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Joyce C, Ramsammy C, Galvin L, Leshabane G, Liberty A, Otwombe K, Buckley J, Milovanovic M, Violari A. Experiences of South African caregivers disclosing to their children living with HIV: Qualitative investigations. PLoS One 2022; 17:e0277202. [PMID: 36445899 PMCID: PMC9707749 DOI: 10.1371/journal.pone.0277202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
Awareness of Human Immunodeficiency Virus (HIV) status improves health outcomes in children living with HIV, yet caregivers often delay disclosure. This qualitative investigation explored, through observation, how 30 caregivers responded to a HIV Disclosure study conducted between 2017 and 2020 at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Caregivers were assisted in disclosing to their children, aged 7-13 years; followed by a sub-sample of caregivers providing in-depth interviews to elaborate on findings.1) Barriers to disclosure included: caregivers being ill equipped, the fear of negative consequences and children considered lacking emotional or cognitive readiness. 2) Deflecting diagnosis from their children and the need for medication, motivated caregivers to disclosure. 3) Apprehension was evident during disclosure; however, overall disclosure was a positive experience with the support of the healthcare providers. These results highlight the significant role healthcare providers' play in supporting caregivers through the disclosure process.
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Affiliation(s)
- Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice 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, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Leshabane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, 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, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Toromo JJ, Apondi E, Nyandiko WM, Omollo M, Bakari S, Aluoch J, Kantor R, Fortenberry JD, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "I have never talked to anyone to free my mind" - challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya. BMC Public Health 2022; 22:1122. [PMID: 35658924 PMCID: PMC9167528 DOI: 10.1186/s12889-022-13519-9] [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: 10/24/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Adolescents living with HIV (ALHIV, ages 10–19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care. Methods This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized. Results Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9–20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure. Conclusions Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13519-9.
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Affiliation(s)
- Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Mark Omollo
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, RI, USA
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kara Wools-Kaloustian
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel C Vreeman
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Arnhold Institute for Global Health, New York, NY, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA. .,Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
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Kanyemba R, Govender K, Jimu C. Living With a Stigmatized Identity; Perceptions of Disclosure, Coping, and Medication Adherence Among Adolescent Boys and Young Men in Chiredzi-Zimbabwe. Front Public Health 2021; 9:628725. [PMID: 34976904 PMCID: PMC8714778 DOI: 10.3389/fpubh.2021.628725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited research on adolescent boys and young men (ABYM)'s initial and onward HIV seropositive status disclosure, coping strategies and treatment adherence journeys especially in Zimbabwe. This qualitative exploratory study employed in-depth individual interviews at Chiredzi General Hospital in Zimbabwe to explore the dynamics of disclosure, coping and treatment adherence among ABYM. Twenty-one HIV positive ABYM with ages ranging from 14 to 21 were recruited from their scheduled visit to collect medication at the hospital. Findings indicate that ABYM disclosure journeys began with shock, confusion or misunderstanding and ended in a positive life outlook. Treatment adherence among ABYM was very poor due to poverty, erratic food supply, feeling sick after taking medication, forgetfulness and the public nature of medication collection centers. The study concluded that ABYM maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation.
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Affiliation(s)
- Roselyn Kanyemba
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
- *Correspondence: Roselyn Kanyemba
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Christopher Jimu
- Discipline of Psychology, University of KwaZulu Natal, Durban, South Africa
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Kodyalamoole NK, Badiger SB, Dodderi SK, Shetty AK. Determinants of HIV status disclosure to children living with HIV in coastal Karnataka, India. AIDS Care 2020; 33:1052-1058. [PMID: 33233927 DOI: 10.1080/09540121.2020.1851018] [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: 10/22/2022]
Abstract
The caregivers of HIV-positive children either delay or avoid disclosure of HIV status to the child due to several reasons. Keeping the child's HIV status a secret puts them at considerable risk of stopping therapy and transmitting HIV to others. Hence this study was conducted to assess the determinants of disclosure of HIV status to infected children in coastal Karnataka. A cross-sectional study was conducted in a District Hospital in Coastal Karnataka from October 2014 to July 2015. One hundred eighty-five caregivers were recruited for the study purposively and interviewed using a pre-tested, semi-structured questionnaire after written informed consent. Of the 185 caregivers interviewed, 78 (42%) caregivers had not disclosed the HIV status to the child. The child being too young was the most common reason for non-disclosure of HIV status. The majority of the caregivers intended to disclose the HIV status fully to the child after the child attained ten years of age. Nearly two-thirds of the caregivers wanted to disclose it themselves in their own homes. The significant determinants of disclosure of HIV status were the age of the child, and person involved in childcare, and the venue of the disclosure.
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Affiliation(s)
- Nishanth Krishna Kodyalamoole
- Former: Department of Community Medicine, K.S.Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte, Mangalore, India
| | - Sanjeev B Badiger
- Former: Department of Community Medicine, K.S.Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte, Mangalore, India
| | - Sunil Kumar Dodderi
- Former Regional Coordinator- Care, Support and Treatment Division, Karnataka State AIDS Prevention Society, National AIDS Control Organisation, Ministry of Health and Family Welfare, Govt of India, Bangalore, India
| | - Avinash K Shetty
- Department of Pediatrics and Office of Global Health, Wake Forest School of Medicine and Brenner Children's Hospital, Winston- Salem, NC, USA
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Saeed A, Farooq S. "I Can't Go Out": Mobility Obstacles to Women's Access to HIV Treatment in KPK, Pakistan. J Assoc Nurses AIDS Care 2017; 28:561-574. [PMID: 28456471 DOI: 10.1016/j.jana.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
We examined the role of outside mobility constraints as barriers to HIV treatment for Pakistani women living with HIV (WLWH) whose husbands were permanently living in other cities. We focused on Khyber Pakhtunkhwa (KPK), which adheres to conservative social and cultural values for female mobility. Open-ended interviews were conducted with 21 WLWH. We found that women's mobility outside the home was shaped by the system of parda (seclusion) and that a husband's lack of support by not being present for clinical appointments, distance to the HIV clinic, and ages of children emerged as crucial contributors to women's outside mobility and their subsequent abilities to access HIV care. These obstacles were more acute for women living with in-laws rather than in nuclear families. Policymakers need to better understand the nuances of local cultures in which women seek HIV treatment so that they can devise practical, culturally appropriate, and acceptable programs.
