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Lukyamuzi Z, Ssuna B, Mirembe RN, Mawanda D, Kinkumu P, Nalugo C, Adikin E, Namisango F, Nakalega R, Atuhaire P, Musoke P, Butler LM. Experiences and challenges of using community health worker-led mechanism in supporting HIV disclosure among adults living with HIV in heterosexual relationships in the rural Uganda. AIDS Res Ther 2023; 20:14. [PMID: 36906557 PMCID: PMC10008611 DOI: 10.1186/s12981-023-00508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND HIV status disclosure among sexual partners is vital in HIV management. Community health workers (CHW) support HIV disclosure among adults living with HIV (ALHIV) in sexual relationships with disclosure difficulties. However, experiences and challenges of using CHW-led disclosure support mechanism were not documented. This study explored experiences and challenges involved in using CHW-led disclosure support mechanism among ALHIV in heterosexual relationships in the rural Uganda. METHODS This was a phenomenological qualitative study involving in-depth interviews among CHWs and ALHIV with HIV disclosure difficulties to sexual partners in greater Luwero region, Uganda. We conducted 27 interviews among purposively selected CHWs and participants who had participated in the CHW-led disclosure support mechanism. Interviews were conducted until saturation was reached; and analysis was done using inductive and deductive content analysis in Atlas. RESULTS All respondents viewed HIV disclosure as an important strategy in HIV management. Provision of adequate counseling and support to those intending to disclose was instrumental for successful disclosure. However, fear of the negative disclosure outcomes was viewed as a barrier to disclosure. The CHWs were viewed as having an added advantage in supporting disclosure as opposed to the routine disclosure counseling. However, HIV disclosure using CHW-led support mechanism would be limited by possible bleach of client's confidentiality. Therefore, respondents thought that appropriate selection of CHWs would improve their trust in the community. Additionally, providing CHWs with adequate training and facilitation during the disclosure support mechanism was viewed to improve their work. CONCLUSION Community health workers were viewed as being more supportive in HIV disclosure among ALHIV with disclosure difficulties to sexual partners compared to routine facility based disclosure counseling. Therefore, near location CHW-led disclosure mechanism was acceptable and useful in supporting HIV disclosure among HIV-affected sexual partners in rural settings.
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Affiliation(s)
- Zubair Lukyamuzi
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - Ruth Nabisere Mirembe
- Infectious Diseases Institute (IDI), College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Mawanda
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Paul Kinkumu
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Christine Nalugo
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Esther Adikin
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | | | - Rita Nakalega
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Patience Atuhaire
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Philippa Musoke
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 06269, USA
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Warburton K, Navér L, Houghton J, Fatikhova K. Talking to children about their HIV diagnosis: a discussion rooted in different global perspectives. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S9. [PMID: 35019738 DOI: 10.12968/bjon.2022.31.1.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An online meeting was arranged with four professionals representing four countries to debate current practices and future steps in naming HIV to children (disclosing HIV status). This article considers the evidence and reports on the commentary and debate from the meeting. Naming HIV to children remains a challenge. Although studies identify some of the facilitators and barriers to informing children of their HIV diagnosis, further review of practice is required. This article presents a global perspective of naming practices from different settings. The article comprises commentary and a report of the online debate, along with supporting evidence. The four participating authors concluded that health professionals must work in collaboration with families to support early naming of HIV to children or having an open discussion about HIV in clinics. Naming when a child is younger reduces self-stigma and empowers children and young people to adhere to their medication, make informed decisions and share their own diagnosis appropriately. The authors concluded that health professionals play a key role in educating colleagues and the public to reduce stigma and discrimination. Professionals working with children and families living with HIV require support and resources to instil confidence in naming and facilitate naming of HIV status to a child.
