HIV-positive status disclosure and associated factors among children in public health facilities in Dire Dawa, Eastern Ethiopia: A cross-sectional study

Disclosure to South African children about their own HIV status over time

Disclosure to children living with HIV (CLHIV) about their own status is associated with positive outcomes such as treatment adherence, but prior cross-sectional studies in sub-Saharan Africa report disclosure rates of <50%. This study aims to assess pediatric disclosure over time. 548 CLHIV were followed from 2/2013-4/2018 in Johannesburg, South Africa. Cumulative incidence of disclosure was calculated with Kaplan-Meier analysis, and disclosure characteristics assessed with a Cox model. By end of follow-up, cumulative disclosure was 70.3% (95% confidence interval: 60.0-79.9). Median age at disclosure was 9 years (range: 3-13). Baseline predictors of disclosure included older child age and the child having a history of going hungry. Prior to disclosure, 98.0% of caregivers who disclosed had conversed with their child about their illness or an HIV-related topic, or their child had asked about HIV, versus 88.6% of caregivers who never disclosed. While many children did not receive disclosure during this relatively large, longitudinal study of South African CLHIV, caregivers who had not yet disclosed may have been preparing to do so by discussing their child's health or HIV generally with their child. This highlights the need for clinicians to consistently support caregivers throughout the incremental disclosure process.

HIV Positivity Disclosure Among Children Living with HIV/AIDS and Currently on HAART in Dessie, Northeast Ethiopia

Background

Disclosure of HIV/AIDS positive test result to children is a continuing routine problem in the health care setting. Some of the families as well as the health care workers are negligent to inform children of their HIV status. This study was aimed at identifying the prevalence of HIV-positivity disclosure and the factors among 6–15-year-old children currently on HAART in Dessie, Ethiopia.

Methods

A facility based cross-sectional study design was performed in Dessie from January 21 to March 12, 2020 among 346 parents/caregivers with children living with HIV and currently on HAART. The data were collected using pre-tested, structured and self-administered questionnaires. The collected data were entered into Epi info v.7.1 and exported into SPSS version 23 for further analysis. Binary and multivariable logistic regression was employed and statistically significant factors were identified at 95% CI and at p-value <0.05.

Results

HIV positivity disclosure was found to be 29.2% (26.3–34.7%). Being widowed mothers/caregivers, 11–15-year-old children, child received support from NGOs and having a mother with a negative HIV test were found to be statistically significant factors for disclosure.

Conclusion

The overall HIV positivity disclosure to children living with HIV was found to be low in contrast to the WHO standard. In other ways, it was comparable with the Ethiopian figures. Health workers and managers need to focus on strengthening child support, make known the maternal/caregivers’ HIV status, and child age specific effective interventions to improve disclosure of HIV positivity status for children living with HIV for better ART adherence and treatment outcomes.

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

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.

HIV Serostatus Disclosure and Its Predictors Among Children Living With HIV in Ethiopia: A Systematic Review and Meta-Analysis

Background

HIV disclosure among children refers to when the caregiver is having disclosed to the child that he or she has HIV specifically. Disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS. Even though, the benefits of disclosure are considerable, informing a child of his or her own HIV status is often delayed. There is a dearth of studies on HIV serostatus disclosure among children in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of HIV serostatus disclosure and associated factors among children living with HIV in Ethiopia.

Methods and Materials

Using a combination of search terms and Boolean operators, studies were retrieved from Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. Five authors independently assessed the quality of each study using the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies. STATA Version 11 software was used for statistical analyses. The random-effects (Der Simonian and Laird) method was used for the meta-analysis. The heterogeneity test was carried out with the help of I-squared (I2) statistics. A leave-one-out sensitivity analysis was carried out.

Results

A total of 12 articles with 3,410 participants were included in this systematic review and meta-analysis. The pooled prevalence of HIV serostatus disclosure among children was 36.87% (95% CI: 29.30, 44.44; I2 = 95.8%). Children aged older than 10 years (p = 0.003) and caregivers with primary and above education (p < 0.001) were factors significantly associated with HIV serostatus disclosure among children.

