri C. Ethical aspect of paediatric HIV infection disclosure to perinatally infected children: The Malawi perspectives. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
40
|
Caregivers Lack of Disclosure Skills Delays Disclosure to Children with Perinatal HIV in Resource-Limited Communities: Multicenter Qualitative Data from South Africa and Botswana. Nurs Res Pract 2016; 2016:9637587. [PMID: 28018673 PMCID: PMC5149670 DOI: 10.1155/2016/9637587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
Abstract
To promote the appropriate implementation of procedures for health disclosure to children, it is important to understand the reasons why caregivers delay the disclosure of healthcare information to children. This paper explored the views of caregivers on what makes disclosure to children with perinatal acquired HIV (PAH) difficult and what could make disclosure in these cases easier. Data were collected using focus group interviews with caregivers who were purposely selected from a multicenter study conducted in Botswana and South Africa. Forty-seven nondisclosed caregivers of children between 5 and 18 years who were receiving ART were interviewed. Caregivers felt that children should be told of their HIV-positive status despite the fact that none had disclosed this information to the children. The caregivers reported lack of disclosure skills but believed they were primarily responsible for disclosure to children and required support from healthcare workers (HCWs) during the disclosure process. They believed that counseling on how to approach disclosure and training on when and how to disclose will make the disclosure process easier. HCWs have a crucial role to play in promoting disclosure to perinatally infected children. The development of appropriate disclosure guidelines and training for HCWs will facilitate disclosure to children.
Collapse
|
41
|
Sariah A, Rugemalila J, Somba M, Minja A, Makuchilo M, Tarimo E, Urassa D, Siril H. "Experiences with disclosure of HIV-positive status to the infected child": Perspectives of healthcare providers in Dar es Salaam, Tanzania. BMC Public Health 2016; 16:1083. [PMID: 27737669 PMCID: PMC5064891 DOI: 10.1186/s12889-016-3749-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider children’s cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers’ experiences in disclosure of HIV-positive status to the infected child. Methods A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC) by purposive sampling. An interview guide, translated into participants’ national language (Kiswahili) was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis. Results The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure content that is age appropriate for children with HIV. Discussion The disclosure process was found to be a complex process. Perspectives regarding disclosure in children infected with HIV varied among healthcare providers in terms of their role in the process, clear national guidelines and appropriate standardized training for paediatric disclosure. Consistent with other studies, healthcare providers reported difficulties during disclosure because parents /guardians largely fear blame, social stigma, child's negative emotional reaction when disclosed to and have concerns about the child being too young and immature to understand the HIV condition. Conclusions In order to prevent inconsistencies during the disclosure process, it is important to have in place clear guidelines and standardized paediatric HIV disclosure training for healthcare providers. This would help improve their skills in paediatric disclosure, leading to positive health outcomes for children infected with HIV.
Collapse
Affiliation(s)
- Adellah Sariah
- Department of Maternal and Child Health, Faculty of Nursing, Hubert Kairuki Memorial University (HKMU), 322 Regent Estate, P.O. Box 65300, Dar es Salaam, +255, Tanzania.
| | - Joan Rugemalila
- Department of Internal Medicine, Muhimbili National Hospital, P.O. Box 65300, Dar es Salaam, Tanzania
| | - Magreat Somba
- Department of qualitative research, African Academy for Public Health (AAPH), P.O. Box 79810, Dar es Salaam, Tanzania
| | - Anna Minja
- Department of qualitative research, African Academy for Public Health (AAPH), P.O. Box 79810, Dar es Salaam, Tanzania
| | - Margareth Makuchilo
- Department of Care and Treatment, Mbagala Rangi Tatu Hospital, P.O. Box 45232, Dar es Salaam, Tanzania
| | - Edith Tarimo
- Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), P.O. Box 65004, Dar es Salaam, Tanzania
| | - David Urassa
- Department of Community Health, School of Public Health and Social Sciences, P.O. Box 65015, Dar es Salaam, Tanzania
| | - Helen Siril
- Department of Public Health Evaluation, Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania
| |
Collapse
|
42
|
Krauss BJ, Letteney S, Okoro CN. Why Tell Children: A Synthesis of the Global Literature on Reasons for Disclosing or Not Disclosing an HIV Diagnosis to Children 12 and under. Front Public Health 2016; 4:181. [PMID: 27660752 PMCID: PMC5014986 DOI: 10.3389/fpubh.2016.00181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022] Open
Abstract
While the psychological and health benefits of knowing one's HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV, and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child's worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child - e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence), understanding social reactions, and maintaining the child-adult relationship - a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during, and after disclosure and to advance the research agenda by broadening samples and refining approaches.