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Affiliation(s)
- Katie Warburton
- Senior Lecturer in Children and Young People's Nursing, University of Central Lancashire
| | - Lars Navér
- Consultant Paediatrician, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, and the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Kamila Fatikhova
- Co-ordinator of Daycare Centre for Children and Families Affected by HIV, Tashkent, Uzbekistan
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Cremonese L, de Mello Padoin SM, de Paula CC. Communication of HIV diagnosis in proper time: scoping review. Rev Esc Enferm USP 2021; 55:e20210153. [PMID: 34730609 DOI: 10.1590/1980-220x-reeusp-2021-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map how the communication of the HIV infection diagnosis occurs in pediatrics. METHODS Scoping review of the 64 original articles. We selected research papers in Portuguese, English, or Spanish, with the participants: child, adolescent, relative/family, and/or health professional from 2011-2020. We accessed the following sources: PubMed, CINAHL, Scopus, WoS, ASSIA, PsycINFO, ERIC, Sociological Abstracts, Edubase, LILACS, BDENF, and IndexPsi. RESULTS Regarding the population, it was evident to us that the relative must be the sender of the diagnosis with the professionals' support; regarding the reasons for the communication, the child maturity, expressed by questions, the necessity of therapy adherence, abilities to communicate and the right of knowing the diagnosis must be considered. The communication channel is centered on materials that promote comprehension, quantity, and quality of information. That indicated an interactive process. Regarding the effects, they are beneficial when the communication occurs at a proper time. CONCLUSION Communication must occur through a process that includes professional support to the relatives/family, development of abilities to evaluate the appropriate moment, and the monitoring effect.
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Affiliation(s)
- Luiza Cremonese
- Universidade Luterana do Brasil, Cachoeira do Sul, RS, Brazil
| | | | - Cristiane Cardoso de Paula
- Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI. (JBI Brazil) São Paulo, SP, Brazil
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Khumalo PN, Katirayi L, Ashburn K, Chouraya C, Mpango L, Mthethwa N, Mofenson LM. 'There are no more secrets': acceptability of a family-centered model of care for HIV positive children in Eswatini. BMC Health Serv Res 2020; 20:951. [PMID: 33059670 PMCID: PMC7559472 DOI: 10.1186/s12913-020-05810-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND HIV-positive children have lagged adults on retention in HIV care and viral suppression. To address this gap, Eswatini's Ministry of Health started a pilot family-centered HIV care model (FCCM) targeting HIV-positive children under 20 years old and their families. METHODS We conducted semi-structured in-depth interviews with 25 caregivers and 17 healthcare workers (HCWs) to assess acceptability of FCCM in four pilot FCCM health facilities in Hhohho region of Eswatini. Thematic analysis with inductive and deductive codes was used to identify salient themes. RESULTS Caregivers and HCWs reported FCCM benefits including strengthening the family bond, encouragement for family members to disclose their HIV status and supporting each other in taking antiretroviral drugs. Caregivers reported that they spent fewer days in clinic, experienced shorter waiting times, and received better counseling services in FCCM compared to the standard-of-care services. FCCM implementation challenges included difficulty for families to attend clinic visits together (e.g., due to scheduling conflicts with weekend Teen Support Club meetings and weekday FCCM appointments). Both HCWs and caregivers mentioned difficulty in sharing sensitive health information in the presence of other family members. HCWs also had challenges with supporting caregivers to disclose HIV status to children and managing the larger group during clinic visits. CONCLUSIONS FCCM for HIV-positive children was acceptable to both caregivers and HCWs, and they supported scaling-up FCCM implementation nationally. However, special considerations should be made to address the challenges experienced by participants in attending clinic visits together as a family in order to achieve the full benefits of FCCM for HIV positive children.
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Affiliation(s)
| | - Leila Katirayi
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Washington, DC, USA
| | - Kim Ashburn
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Washington, DC, USA
| | | | - Lydia Mpango
- Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | | | - Lynne M Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Washington, DC, USA
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Chiang FM, Hsieh JG, Fan SY, Wang YW, Wang SC. Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051594. [PMID: 32121624 PMCID: PMC7084922 DOI: 10.3390/ijerph17051594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/02/2022]
Abstract
The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver's experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and "not becoming a burden" is their primary consideration. It's suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.
