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Mabasa RA, Muthelo L, Skaal L, Mothiba TM. Qualitative Study on the Voices of Adolescents Living with Perinatally Acquired HIV in Selected Clinics in the Limpopo Province of South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 11:28. [PMID: 38255342 PMCID: PMC10814135 DOI: 10.3390/children11010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
The disclosure of HIV status among adolescents living with perinatally acquired HIV (APHIV) has become one of the core challenges in the management of APHIV. Disclosure is a challenge that undermines positive advances and achievements in HIV management. There is limited literature on the voices of APHIV on disclosure of their status. This study aims to explore the current disclosure process and how it affects APHIV. A qualitative exploratory design was employed to conduct one-on-one in-depth interviews using a semi-structured interview guide. Purposive sampling was used to sample 21 APHIV in 16 selected health facilities in the Vhembe district of Limpopo Province, South Africa. Data were analyzed using Tesch's qualitative data method. The findings of this study reflect the gaps in the current disclosure process and guidelines while acknowledging the importance of disclosure to APHIV. A notable finding in this study is that most APHIV, especially those in early adolescence, did not want to know their HIV status due to the stigma attached to an HIV-positive diagnosis. This study suggests that proper training and support of parents and/or guardians in the disclosure process are needed, as they are the primary caregivers of APHIV. The disclosure of HIV status must be a comprehensive part of the management and care of HIV for APHIV. Furthermore, dedicated support programs should be developed and implemented to improve their lives post-disclosure.
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Affiliation(s)
- Rirhandzu Austice Mabasa
- Department of Optometry, Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa;
| | - Livhuwani Muthelo
- Department of Nursing Science, Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa;
| | - Linda Skaal
- Department of Public Health, Faculty of Health Sciences, Sefako Makgato University, Ga-Rankuwa 0208, South Africa;
| | - Tebogo Maria Mothiba
- Department of Optometry, Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa;
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Magill EB, Nyandiko W, Baum A, Aluoch J, Chory A, Ashimoshi C, Lidweye J, Njoroge T, Sang F, Nyagaya J, Scanlon M, Hogan J, Vreeman R. Factors associated with caregiver compliance to an HIV disclosure intervention and its effect on HIV and mental health outcomes among children living with HIV: post-hoc instrumental variable-based analysis of a cluster randomized trial in Eldoret, Kenya. Front Public Health 2023; 11:1150744. [PMID: 37213654 PMCID: PMC10196043 DOI: 10.3389/fpubh.2023.1150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
Background The HADITHI study is a cluster-randomized trial of children living with HIV and their caregivers in Kenya that aimed to increase rates of caregiver disclosure of their child's HIV status, encourage earlier status disclosure, and improve pediatric mental health and HIV outcomes. This analysis identified characteristics predicting caregiver non-responsiveness and compared outcomes among children based on disclosure status. Methods A penalized logistic regression model with lasso regularization identified the most important predictors of disclosure. The two-stage least squares instrumental variable approach was used to assess outcomes accounting for non-compliance to disclosure. Results Caregiver non-isolation and shorter time on antiretroviral therapy were predictive of HIV status disclosure. There were no statistically significant differences found in CD4 percentage, depression status, or mental and emotional status based on disclosure status up to 24 months-post intervention. Conclusion These findings have implications for specialists seeking to tailor disclosure interventions to improve caregiver-child dyad responsiveness.