Collapse
Affiliation(s)
| | - Susan Letteney
- Department of Social Work, York College, City University of New York, New York, NY, USA
| | - Chioma N. Okoro
- Public Health Initiative Consultant, Lagos, Nigeria (formerly affiliated with Rogosin Institute, New York, NY, USA)
| |
Collapse
|
43
|
Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa. AIDS Res Treat 2016; 2016:2607249. [PMID: 27672451 PMCID: PMC5031873 DOI: 10.1155/2016/2607249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022] Open
Abstract
Background. There is limited research on the disclosure experiences of adolescents with perinatal acquired HIV (PAH). The study explores how adolescents with PAH experience living with HIV and examined their perceptions and experiences regarding disclosure and onward self-disclosure to friends and sexual partners. Methods. Thematic analysis was used to analyze in-depth interviews conducted with 37 adolescents. Findings. Adolescents received disclosure about their status at mean age of 12 years. They perceived disclosure as necessary and appreciated the truthful communication they received. Adolescents have learned to accept and live with HIV, and they desired to be healthy and normal like other people. After receiving disclosure, they found their treatment meaningful, and they adhered to medication. However, they also expressed a strong message that their HIV status was truly their secret and that self-disclosure to others will take the feeling of being normal away from them because they will be treated differently. Conclusion. Adolescents maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation. Given that adolescents want to be informed of their HIV status but desire controlling self-disclosure of their HIV status, these should form the basis for development of disclosure interventions.
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Das A, Detels R, Javanbakht M, Panda S. Issues around childhood disclosure of HIV status - findings from a qualitative study in West Bengal, India. Child Care Health Dev 2016; 42:553-64. [PMID: 27116937 PMCID: PMC4913886 DOI: 10.1111/cch.12338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 02/04/2016] [Accepted: 02/22/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Informing the children living with HIV (CLH) about their disease (disclosure) is important from the perspective of disease treatment and overall psychosocial development. There are no published studies that qualitatively explored HIV disclosure-related issues among CLH in India. Our aim was to provide insights into the perceptions of informal caregivers of CLH regarding childhood disclosure. METHODS Children were defined as those aged <16 years. In-depth interviews were conducted with 34 primary caregivers of CLH aged 8 to 15 years old who were residing in West Bengal, India. The participants were recruited with the help of a community-based organization that provides need-based services to people living with HIV. RESULTS We obtained caregivers' perspectives on the motivators and barriers of childhood disclosure. Health benefits such as medication adherence emerged as an important motivator, while distress caused by disclosure and potential for stigma were identified as barriers. Health care providers were the preferred disclosers for most caregivers, followed by the caregivers themselves. Some caregivers wanted their child to learn about his/her HIV status by him/herself. There was no consensus among the caregivers about the ideal age for disclosure. Many preferred to wait until the child attained maturity or was of marriageable age. DISCUSSION Disclosure of HIV status to children is an emotional issue, both for the caregiver and the child. Like most low-or middle-income countries, no standardized, age-appropriate disclosure guidelines exist in India. Our findings advocate adoption of a multi-faceted approach, including increased availability of social and familial support, for childhood HIV disclosure.
