‘HIV is like a tsotsi. ARVs are your guns’

Cluver, Lucie; Hodes, Rebecca; Toska, Elona; Kidia, Khameer; Orkin, F Mark; Sherr, Lorraine; Meinck, Franziska

doi:10.1097/qad.0000000000000695

Cited by 97 publications

(61 citation statements)

References 36 publications

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“…Furthermore, we found an improved mean CD4 count with a younger age of disclosure (conversely, delayed disclosure predicts a lower mean CD4 count, as the correlation and regression models illustrate). Our findings are consistent with previous qualitative and cross-sectional studies that have described improved adherence with disclosure[8,11,12,14,18,22,26,29,30]. Far fewer longitudinal studies, such as ours, have looked at the associations between disclosure and adherence or outcomes over time[9,23].…”

Section: Discussionsupporting

confidence: 92%

“…Quantitative studies and outcomes data are far less prevalent; one study done in Romania showed that a patient’s knowledge of his or her HIV infection was related to delayed disease progression[23], while an adherence study in Zambia showed a positive correlation between adherence to ART and knowledge of one’s own HIV infection in young adolescents[9]. A recent study in West Africa showed an improved retention in care when adolescents were aware of their HIV status[25], and a cross-sectional study in South Africa showed that early and full disclosure was strongly associated with ART adherence[26]. Given the paucity of research on the medical benefits or drawbacks to HIV disclosure to adolescents, and the growing number of ALHIV, there is an urgent need to assess the medical outcomes of disclosure of HIV infection to those patients.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study

et al. 2017

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Background & aimsEmphasis 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.MethodsRetrospective, 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.ResultsNinety-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).ConclusionART 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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study

et al. 2017

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“…Interestingly, when evaluating continuous measures of VL and adherence, we saw improved adherence measurements preceding improvements in VL. Although nonintervention studies have also shown that disclosure of HIV status is associated with improved adherence to ART regimens among children and adolescents, 6,10 our study is the first to evaluate changes in adherence longitudinally before and after the introduction of a disclosure intervention.…”

Section: Discussionmentioning

confidence: 97%

Pediatric HIV Disclosure Intervention Improves Knowledge and Clinical Outcomes in HIV-Infected Children in Namibia

Beima‐Sofie

Brandt

Hamunime

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives:Using routinely collected data, we evaluated a nationally implemented intervention to assist health care workers and caregivers with HIV disclosure to children. We assessed the impact of the intervention on child's knowledge and health outcomes.Methods:Data were abstracted from national databases and patient charts for HIV-infected children aged 7–15 years attending 4 high-volume HIV clinics in Namibia. Disclosure rates, time to disclosure, and HIV knowledge in 314 children participating in the intervention were analyzed. Logistic regression was used to identify correlates of partial vs. full disclosure. Paired t-tests and McNemar tests were used to compare adherence and viral load (VL) before versus after intervention enrollment.Results:Among children who participated in the disclosure intervention, 11% knew their HIV status at enrollment and an additional 38% reached full disclosure after enrollment. The average time to full disclosure was 2.5 years (interquartile range: 1.2–3 years). Children who achieved full disclosure were more likely to be older, have lower VLs, and have been enrolled in the intervention longer. Among children who reported incorrect knowledge regarding why they take their medicine, 83% showed improved knowledge after the intervention, defined as knowledge of HIV status or adopting intervention-specific language. On comparing 0–12 months before vs. 12–24 months after enrollment in the intervention, VL decreased by 0.5 log10 copies per milliliter (N = 42, P = 0.004), whereas mean adherence scores increased by 10% (N = 88, P value < 0.001).Conclusions:This HIV disclosure intervention demonstrated improved viral suppression, adherence, and HIV knowledge and should be considered for translation to other settings.

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“…Of the 13 disclosure intervention studies they identified, only one was concerned with disclosure to children, focusing in particular on maternal HIV status disclosure to HIV-uninfected children [32]. Cluver et al [33] extended the evidence base regarding the important benefits of HIV status disclosure, and their study in South Africa showed that early and full disclosure of HIV status for perinatally infected adolescents was strongly associated with improved treatment adherence.…”

mentioning

confidence: 99%

HIV disclosure to children in low-and middle-income countries

Wit

Qiao

et al. 2015

Aids

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‘HIV is like a tsotsi. ARVs are your guns’

Abstract: Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission.

Cited by 97 publications

References 36 publications

Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study

Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study

Pediatric HIV Disclosure Intervention Improves Knowledge and Clinical Outcomes in HIV-Infected Children in Namibia

HIV disclosure to children in low-and middle-income countries

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