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Health-related quality of life (HRQoL) and its correlates among community-recruited children living with HIV and uninfected children born to HIV-infected parents in West Bengal, India. Qual Life Res 2017; 26:2171-2180. [PMID: 28343351 DOI: 10.1007/s11136-017-1557-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Helping children living with HIV (CLH) to attain an optimum quality of life is an important goal for HIV programs around the world. Our principal objectives were to determine the association of HIV infection with different domains of health-related quality of life (HRQoL) among 8- to 15-year-old CLH in India and to compare the HRQoL parameters between CLH and HIV-negative children born to HIV-infected parents ("HIV-affected"). We also assessed whether antiretroviral therapy (ART) and CD4 lymphocyte counts were associated with HRQoL among CLH. METHODS Using the "Quality of Life (health-related) of Children Living with HIV/AIDS in India" instrument, we interviewed 199 CLH and 194 HIV-affected children from three districts of West Bengal, India. Participants were asked to quantify the difficulties faced by them in six HRQoL domains: physical, emotional, social, school functioning, symptoms, and discrimination. RESULTS The mean age of the participants was 11.6 (SD ± 2.5) years. CLH, compared to HIV-affected children, had poorer scores on all HRQoL domains except 'discrimination.' Among CLH, there were no significant differences in HRQoL domain scores (except in the 'discrimination' domain) between ART-treated and -untreated groups. CD4 lymphocyte count was found to be a significant positive predictor of the 'symptom' scale score. CONCLUSIONS In India, interventions for CLH mostly focus on biological disease. However, the current study revealed that HRQoL among CLH was much poorer than that of a socio-demographically comparable group. Culturally and developmentally appropriate psychosocial support measures for Indian CLH are urgently needed.
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Das A, Detels R, Afifi AA, Javanbakht M, Sorvillo F, Panda S. Formation and psychometric evaluation of a health-related quality of life instrument for children living with HIV in India. J Health Psychol 2016; 23:577-587. [PMID: 27703079 DOI: 10.1177/1359105316671022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In-depth interviews and focus group discussions were conducted to inform the development of an instrument to measure the health-related quality of life of children living with HIV. The QOL-CHAI instrument consists of four generic core scales of the "Pediatric Quality of Life Inventory" and two HIV-targeted scales-"symptoms" and "discrimination." A piloting exercise involving groups of children living with HIV and HIV-negative children born to HIV-infected parents provided evidence for the acceptable psychometric properties and usability of the instrument. It is expected that the QOL-CHAI can serve well as a brief, standardized, and culturally appropriate instrument for assessing health-related quality of life of Indian children living with HIV.
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Affiliation(s)
- Aritra Das
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Roger Detels
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Abdelmonem A Afifi
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Marjan Javanbakht
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Frank Sorvillo
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Samiran Panda
- 2 National Institute of Cholera and Enteric Diseases, India
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Das A, Detels R, Javanbakht M, Panda S. Living with HIV in West Bengal, India: perceptions of infected children and their caregivers. AIDS Care 2016; 29:800-806. [PMID: 27608501 DOI: 10.1080/09540121.2016.1227059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children living with HIV (CLH) face several physical and psychological challenges. The impact of the disease is not limited to the affected CLH, but also affects their caregivers and family members. We qualitatively explored the experiences, knowledge, concerns, and perceptions of primary caregivers and triangulated those aspects with those expressed by their CLH. We conducted 34 in-depth interviews (IDI) with primary caregivers of 8- to 15-year-old CLH residing in West Bengal, India. Four focus group discussions (FGD) with CLH were held, two each with children aged 8-12 and 13-15 years. Participants were recruited with the help of a community-based organization providing need-based services to adults and CLH. Five major themes shared by caregivers and children were identified, including concerns about HIV, medications, discriminatory behaviors, having a "healthy mind", and the advantages and limitations of available HIV-related health services. Two primary themes exclusively from IDI with caregivers were caregiving challenges and concerns about the future of their CLH. Indian CLH and their caregivers face many daily challenges, and there are many unmet but relevant expectations. Caregiving goes beyond the child-caregiver dynamic, and is intertwined with the local community and the healthcare and support system structures. The current study underscores the need for comprehensive care programs focusing on improving support to both CLH and caregivers.
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Affiliation(s)
- Aritra Das
- a Department of Epidemiology, Fielding UCLA School of Public Health , University of California , Los Angeles , CA , US
| | - Roger Detels
- a Department of Epidemiology, Fielding UCLA School of Public Health , University of California , Los Angeles , CA , US
| | - Marjan Javanbakht
- a Department of Epidemiology, Fielding UCLA School of Public Health , University of California , Los Angeles , CA , US
| | - Samiran Panda
- b National Institute of Cholera and Enteric Diseases (NICED/ICMR) , Kolkata , West Bengal , India
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