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

Abstract

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.

Models of support for disclosure of HIV status to HIV‐infected children and adolescents in resource‐limited settings

“…Our study showed that counsellors were frequently the primary individuals involved in the disclosure process in our sites. However, in the literature describing interventions to support disclosure, there is no specific mention of counsellors having a role in this process , as usually “healthcare workers” or “providers” are cited as being involved with disclosure. Counsellors and social workers may have been combined into the designation of “provider,” and play key roles in the delivery of care.…”

Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia’s Ability to Achieve UNAIDS 90-90-90 Targets

“…This will also reduce the estimated 29% of new infections from patients who are not virally suppressed. To improve pediatric adherence, Namibia plans to roll out a standardized pediatric HIV disclosure program that has been demonstrated to improve HIV outcomes, including HIV VL suppression [38], and to expand teen clubs and other community-based HIV care and treatment programs for adolescents [24, 37]. …”

Should There Be a Disclosure Mandate for Physicians Caring for Perinatally Infected Adolescents Who Don't Know Their HIV Serostatus?

“…7,12,17 Disclosure of serostatus is also positively associated with engaging in fewer acts of unprotected anal and vaginal sex, facilitating partner HIV testing, and improving ART adherence by reducing the need to hide medications from partners. 18,19 The link between disclosure and adherence to ART is vital, as adherence is critical to maximizing the clinical benefits of ART and is the most reliable determinant of patient survival.…”

“…9 In addition to preventing disease transmission, evidence suggests that disclosure can positively impact physical and psychological health by improving ART adherence, clinical care retention, and social relationships, as one no longer has to hide medications or doctor's appointments. 12,15,16 Adolescents living with HIV have an ethical right to know their serostatus. Given the health and social benefits and ethical value of disclosing HIV serostatus-and the potential negative implications of not disclosing-this article outlines and provides justification for bridging the current gap between adolescent and adult HIV serostatus disclosure policies in the United States.…”