An Integrated Approach to HIV Disclosure for HIV-Affected Families in Thailand

Jantarapakde, Jureeporn; Pancharoen, Chitsanu; Teeratakulpisarn, Somsong; Mathajittiphan, Pornpen; Kriengsinyot, Rosalin; Channgam, Taweeksak; Pengnonyang, Supabhorn; Plodgratok, Prapaipan; Lakhonphon, Sudrak; Luesomboon, Wicharn; Jadwattanakul, Tanate; Avihingsanon, Anchalee; Ananworanich, Jintanat; Ungaro, P.; Phanuphak, Praphan

doi:10.1177/2325958219831021

Cited by 4 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It may be valuable to further leverage peer support groups and peer mentors to facilitate pre- and post-disclosure support to both caregivers and adolescents, and to empower peer mentors to lead post-disclosure support and follow-up. There is increasing evidence that adolescent peer support interventions are feasible, practical, and effective to support ALHIV care in LMIC [ 16 , 43 ]. Directed training to empower peers in lead roles in disclosure and follow-up support is critical and may be sustainable in the setting.…”

Section: Discussionmentioning

confidence: 99%

“…Complex factors surround caregiver decision-making on disclosure to adolescents. These include caregivers’ feelings of guilt for the child’s infection; difficulties initiating disclosure discussions with their children; fears of negative outcomes and perceived inadequate preparation to manage them; perceived HIV stigma; and concerns that the adolescent may be too young, cognitively unable to understand the disclosure, or unable to maintain secrecy regarding their status [ 11 , 12 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

“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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A study in Thailand reported a similar result, where a FCCM program improved readiness and willingness of parents to disclose their HIV status to their children, and improved HIV disclosure among families [ 16 ]. Disclosure of HIV status among family members can have important benefits for treatment, care and support for both children and adults living with HIV, improving communication between family members and providing social support, which may improve adherence to HIV treatment and improve health outcomes [ 16 – 18 ]. In the FCCM program, children learned that their caregivers were also taking HIV treatment.…”

Section: Discussionmentioning

confidence: 86%

‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

Khumalo

Katirayi

Ashburn

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background HIV-positive children have lagged adults on retention in HIV care and viral suppression. To address this gap, Eswatini’s Ministry of Health started a pilot family-centered HIV care model (FCCM) targeting HIV-positive children under 20 years old and their families. Methods We conducted semi-structured in-depth interviews with 25 caregivers and 17 healthcare workers (HCWs) to assess acceptability of FCCM in four pilot FCCM health facilities in Hhohho region of Eswatini. Thematic analysis with inductive and deductive codes was used to identify salient themes. Results Caregivers and HCWs reported FCCM benefits including strengthening the family bond, encouragement for family members to disclose their HIV status and supporting each other in taking antiretroviral drugs. Caregivers reported that they spent fewer days in clinic, experienced shorter waiting times, and received better counseling services in FCCM compared to the standard-of-care services. FCCM implementation challenges included difficulty for families to attend clinic visits together (e.g., due to scheduling conflicts with weekend Teen Support Club meetings and weekday FCCM appointments). Both HCWs and caregivers mentioned difficulty in sharing sensitive health information in the presence of other family members. HCWs also had challenges with supporting caregivers to disclose HIV status to children and managing the larger group during clinic visits. Conclusions FCCM for HIV-positive children was acceptable to both caregivers and HCWs, and they supported scaling-up FCCM implementation nationally. However, special considerations should be made to address the challenges experienced by participants in attending clinic visits together as a family in order to achieve the full benefits of FCCM for HIV positive children.

show abstract

Disclosure of HIV status and associated clinical outcomes of children and adolescents living with HIV in Asia

et al. 2023

View full text Add to dashboard Cite

An Integrated Approach to HIV Disclosure for HIV-Affected Families in Thailand

Cited by 4 publications

References 34 publications

“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

“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

‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

Disclosure of HIV status and associated clinical outcomes of children and adolescents living with HIV in Asia

Contact Info

Product

Resources

About