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Affiliation(s)
- Elizabeth B. Magill
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Elizabeth B. Magill
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Aaron Baum
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Center for Global Health, Indiana School of Medicine, Bloomington, IN, United States
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Vreeman
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- *Correspondence: Rachel Vreeman
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Armoon B, Fleury MJ, Higgs P, Bayat AH, Bayani A, Mohammadi R, Ahounbar E. Prevalence, socio-demographics and service use determinants associated with disclosure of HIV/AIDS status to infected children: a systematic review and meta-analysis by 1985-2021. Arch Public Health 2022; 80:154. [PMID: 35681146 PMCID: PMC9178876 DOI: 10.1186/s13690-022-00910-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a public health issue of global importance. To our knowledge, no previous meta-analysis documenting the prevalence, socio-demographic, and service use determinants associated with HIV/AIDS disclosure to infected children has been conducted. The present study aimed to determine the prevalence, socio-demographics and service use determinants associated with the disclosure of HIV/AIDS status to infected children. METHODS Studies in English published between 01 January 1985 and 01 November 2021, and available on PubMed, Scopus, Web of Science, and Cochrane electronic databases were searched. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. RESULTS After article duplicates were excluded, assessments of abstracts were completed, and full-text papers evaluated, 37 studies were included in this meta-analysis. The prevalence of the disclosure of HIV status to children was measured to be 41% in this research. The odds that a child of 10 years and older is informed that they are HIV-positive is 3.01 time the odds that younger children are informed. Those children who had primary or lower schooling level were 2.41 times more likely to be informed of their HIV-positive status than children with higher levels of schooling. Children who had a non-biological parents were 3.17 times more likely to have been disclose being HIV-positive; social support (OR = 8.29, 95%CI = 2.34, 29.42), children who had higher levels of social supports were 8.29 times more likely to disclose HIV-positive; the primary educational level of caregivers (OR = 2.03, 95%CI = 1.43, 2.89), respondents who had caregivers with primary education level were 2.03 times more likely to disclose HIV-positive; antiretroviral treatment (ART) adherence (OR = 2.59, 95%CI = 1.96, 3.42), participants who adhered to ART were 2.59 times more likely to disclose HIV-positive and hospital follow-up (OR = 2.82, 95%CI = 1.85, 4.29), those who had hospital follow-up were 2.82 times more likely to disclose HIV-positive; were all significantly associated with the disclosure of HIV/AIDS status to infected children. CONCLUSION Such data are of importance for healthcare pediatrics HIV care professionals. Facilitating HIV diagnosis and disclosure to the infected children and ensuring access to HIV treatment will likely prevent secondary HIV transmission. Healthcare professionals are expected to provide age-appropriate counseling services to this population.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Toromo JJ, Apondi E, Nyandiko WM, Omollo M, Bakari S, Aluoch J, Kantor R, Fortenberry JD, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "I have never talked to anyone to free my mind" - challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya. BMC Public Health 2022; 22:1122. [PMID: 35658924 PMCID: PMC9167528 DOI: 10.1186/s12889-022-13519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Adolescents living with HIV (ALHIV, ages 10–19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care. Methods This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized. Results Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9–20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure. Conclusions Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13519-9.
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Affiliation(s)
- Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Mark Omollo
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, RI, USA
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kara Wools-Kaloustian
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel C Vreeman
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Arnhold Institute for Global Health, New York, NY, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA. .,Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
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Buckley J, Otwombe K, Joyce C, Leshabane G, Galvin L, Ramsammy C, Lebotsa ME, Liberty A, Violari A. Impact of Disclosure over Time on the Emotional Well-Being of Children with Perinatally Acquired HIV Infection in South Africa. J Dev Behav Pediatr 2022; 43:e188-e196. [PMID: 34570068 PMCID: PMC8953412 DOI: 10.1097/dbp.0000000000001008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe the disclosure process in children with perinatally acquired HIV infection (PHIV+) and its impact on their emotional well-being and adherence to antiretroviral therapy (ART) in South Africa. METHODS This prospective cohort study followed PHIV+ children aged 7 to 13 years attending counseling over 18 months. Standardized disclosure tools were used by a counselor with both child and caregiver present. Assessments included the Child Behavior Checklist (CBCL), Vineland Adaptive Behavior Scale (VABS), Child Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Adherence to ART was recorded through pharmacy pill returns. Changes over time and their differences from baseline were assessed by linear mixed models. RESULTS Thirty children with median age 10 years (interquartile range [IQR]: 9.0-11.0) were enrolled. The median time to disclosure was 48 weeks (IQR: 48.0-54.6). There was a significant decrease from baseline (p < 0.0001) and over time (p = 0.0037) in the total CDI score. A positive trend in the changes from baseline and over time was observed for internalizing (p values < 0.0001) and externalizing (p values < 0.0001) CBCL scales and Total Anxiety score of the RCMAS (p < 0.0001 and p < 0.0002, respectively). Only the Defensiveness median T-score increased during the follow-up (p = 0.004) and in the change from baseline (p = 0.0005). The adaptive (p = 0.0092) and maladaptive (p < 0.0001) scores of the VABS showed a decrease from baseline. ART adherence remained high throughout this study. CONCLUSION Disclosure does not worsen the child's emotional well-being and adherence to ART over time. This study adds to research from low- and middle-income countries to alleviate fears that disclosure may have an adverse outcome on children with PHIV+.