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Affiliation(s)
- Fu-Ming Chiang
- Department of Nursing, Institute of Medical Sciences, Tzu Chi University, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Institute of Health and Welfare Policy, National Yang-Ming University, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
| | - Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Ying-Wei Wang
- Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
- Correspondence: ; Tel.: +886-2-2522-0888 (ext. 506)
| | - Shu-Chen Wang
- Department of Nursing, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
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Mo PKH, Wang Z, Lau JTF, Li AYC, Wang Q. Disclosure of maternal HIV infection to children among Chinese women with HIV: The application of the Theory of Planned Behaviour and the role of various norms. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1544-1554. [PMID: 31373425 DOI: 10.1111/hsc.12825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/10/2019] [Accepted: 07/09/2019] [Indexed: 05/22/2023]
Abstract
Maternal HIV disclosure to children has numerous benefits for both mothers and children. However, the prevalence of maternal HIV disclosure to children remains low in many countries. The present study examined factors associated with intention to disclose maternal HIV status to children among Chinese HIV+ women who have not disclosed their HIV status to their child. Factors from the Theory of Planned Behavior and various norms (injunctive, descriptive and moral norm) were examined. Findings from 179 HIV+ women revealed that only 16.8% intended to disclose their HIV status to their child in the future. Adjusted for significant background variables, all factors from the TPB and various norms (i.e. attitude, injunctive norm, descriptive norm, moral norm, perceived behavioural control) were associated with intention to disclose HIV status (adjusted odds ratios ranged from 3.22, 15.85). Stepwise logistic regression showed that attitude (ORm = 6.96) and injunctive norm (ORm = 6.81) were associated with intention to disclose HIV status. Interventions to promote maternal HIV disclosure were warranted to promote attitude, perceived behavioural control, and various norms associated with HIV disclosure.
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Affiliation(s)
- Phoenix K H Mo
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Zixin Wang
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Angela Y C Li
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Qian Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Baker AN, Bayer AM, Kolevic L, Najarro L, Viani RM, Deville JG. Child, Caregiver, and Health Care Provider Perspectives and Experiences Regarding Disclosure of HIV Status to Perinatally Infected Children in Lima, Peru. J Int Assoc Provid AIDS Care 2019; 17:2325957417752257. [PMID: 29347903 PMCID: PMC6748514 DOI: 10.1177/2325957417752257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite recommendations for disclosure of HIV status to children living with HIV (CLHIV), fewer than half of CLHIV at the Instituto Nacional de Salud del Niño (INSN) in Lima, Peru, have had disclosure. How and when the disclosure process for CLHIV should take place in Peru has not been studied. METHODS We conducted a qualitative study at INSN to explore perceptions and experiences of 6 health care providers (HCPs), 14 disclosed and nondisclosed CLHIV (8-17 years), and their 14 caregivers regarding knowledge of illness, disclosure of HIV status, and appropriate disclosure approaches. RESULTS Disclosed children wanted to be told their diagnosis earlier. Nondisclosed children expressed frustration taking medications. Caregivers and HCPs discussed motivations to disclose, including educating, honesty, improving medication adherence, and preventing secondary transmission. CONCLUSION Culturally appropriate guidelines and training for HCPs and caregivers are needed to support disclosure of children's HIV status and ongoing support for CLHIV.
