Factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania

Abstract

IntroductionWith the introduction of antiretroviral drugs HIV-infected children live longer. Disclosure of HIV diagnosis is increasingly an important and inevitable issue. Both healthcare providers and caregivers face challenges of disclosure to children. The objective of the study was to explore factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC).MethodsA cross-sectional hospital-based study was conducted from October 2011 to April 2012. Study population included HIV-infected children aged 5 to 14 years, their caregivers and healthcare providers. Structured questionnaires were used to collect information. Children were asked the reason for hospital visits. Outcome of interest was HIV disclosure status. Data was processed and analysed using SPSS version 16.0. Multivariate logistic regression at 5% margin error was used to account for confounders.ResultsA total of 211 children were enrolled with mean age of 9.7 (SD ± 2.6; range 5-14) years. Only 47 (22.3%) children knew their HIV-status. The mean age of disclosure was 10.6 years. Most of disclosed children were aged above 10 years (p).ConclusionMost of children were not disclosed. Ages, self medication, getting other support and parents/caregivers prior discussion were strong predictors of disclosure status.

Surviving Overwhelming Challenges: Family Caregivers’ Lived Experience of Caring for a Child Diagnosed with HIV and Enrolled in Antiretroviral Treatment in Ethiopia

“…Abebe & Teferra, 2012;Kyaddondo et al, 2013;Mengistu, 2013). Other researchers have emphasized that family caregivers should be empowered through detailed and continuous discussions to reveal the child's status and treatment in order to avoid confusion prior to a child's treatment initiation (Abebe & Teferra, 2012;Kyaddondo et al, 2013;Mumburi et al, 2014).…”

“…One of the limitations in this study is that the children's experiences were not illuminated. However, since the HIV status of children in Ethiopia seldom is disclosed (Brown et al, 2011;Mumburi et al, 2014), this was not possible. During the study we carefully avoided inadvertent disclosure of the child's status (Mumburi et al, 2014).…”

Revelação do diagnóstico de HIV para crianças e adolescentes: subsídios para prática assistencial

“…Considering its understanding as a process, the participants mentioned that the reveal happens in stages, throughout which information is slowly revealed, until the stage where the disease is named (5,7) . An honest dialogue between the child or adolescent and their caretaker allows them to reveal it to them, but later, another, a more adult explanation, can be carried out (6) .…”

“…The average age in which the children were informed about the diagnosis was nine year of age (5,13) . However, it is believed that the discussion regarding the health of these children should happen around their sixth year of age, mentioned as the school age, since it is in this stage that children acquire the ability to relate events and mental representations, expressed both verbally and symbolically (7) . Preschool children, below ten years of age, are seen as too young to know their diagnosis.…”

“…A well-trained team needs to be involved and face the obstacles needed to obtain the consent of the family to share the information regarding this illness with the child, so they can offer support both to the family and to the child or adolescent, also guaranteeing co-accountability in the health care plan. Therefore, it represents a task not yet systematized in the routine assistance offered to the population (7) -as is the case of the Spikes protocol, whose objective is to transmit bad news (8) . Therefore, it is still unclear for the professionals when to reveal, and what is the role of each professional as they follow-up on this process.…”