Determinants and processes of HIV status disclosure to HIV - infected children aged 4 to 17 years receiving HIV care services at Baylor College of Medicine Children’s Foundation Tanzania, Centre of Excellence (COE) in Mbeya: a cross-sectional study

Nzota, Mary S; Matovu, Joseph K. B.; Draper, Heather R.; Kisa, Rose; Kiwanuka, Suzanne N

doi:10.1186/s12887-015-0399-3

Cited by 29 publications

(52 citation statements)

References 20 publications

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“…Although the frequency of ALHIV fully disclosed of their HIV-serostatus varies according to studies in Africa, it remains overall low ranging from 16% to 39% [36][37][38][39][40][41]. In our study, we found that only 46.1% knew their HIV status at baseline, and 74.2% by 24 months of follow-up.…”

Section: Discussioncontrasting

confidence: 60%

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

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Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including the disclosure of their HIV-serostatus that we explored in the West-African COHADO cohort. We assessed the 24-month outcomes among APHIV in relation to the disclosure of their own HIV-serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. An unfavorable outcome was defined when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (>50copies/mL) were notified at 24 months. None of these events defined a favorable outcome. We investigated correlates of APHIV favorable 24-month outcome using a logistic regression model.Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01): adjusted on baseline variables, it was not significantly associated with HIV-disclosure but significantly higher for APHIV living in Lomé compared to those in Abidjan (aOR: 17.24, 95%CI [3.69-80.44]).Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed across countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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Section: Discussioncontrasting

confidence: 60%

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 60%

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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“…Other factors that may influence the decision to disclose include: caregivers wanting their child to improve or maintain a certain level of adherence, the caregiver's level of knowledge of HIV disclosure, and the child or adolescent's status on ART [21][22][23].…”

Section: Severalmentioning

confidence: 99%

HIV Disclosure in Children in This Millenium – Should It still be an Issue?

Eneh

Ugwu

Paul

2020

AIR

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Background: As more children with HIV survive into adolescence and adulthood, one of the most difficult issues that families with HIV-infected children face is disclosure of their children’s status to them. Objective: To explore factors associated with disclosure or none disclosure and whether disclosure is beneficial or not. Methods: The mothers of HIV positive children who brought their children aged 5-18 years to the Paediatric Infectious Disease Clinic of the University of Port Harcourt Teaching Hospital from January to December 2015 were interviewed using a structured investigator administered questionnaire. Results: Of the 100 caregivers interviewed, 26.0% have disclosed the HIV status to the children. The mean age at disclosure was 14.42 ± 2.45 years. Care givers that have disclosed were significantly older (45.58±8.32 years vs 38.18±9.2 years; p = .0002). The mean age of children whose status have been disclosed was significantly higher than those who were yet to be aware of their status (14.42±2.45years vs 10.97±3.11 years; p = 0.00001). There was no significant difference in the mode of transmission and orphan status between the two groups. Disclosure was significantly more among children who were diagnosed between 5-10 years of age (14; 53.8%) (p=0.013), have taken antiretroviral drugs for over 24 months (22; 84.6%) (p= 0.003) and had at least one HIV-infected sibling (21; 80.8%) (p=0.00001). Among 13 (50.0%) whose status have been disclosed and 59 (79.7%) whose status had not been disclosed, the caregiver had disclosed the child’s status to others (p= 0.004). The major reason for disclosing was because the child was either asking questions on why he/she is taking drugs or he/she is refusing to take drugs (15; 57.7%) respectively. Only 6 (23.1%) caregivers disclosed because they felt the child has a right to know. Most difficult question asked by the children during disclosure was how they got the HIV (22; 84.6%). Reasons given for non-disclosure included fear of disclosure to others (74; 100%), child too young to understand (70; 94.5%) and fear of impact on child’s emotional health (42; 56.7%). Majority 20 (76.9%) of the care givers felt relieved after disclosure. Twenty-four (92.3%) caregivers felt disclosure had improved child’s adherence to antiretroviral therapy and determination to survive (22; 84.6%). Conclusion: Disclosure is beneficial to both the child and caregiver. Healthcare providers should encourage caregivers to disclose HIV status to their children as soon as possible.

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Determinants and processes of HIV status disclosure to HIV - infected children aged 4 to 17 years receiving HIV care services at Baylor College of Medicine Children’s Foundation Tanzania, Centre of Excellence (COE) in Mbeya: a cross-sectional study

Cited by 29 publications

References 20 publications

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

HIV Disclosure in Children in This Millenium – Should It still be an Issue?

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