Collapse
Affiliation(s)
- A Das
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - S Panda
- National Institute of Cholera and Enteric Diseases (NICED/ICMR), Kolkata, West Bengal, India
| |
Collapse
|
46
|
Lawan UM, Envuladu EA, Abubakar S. Does Awareness of Status and Risks of Human Immunodeficiency Virus Impact Risky Transmission Behavior Among Infected Adolescents? A Case Study of Clients Attending an Antiretroviral Therapy (ART) Clinic in Kano, Kano State, Nigeria. Indian J Community Med 2016; 41:126-32. [PMID: 27051087 PMCID: PMC4799635 DOI: 10.4103/0970-0218.177533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive adolescents by virtue of their position are prone to dangerous behaviors including risk-taking for HIV transmission. OBJECTIVE To determine the awareness of HIV status and risk factors for HIV transmission among HIV-positive adolescents, and how these impact their behavior. MATERIALS AND METHODS A case study approach was used to study a random sample of 400 HIV-positive adolescent children attending an antiretroviral (ART) clinic in Kano, Kano State, Nigeria. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 computer statistical software. RESULT The mean age of the adolescents was 14.9 ± 3.15 years. The majority were females (54.8%) from a polygamous family (57.5%). About two-thirds or 251 (62.8%) patients knew their HIV status. The age of 14 years and above (z = 11.36, P = 0.0001) and having at least secondary school level of education (z = 2.78, P = 0.005) were significantly associated with awareness of HIV status on binary logistic regression. Up to 311 (77.8%) patients had good awareness of the risks of HIV transmission. Awareness of risk of HIV transmission was associated with awareness of HIV status (X(2) = 166.2, P = 0.0001). There was a significant variation in the behaviors between those who were aware of their HIV status and those who were not. Paradoxically, the percentage differences in risk-taking were remarkably high in all the variables examined, and were all in the direction of the adolescents who had good knowledge of the risk factors for HIV transmission. CONCLUSION AND RECOMMENDATION Health ministries, development partners working in this field, and behavioral change communication experts should develop formidable strategies for addressing this menace. There is also a dire need for further research in this area.
Collapse
Affiliation(s)
- Umar Muhammad Lawan
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Esther Awazzi Envuladu
- Department of Community Health, University of Jos, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Sanusi Abubakar
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| |
Collapse
|
47
|
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.
Collapse
Affiliation(s)
- Heidi Eve Van Rooyen
- Human and Social Development Programme, Human Sciences Research Council, Durban, South Africa.
| | | | | |
Collapse
|
48
|
Lorenz R, Grant E, Muyindike W, Maling S, Card C, Henry C, Nazarali AJ. Caregivers' Attitudes towards HIV Testing and Disclosure of HIV Status to At-Risk Children in Rural Uganda. PLoS One 2016; 11:e0148950. [PMID: 26881773 PMCID: PMC4755560 DOI: 10.1371/journal.pone.0148950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/24/2015] [Indexed: 12/05/2022] Open
Abstract
Caregivers of HIV-positive children were interviewed in the Mbarara and Isingiro districts of Uganda to identify current trends in practices related to HIV testing and the disclosure of HIV status to the child. A total of 28 caregivers of at least one HIV-positive child participated in semi-structured interviews exploring when and why they tested the child for HIV, when the child was informed of their positive status, and what the caregiver did to prepare themselves and the child for status disclosure. For a majority (96%) of respondents, the decision to test the child for HIV was due to existing illness in either the child or a relative. Other common themes identified included the existence of stigma in the caregivers’ communities and doubt that the children truly understood what was being explained to them when their status was disclosed. Most (65%) children were informed of their HIV status between the ages of 5 and 9, with the mean age of disclosure occurring at the age of 7. General provision of HIV information typically began at the same age as disclosure, and as many as two thirds (64%) of the caregivers sought advice from an HIV counsellor prior to disclosure. How a caregiver chose to prepare themselves and the child did not affect the caregiver’s perception of whether the disclosure experience was beneficial or not. These findings suggest that the HIV disclosure experience in Mbarara and Isingiro districts differs from current guidelines, especially with respect to age of disclosure, how caregivers prepare themselves and the child, and approaching disclosure as an ongoing process. The doubts expressed by caregivers regarding the child’s level of HIV understanding following the disclosure experience suggest the children may be insufficiently prepared at the time of the initial disclosure event. The findings also suggest that examining the content of pre-disclosure counselling and HIV education, and how health care professionals are trained to facilitate the disclosure process as important avenues for further research.