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Affiliation(s)
- Amira Noori Baker
- 1 Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA
| | - Angela Marie Bayer
- 2 Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA.,3 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lenka Kolevic
- 4 Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Lizzete Najarro
- 3 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rolando Mario Viani
- 5 Department of Pediatrics, Division of Infectious Diseases, University of California, San Diego, CA, USA.,6 Rady Children's Hospital San Diego, La Jolla, CA, USA.,7 AbbVie, Inc, North Chicago, IL, USA
| | - Jaime Gerardo Deville
- 1 Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, USA
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Klingberg S, King R, Seeley J, Lubwama R, Namuganga M, Nabiryo B, Etima M, Musoke P, Butler LM. Courage and confidence to stop lying: caregiver perspectives on a video to support paediatric HIV disclosure in Kampala, Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 17:273-279. [PMID: 30355059 DOI: 10.2989/16085906.2018.1521850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The World Health Organization (WHO) recommends that HIV-positive children are told their diagnosis by age 12 years. However, most perinatally-infected children reach adolescence without being told their HIV status. Effective strategies are needed to promote disclosure, and optimise children's health outcomes as they transition to adolescence and adulthood. This qualitative study explored how caregivers of HIV-positive children aged 7-12 years perceived and related to a video used as part of a larger behavioural intervention to promote full disclosure to children by age 12 years. Eight semi-structured interviews and 3 group reflection sessions with 28 caregivers were analysed thematically. Five themes were generated: courage and confidence; reasoning and empathy; child- caregiver relationship; foreign but relatable; and not reaching everyone. The video was found acceptable and appropriate for fostering readiness to disclose. Through watching it, participants reported they could see people similar to themselves prevail despite challenges, which gave them courage.
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Affiliation(s)
- Sonja Klingberg
- a Medical Research Council Epidemiology Unit & UK Clinical Research Collaboration Centre for Diet and Activity Research , University of Cambridge , Cambridge , United Kingdom.,b Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine , Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | - Rachel King
- c Global Health Sciences , University of California , San Francisco , Kampala , Uganda
| | - Janet Seeley
- d Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , United Kingdom.,e Medical Research Council/Uganda Virus Research Institute , Uganda Research Unit on Aids , Entebbe , Uganda
| | - Resty Lubwama
- f Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda
| | - Margaret Namuganga
- f Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda
| | - Barbara Nabiryo
- f Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda
| | - Monica Etima
- f Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda
| | - Philippa Musoke
- f Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda.,g Department of Paediatrics and Child Health , Makerere University , Kampala , Uganda
| | - Lisa M Butler
- h Institute for Collaboration on Health, Intervention and Policy , University of Connecticut , Storrs , Connecticut
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Rankin-Williams AC, Geoffroy EM, Schell ES, Mguntha AM. How can male rates of HIV testing be increased? Recommendations from a mixed methods study in southern Malawi. Int Health 2018; 9:367-373. [PMID: 29236985 DOI: 10.1093/inthealth/ihx042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background In southern Malawi, 12.8% of adults are HIV positive. Men are less likely to have been tested than women. We investigated men's HIV knowledge and the attitudes, influencers, facilitators and barriers affecting HIV testing. Methods We conducted an explanatory mixed-methods study with analysis of secondary quantitative data from 425 rural men collected in January 2014 (time 1) and April 2015 (time 2) and qualitative interviews with 50 men in September 2015. All respondents lived in villages receiving HIV education and testing. Results Quantitative data revealed that comprehensive HIV knowledge increased and was associated with having been tested by time 2. Educational level was positively associated with having been tested. Men's reasons for not getting tested were fear of learning their HIV status, fear of rejection by partners and wives and fear of discrimination. Wives influenced men's opinions about healthcare. The qualitative results demonstrated that men feared being seen at test sites and feared discrimination. Wives had the greatest reported influence on male testing. Men perceived services as female-oriented and stigmatizing. They preferred door-to-door testing. Conclusions Providers can improve uptake by increasing men's HIV knowledge, leveraging the influence of spouses and offering door-to-door testing with male health workers.