Conclusions

The finding of this study showed that HIV serostatus disclosure among children is relatively low. Therefore, developing clear guideline on HIV serostatus disclosure among children, strengthening public health education or community awareness creation about HIV/AIDS to promote the benefits of disclosure and extensively provision of counseling by health care providers are essential to enhance HIV serostatus disclosure among children.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021239035.

Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study

INTRODUCTION

The World Health Organization recommends full disclosure of HIV-positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10-19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents' mental health as reasons for non-disclosure. We aimed to identify the predictors of disclosure and the association of disclosure with adherence, viral suppression and mental health outcomes among adolescents in sub-Saharan Africa.

METHODS

Analyses included three rounds (2014-2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random-effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression and mental health symptoms between adolescents by disclosure status. We also explored differences in the change in mental health symptoms and adherence between study rounds and disclosure groups with logistic regression.

RESULTS

Eight hundred and thirteen APHIV were interviewed at baseline, of whom 769 (94.6%) and 729 (89.7%) were interviewed at the second and third rounds, respectively. The proportion aware of their HIV-positive status increased from 63.1% at the first round to 85.5% by the third round. Older age (adjusted odds ratio [aOR]: 1.27; 1.08-1.48) and living in an urban location (aOR: 2.85; 1.72-4.73) were associated with disclosure between interviews. There was no association between awareness of HIV-positive status and ART adherence, viral suppression or mental health symptoms among all APHIV interviewed. However, among APHIV not aware of their status at baseline, adherence decreased at the second round among those who were disclosed to (N = 131) and increased among those not disclosed to (N = 151) (interaction aOR: 0.39; 0.19-0.80). There was no significant difference in the change in mental health symptoms between study rounds and disclosure groups.

CONCLUSIONS

Awareness of HIV-positive status was not associated with higher rates of mental health symptoms, or lower rates of viral suppression among adolescents. Disclosure was not associated with worse mental health. These findings support the recommendation for timely disclosure to APHIV; however, adherence support post-disclosure is important.

Disclosure status of HIV-positive children and associated factors among children in public health facilities in East Arsi zone, Oromia regional state, South Eastern Ethiopia: A cross-sectional study

Objectives:

This study aims to assess the disclosure status of HIV-positive children and its associated factors in selected hospitals in East Arsi zone, Oromia regional state, Ethiopia, 2020.

Methods:

Institutional-based cross-sectional study design was conducted on 410 sample size. Four hospitals were randomly selected among hospitals that currently gave service. Data were collected from caregivers/biological parents by interviewing from 30 July 2020 to 30 August 2020 using the systematic random sampling technique. In logistic regression analysis, the variables which had independent correlations with dependent variable were identified based on adjusted odds ratio and a p value <0.05 with 95% confidence interval was claimed as statistically significant.

Results:

Disclosure status of HIV-positive children was 59.8%, 95% confidence interval (54.9, 64.1). Children diagnosed at the age of <5 (adjusted odds ratio = 0.25, 95% confidence interval (0.126, 0.49)), antiretroviral therapy follow-up for 6–15 years (adjusted odds ratio = 2.08, 95% confidence interval (1.013, 4.29)), children diagnosed at the appropriate age of ⩾12 years (adjusted odds ratio = 1.95, 95% confidence interval (1.09, 3.49)), and children diagnosed at the age of <11 years (adjusted odds ratio = 4.5, 95% confidence interval (3.45, 8.38)) were positively associated factors to disclose status.

Conclusion:

The disclosure status of HIV-positive children was low in this study. Antiretroviral therapy follow-up for 6–15 years, children diagnosed at the appropriate age of ⩾12 years, children diagnosed at the age of <5 years, and children who aged below 11 years were positively associated with disclosure status. Thus, we recommended, health care providers and all stakeholders should give age-appropriate counseling regarding when and why to disclose their status.