Notification of HIV status disclosure and its related factors in HIV‐infected adolescents in 2009 in the Aconda program (CePReF, CHU Yopougon) in Abidjan, Côte d'Ivoire, The PRADO‐CI Study

Abstract

IntroductionWe studied the frequency of documentation of disclosure of HIV status in medical charts and its correlates among HIV-infected adolescents in 2009, in Abidjan, Côte d'Ivoire.MethodsThe PRADO-CI is a cross-sectional study aimed at studying HIV-infected adolescents’ social, psychological, and behavioural difficulties and their determinants in Abidjan, Côte d'Ivoire. In this study, we present specific analyses on disclosure. All HIV-infected adolescents aged 13–21 years and followed at least once in 2009 in two urban HIV-care centres in Abidjan (Cepref and Yopougon Teaching Hospital) were enrolled in the study. Standardized data were extracted from medical records to document if there was notification of disclosure of HIV status in the medical record. Frequency of notification of HIV disclosure was estimated with its 95% confidence interval (CI) and correlates were analyzed using logistic regression.ResultsIn 2009, 229 adolescents were included: 126 (55%) males; 93% on antiretroviral therapy (ART), 61% on cotrimoxazole prophylaxis. Their median age was 15 years at the time of the study. Among the 193 patients for whom information on HIV status disclosure was documented (84%), only 63 (32.6%; 95% CI=26.0–39.3%) were informed of their status. The proportion of adolescents informed increased significantly with age: 19% for 13–15 years, 33% for 16–18 years and 86% for 19–21 years (p <0.0001). Adolescents on ART tended to be more likely to be informed of their HIV status (34.5%) than those not treated (13.3%) (p=0.11). Those on cotrimoxazole were significantly more likely to be informed (39.6%) than those not (21.9%) (p=0.01). Disclosure was significantly higher in adolescents with a history of ART regimen change (p=0.003) and in those followed in the Cepref (48.4%) compared to the Yopougon Teaching Hospital (24.8%), (p=0.001). In multivariate analyses, disclosed HIV status was significantly higher in those followed-up in the Cepref compared to the other centre: adjusted odds ratio (aOR)=3.5 (95% CI: 1.1–10.9), and among older adolescents compared to those aged 13–15 years: [16–18 years] aOR=4.2 (95% CI: 1.5–11.5) and [>18 years]: aOR=22.1 (95% CI: 5.2–93.5).ConclusionsHIV disclosure rate was low among Ivoirian HIV adolescents and was site- and age-dependent. There is a need for practical interventions to support HIV disclosure to adolescents which provides age-appropriate information about the disease.

HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

“…It was similar to other studies conducted in Uganda and Zambia in children aged 12 in median [4], [11] or Thailand (mean age 9.2 years) [15] but a bit lower than an Ivorian study involving adolescents older than 13 years [19]. Indeed, disclosure was often associated with an age>10 or even older [13], [17], [18], [29], [30], supporting our observations.…”

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

“…These latter issues may be more pertinent for perinatally infected adolescents compared to behaviourally infected adolescents. Adolescents and youth living with HIV are also at high risk of depression [5,6], may deny or be unaware of their HIV status [7], and as adolescents are prone to risk taking [8]. This vulnerable period during adolescence can lead to higher risks of HIV transmission to uninfected sexual partners, treatment interruption and overall adherence problems, treatment failure and loss to follow-up from HIV care.…”

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

“…In our study, we found that only 46.1% knew their HIV status at baseline, and 74.1% by 24 months of follow-up. Although this should be closer to 100% according to the WHO recommendations, this is higher than reported in previous studies, particularly for West Africa [25,31,42]. In Ghana, two separate studies reported the proportion of HIV disclosure to be 11.2% among children and adolescents aged 8-14 years in 2009 and 44% among ALHIV aged 12 -19 years in 2015 [25,43].…”

“…According to a previous review, 1.7% to 41% of children and ALHIV in low and middle-income countries are fully disclosed of their HIV-positive status [29]. In West-Africa, less than a third of APHIV knew their status in 2011 and the HIV-disclosure process often occurs late, after the WHO-recommended age of 12 years [30,31].…”