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Affiliation(s)
- Amy C Rankin-Williams
- Department of Health Policy and Management, Gillings School of Global Pubic Health, University of North Carolina, Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Elizabeth M Geoffroy
- Global AIDS Interfaith Alliance, 2171 Francisco Blvd East, San Rafael, CA 94901, USA
| | - Ellen S Schell
- Global AIDS Interfaith Alliance, 2171 Francisco Blvd East, San Rafael, CA 94901, USA
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Evangeli M. The Adolescent HIV Disclosure Cognition and Affect Scale: Preliminary Reliability and Validity. J Pediatr Psychol 2018; 42:711-720. [PMID: 28339782 DOI: 10.1093/jpepsy/jsw107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/12/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives Globally, there are 2 million HIV-positive 10-19-year-olds. One challenge for this population is sharing their HIV status with others (onward HIV disclosure). There are no multi-item, multidimensional scales of HIV disclosure cognitions and affect for young people living with HIV. An 18-item measure of HIV disclosure cognition and affect was developed, administered to 65 adolescents living with HIV (aged 12-16 years). Data were explored using principal component analysis and preliminary construct and criterion validity assessed. Three factors were revealed: negative disclosure attitudes and feelings, self-efficacy, and positive disclosure attitudes and feelings. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV disclosure in the past 6 months, HIV disclosure intention and self-perception. Preliminary evidence of the measure's good psychometric properties suggests it may be helpful in future clinical and research work.
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Krauss BJ, Letteney S, Okoro CN. Why Tell Children: A Synthesis of the Global Literature on Reasons for Disclosing or Not Disclosing an HIV Diagnosis to Children 12 and under. Front Public Health 2016; 4:181. [PMID: 27660752 PMCID: PMC5014986 DOI: 10.3389/fpubh.2016.00181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022] Open
Abstract
While the psychological and health benefits of knowing one's HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV, and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child's worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child - e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence), understanding social reactions, and maintaining the child-adult relationship - a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during, and after disclosure and to advance the research agenda by broadening samples and refining approaches.
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Affiliation(s)
| | - Susan Letteney
- Department of Social Work, York College, City University of New York, New York, NY, USA
| | - Chioma N. Okoro
- Public Health Initiative Consultant, Lagos, Nigeria (formerly affiliated with Rogosin Institute, New York, NY, USA)
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Abstract
Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one's status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers and maximise available support. Yet deciding whether, what, how and when to tell HIV-positive children about their condition is challenging for caregivers. We systematically review HIV disclosure theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention stage, integrates individual and contextual determinants. It aims to be situationally specific, broadly applicable and consistent with the empirical literature. Research and practice implications are discussed.
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Affiliation(s)
- Michael Evangeli
- a Department of Psychology , Royal Holloway University of London , Egham Hill, Egham, Surrey, TW20 0EX , UK
| | - Ashraf Kagee
- b Department of Psychology , Stellenbosch University , Stellenbosch, Private Bag X1, Matieland, 7602 , South Africa
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13
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Abstract
With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this potential, children must navigate normative developmental processes and challenges while living with an unusually complex, stigmatizing, potentially fatal chronic illness and meeting the demands of treatment.Yet many of these children, especially preadolescents, do not know they are HIV-infected. Despite compelling evidence supporting the merits of informing children of their HIV status, there has been little emphasis on equipping the child's caregiver with information and skills to promote disclosure, particularly, when the caregiver faces a variety of sociocultural barriers and is reluctant to do so. In this study, we present the background, process and methods for a first of its kind collaboration that is examining the efficacy of an intervention developed to facilitate the engagement of caregivers in the process of disclosure in a manner suitable to the sociocultural context and developmental age and needs of the child in Ghana. We also report preliminary data that supported the design of the intervention approach and currently available domains of the data system. Finally, we discuss challenges and implications for future research.