Collapse
Affiliation(s)
- Rick Lorenz
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eisha Grant
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Winnie Muyindike
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Samuel Maling
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Carol Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adil J. Nazarali
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- * E-mail:
| |
Collapse
|
49
|
Gachanja G, Burkholder GJ. A model for HIV disclosure of a parent's and/or a child's illness. PeerJ 2016; 4:e1662. [PMID: 26870614 PMCID: PMC4748695 DOI: 10.7717/peerj.1662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022] Open
Abstract
HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent's and/or a child's HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent's and/or a child's HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent's and/or a child's HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV-positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utility and viability of our HIV disclosure model in different settings and cultures.
Collapse
Affiliation(s)
- Grace Gachanja
- College of Health Sciences, Walden University, Minneapolis, MN, United States
| | - Gary J. Burkholder
- College of Health Sciences, Walden University, Minneapolis, MN, United States
- College of Social and Behavioral Sciences, Walden University, Minneapolis, MN, United States
- Laureate Education, Inc., Baltimore, MD, United States
| |
Collapse
|
50
|
Kajubi P, Whyte SR, Kyaddondo D, Katahoire AR. Tensions in Communication between Children on Antiretroviral Therapy and Their Caregivers: A Qualitative Study in Jinja District, Uganda. PLoS One 2016; 11:e0147119. [PMID: 26784904 PMCID: PMC4718696 DOI: 10.1371/journal.pone.0147119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction HIV treatment and disclosure guidelines emphasize the importance of communicating diagnosis and treatment to infected children in ways that are appropriate to children’s developmental stage and age. Minimal attention, however, has been given to communication challenges confronted by HIV-infected children and their caregivers. This study examined the tensions between children and their caregivers arising from differing perspectives regarding when and what to communicate about antiretroviral therapy (ART). Methods This qualitative study was conducted between November 2011 and December 2012 and involved 29 HIV-infected children aged 8–17 years on ART and their caregivers. Data were collected through observations and in-depth interviews, which took place in homes, treatment centres and post-test clubs. Children and caregivers were sampled from among the 394 HIV-infected children and (their) 393 caregivers who participated in the cross-sectional survey that preceded the qualitative study. ATLAS.ti. Version 7 was used in the management of the qualitative data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results While the children felt that they were mature enough to know what they were suffering and what the medications were for, the caregivers wanted to delay discussions relating to the children’s HIV diagnosis and medication until they felt that the children were mature enough to deal with the information and keep it a secret and this caused a lot of tension. The children employed different tactics including refusing to take the medicines, to find out what they were suffering from and what the medications were for. Children also had their own ideas about when, where and with whom to discuss their HIV condition, ideas that did not necessarily coincide with those of their caregivers, resulting in tensions. Conclusions Guidelines should take into consideration differing perceptions of maturity when recommending ages at which caregivers should communicate with their children about diagnosis and ART. Health care providers should also encourage caregivers to recognize and respect children’s efforts to learn about and manage their condition. Children’s questions and expressions of feelings should be treated as openings for communication on these issues.
Collapse
Affiliation(s)
- Phoebe Kajubi
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | | | - David Kyaddondo
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne Ruhweza Katahoire
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|