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Affiliation(s)
- Janice Buckley
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Leshabane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Galvin
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice Ramsammy
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moshoko Emily Lebotsa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zanon BP, Paula CCD, Ribeiro AC, Padoin SMDM. Content validation to support the monitoring of disclosure of HIV diagnosis in childhood. Rev Bras Enferm 2021; 75Suppl 2:e20210027. [PMID: 34787279 DOI: 10.1590/0034-7167-2021-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to create and validate the content of a guide for monitoring the communication of the HIV diagnosis in childhood. METHODS methodological study, with a design guided by the Knowledge-to-Action (KTA) Framework, supported by a participatory approach. The guide's content was structured according to the communication elements proposed by Lasswel from review studies. RESULTS the content was validated by 26 experts from nursing, medicine, psychology and pedagogy, using a Likert-type scale for relevance, clarity and precision. Data collection took place online and achieved a Content Validity Index of 0.94. CONCLUSIONS the guide can contribute to the practice of professionals who care for children living with HIV, to support the family in communication and to the child's right to know their diagnosis. For further research, it is recommended to create and validate the face of the technology in order to implement it.
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Affiliation(s)
- Bruna Pase Zanon
- Faculdade Integrada de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.,Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil
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Abstract
Background HIV-related stigma and HIV status disclosure are important elements in the continuous fight against HIV as these impact the prevention efforts and antiretroviral treatment adherence among people living with HIV/AIDS (PLWHA) in many communities. Objectives The objectives of the study were to examine the prevalence and experience of various types of HIV-related stigma and HIV status disclosure among PLWHA in Volta region. Methods A cross-sectional design was used to collect quantitative data from 301 PLWHA. Descriptive statistics were used to analyze and present data on socio-demographic variables. Correlation analysis was done to determine factors associated with HIV stigma and status disclosure while a Mann-Whitney U test was used to determine differences in internalized HIV stigma. Findings The mean age of the participants was 44.82 (SD: 12.22), 224 (74.4%) were female, and 90% attained at least primary education. A Pearson r analysis revealed that ethnicity (r[299] = 0.170, p = 0.003), religious affiliation (r[299] = -0.205, p = 0.001) and social support (r[299] = 0.142, p = 0.014) significantly predicted disclosure of HIV status. Fear of family rejection (62%) and shame (56%) were reasons for non-disclosure of HIV status. A Mann-Whitney's U-test revealed that females are more likely than males to internalize HIV stigma. Community-related HIV stigma in the form of gossip (56.1%), verbal harassment (30.9%), and physical harassment (8.6%) was reported. Conclusion A high rate of HIV status disclosure was found with social support, ethnicity, and religious affiliation being the associated factors. Internalized HIV stigma is prevalent among PLWHA while community-related stigma impacts HIV status disclosure. Strengthening social support systems and implementing culturally appropriate educational interventions may help in reducing community-related HIV stigma.
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Radcliffe C, Sam A, Matos Q, Antwi S, Amissah K, Alhassan A, Ofori IP, Xu Y, Deng Y, Reynolds NR, Paintsil E. Sankofa pediatric HIV disclosure intervention did not worsen depression scores in children living with HIV and their caregivers in Ghana. BMC Public Health 2020; 20:1578. [PMID: 33081739 PMCID: PMC7576749 DOI: 10.1186/s12889-020-09678-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/12/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The 'Sankofa' pediatric HIV disclosure study (2013-2017) was an intervention that aimed to address the low prevalence of disclosure of HIV status in Ghana. METHODS We conducted a cross-sectional study at the intervention site in Kumasi, Ghana, in 2019, (2 years after study closure) and administered the 21-item Beck Depression Inventory (BDI) and the 10-item Child Depression Inventory (CDI) to caregiver-child dyads who received the intervention. RESULTS We enrolled 65% (N = 157) of the original dyads in the present study. Between Sankofa enrollment baseline and the present study, both children and caregivers had significant (p < 0.0001) mean reductions in CDI scores and BDI scores, respectively. CDI scores of the children were significantly correlated with BDI scores of the caregivers (r = 0.019, p = 0.019). No statistically significant associations between disclosure status and either CDI score or BDI score were found. CONCLUSIONS Our findings did not support caregivers' fears that disclosure leads to depression. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01701635 (date of registration Oct 5, 2012).
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Affiliation(s)
- Christopher Radcliffe
- Department of Pediatrics, Pharmacology & Public Health, Yale School of Medicine, 464 Congress Avenue, New Haven, CT, 06520, USA
| | - Aba Sam
- Department of Pediatrics, Pharmacology & Public Health, Yale School of Medicine, 464 Congress Avenue, New Haven, CT, 06520, USA
| | - Quinn Matos
- Department of Pediatrics, Pharmacology & Public Health, Yale School of Medicine, 464 Congress Avenue, New Haven, CT, 06520, USA
| | - Sampson Antwi
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kofi Amissah
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Amina Alhassan
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Irene Pokuaa Ofori
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Yunshan Xu
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Elijah Paintsil
- Department of Pediatrics, Pharmacology & Public Health, Yale School of Medicine, 464 Congress Avenue, New Haven, CT, 06520, USA.
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