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Beima-Sofie K, John-Stewart G, Shah B, Wamalwa D, Maleche-Obimbo E, Kelley M. Using health provider insights to inform pediatric HIV disclosure: a qualitative study and practice framework from Kenya. AIDS Patient Care STDS 2014; 28:555-64. [PMID: 25216105 DOI: 10.1089/apc.2014.0040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Optimal pediatric HIV disclosure impacts illness and developmental experiences while improving access to timely treatment. However, disclosure rates in high HIV prevalence countries remain low and there are limited data on best practices. We conducted a qualitative study of disclosure practices and interviewed healthcare providers from five pediatric HIV clinics in Kenya. We identified themes central to disclosure practices, rationale for approaches, barriers to implementing disclosure, and creative strategies to overcome challenges. We used these insights to develop a practice-based framework for disclosure that is sensitive to practical challenges. Overall, providers had limited training but extensive experience in disclosure, endorsed individualized disclosure practices, invested substantial time on disclosure despite clinical burden, and noted adverse outcomes associated with unplanned or abrupt disclosure. Providers advocated for an approach to disclosure that is child-centered but respects caregiver fears and values. Caregiver support was provided to enable caregivers to be the person who ultimately disclosed HIV status to children. Unplanned or abrupt disclosure to children was reported to have severe and persistent adverse impact and was a stimulus to accelerate disclosure in scenarios when providers believed children may be suspecting their diagnosis. Based on these expert insights, the framework we developed incorporates concurrent evaluation of child and caregiver readiness, identifies cues to prompt disclosure discussions, includes caregiver education and support, and utilizes a gradual approach of unveiling HIV diagnosis to the child.
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Affiliation(s)
- Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington
- Institute for Public Health Genetics, University of Washington, Seattle, Washington
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Brandi Shah
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Maureen Kelley
- Department of Pediatrics, University of Washington, Seattle, Washington
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle, Washington
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Jemmott JB, Jemmott LS, O'Leary A, Ngwane Z, Lewis DA, Bellamy SL, Icard LD, Carty C, Heeren GA, Tyler JC, Makiwane MB, Teitelman A. HIV/STI risk-reduction intervention efficacy with South African adolescents over 54 months. Health Psychol 2014; 34:610-21. [PMID: 25110841 DOI: 10.1037/hea0000140] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little research has tested HIV/sexually transmitted infection (STI) risk-reduction interventions' effects on early adolescents as they age into middle and late adolescence. This study tested whether intervention-induced reductions in unprotected intercourse during a 12-month period endured over a 54-month period and whether the intervention reduced the prevalence of STIs, which increase risk for HIV. METHOD Grade 6 learners (mean age = 12.4 years) participated in a 12-month trial in Eastern Cape Province, South Africa, in which 9 matched pairs of schools were randomly selected and within pairs randomized to a theory-based HIV/STI risk-reduction intervention or an attention-control intervention. They completed 42- and 54-month postintervention measures of unprotected intercourse (the primary outcome), other sexual behaviors, theoretical constructs, and, at 42- and 54-month follow-up only, biologically confirmed curable STIs (chlamydial infection, gonorrhea, and trichomoniasis) and herpes simplex virus 2. RESULTS The HIV/STI risk-reduction intervention reduced unprotected intercourse averaged over the entire follow-up period (OR = 0.42, 95% CI [0.22, 0.84]), an effect not significantly reduced at 42- and 54-month follow-up compared with 3-, 6-, and 12-month follow-ups. The intervention caused positive changes on theoretical constructs averaged over the 5 follow-ups, although most effects weakened at long-term follow-up. Although the intervention's main effect on STIs was nonsignificant, an Intervention Condition × Time interaction revealed that it significantly reduced curable STIs at 42-month follow-up in adolescents who reported sexual experience. CONCLUSION These results suggest that theory-based behavioral interventions with early adolescents can have long-lived effects in the context of a generalized severe HIV epidemic.
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Affiliation(s)
- John B Jemmott
- Annenberg School for Communication, University of Pennsylvania
| | | | | | | | | | - Scarlett L Bellamy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
| | - Larry D Icard
- College of Health Professions and Social Work, Temple University
| | - Craig Carty
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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