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Puffer ES, Finnegan A, Schenk K, Langhaug L, Rusakaniko S, Choi Y, Mahaso S, Simmons R, Green EP. Comparing fears about paediatric HIV disclosure to the lived experiences of parents and guardians: a prospective cohort study. Psychol Health 2023; 38:1587-1605. [PMID: 35188010 PMCID: PMC9392813 DOI: 10.1080/08870446.2022.2041637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/16/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being. DESIGN We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status. MAIN OUTCOME MEASURES We used three waves of data to compare caregivers' pre-disclosure worries to post-disclosure reports and to characterise associations between disclosure and well-being of the child (Strengths and Difficulties Questionnaire), caregiver (Patient Health Questionnaire-9), and family (Family Relationship Quality) over time. RESULTS Caregivers' pre-disclosure worries and fears about how their child would react to disclosure of their HIV status largely went unrealised. Furthermore, we did not find strong evidence of clinically-important increases in problems on average following disclosure. CONCLUSION Findings support the call to identify supportive intervention strategies that address caregiver fears at the beginning of the disclosure process.
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Affiliation(s)
- Eve S. Puffer
- Duke University, Department of Psychology and Neuroscience, Durham, NC, USA
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Amy Finnegan
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Lisa Langhaug
- Regional Psychosocial Support Initiative, Harare, Zimbabwe
| | | | - Yujung Choi
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Ryan Simmons
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Eric P. Green
- Duke University, Duke Global Health Institute, Durham, NC, USA
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Wu M, Shiau S, Strehlau R, Liberty A, Patel F, Burke M, Murnane PM, Violari A, Yin MT, Abrams EJ, Kuhn L, Arpadi S. Disclosure to South African children about their own HIV status over time. AIDS Care 2023; 35:334-340. [PMID: 34930060 PMCID: PMC9209585 DOI: 10.1080/09540121.2021.2017397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela M. Murnane
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T. Yin
- HIV Center for Clinical and Behavioral Studies, New York Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Elaine J. Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Louise Kuhn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephen Arpadi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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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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Lemon TL, Tassiopoulos K, Tsai AC, Cantos K, Escudero D, Quinn MK, Kacanek D, Berman C, Salomon L, Nichols S, Chadwick EG, Seage GR, Williams PL. Health Insurance Coverage, Clinical Outcomes, and Health-Related Quality of Life Among Youth Born to Women Living With HIV. J Acquir Immune Defic Syndr 2023; 92:6-16. [PMID: 36150048 PMCID: PMC9742193 DOI: 10.1097/qai.0000000000003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although sustained access to health care is essential, little is known about the relationship between insurance coverage and health among people born to women living with HIV (WLHIV). SETTING Prospective cohort studies of youth and young adults born to WLHIV from 2007 to 2019. METHODS We used adjusted generalized estimating equation models to estimate mean differences in, and relative risks (RRs) of, health-related quality of life (HR-QoL) and HIV disease measures over time by insurance status. HR-QoL scales with limited variability were dichotomized. Modified Poisson models were used to estimate RRs. RESULTS Six hundred sixty-nine Adolescent Master Protocol (AMP) youth [66% living with perinatally-acquired HIV (PHIV), 72% Black] and 939 AMP Up/AMP Up Lite young adults (89% PHIV, 68% Black) reported insurance. Most were publicly insured (87% youth, 67% young adults). Privately insured young adults living with PHIV had lower risk of antiretroviral therapy nonadherence [adjusted RR (aRR): 0.82, 95% CI: 0.70 to 0.97] than those with public insurance. There was a lower risk of suboptimal role functioning for young adults with private insurance (aRR: 0.58, 95% CI: 0.35 to 0.97) and those unaware of their coverage (aRR: 0.41, 95% CI: 0.21 to 0.78). Young adults with private insurance had higher health perception scores than those with public insurance (adjusted mean difference: 3.87, 95% CI: 0.37 to 7.38). For youth, we observed no differences in HR-QOL and HIV disease measures by insurance. CONCLUSION These findings suggest meaningful differences in antiretroviral therapy adherence and some HR-QoL outcomes by health insurance coverage among young adults born to WLHIV.
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Affiliation(s)
- Tiffany L Lemon
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | | | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry Harvard Medical School, Boston, MA
| | - Krystal Cantos
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- IQVIA Epidemiology & Drug Safety, Cambridge, MA
| | - Dan Escudero
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - M K Quinn
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claire Berman
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Liz Salomon
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego San Diego, CA; and
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - George R Seage
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Paige L Williams
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
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Lessons Learned from the Impact of HIV Status Disclosure to Children after First-Line Antiretroviral Treatment Failure in Kinshasa, DR Congo. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121955. [PMID: 36553398 PMCID: PMC9777424 DOI: 10.3390/children9121955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
HIV status disclosure to children remains a challenge in sub-Saharan Africa. For sociocultural reasons, parents often delay disclosure with subsequent risks to treatment compliance and the child’s psychological well-being. This article assesses the effects of HIV disclosure on second-line ART compliance after first-line failure. We conducted a retrospective study of 52 HIV-positive children at Kalembelembe Pediatric Hospital in Kinshasa who were unaware of their HIV status and had failed to respond to the first-line ART. Before starting second-line ART, some parents agreed to disclosure. All children were followed before and during the second-line ART. Conventional usual descriptive statistics were used. For analysis, the children were divided into two groups: disclosed to (n = 39) and not disclosed to (n = 13). Before starting the second-line ART, there was no difference in CD4 count between the two groups (p = 0.28). At the end of the first year of second-line ART, the difference was statistically significant between the two groups with regard to CD4% (p < 0.001) and deaths (p = 0.001). The children disclosed to also reported fewer depressive symptoms post-disclosure and had three times fewer clinic visits. HIV status disclosure to children is an important determinant of ART compliance and a child’s psychological well-being.
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Edun O, Shenderovich Y, Zhou S, Toska E, Okell L, Eaton JW, Cluver L. Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study. J Int AIDS Soc 2022; 25:e25910. [PMID: 35543100 PMCID: PMC9092159 DOI: 10.1002/jia2.25910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Olanrewaju Edun
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental HealthCardiff UniversityCardiffUK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)School of Social SciencesCardiff UniversityCardiffUK
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
| | - Elona Toska
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- AIDS and Society Research UnitUniversity of Cape TownCape TownSouth Africa
| | - Lucy Okell
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Jeffrey W. Eaton
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Lucie Cluver
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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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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Tucho WA, Tekelehaimanot AN, Habte MB. Disclosure Status and Associated Factors Among Children on Antiretroviral Therapy in Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:299-306. [PMID: 34211313 PMCID: PMC8242142 DOI: 10.2147/phmt.s314259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
Background The World Health Organization recommends that children should be informed of their HIV status at age 6–12 years. However, disclosure of HIV status among children is very low in resource-limited areas, particularly in Ethiopia. So, the aim of this study was to determine the prevalence of disclosure and associated factors among a cohort of HIV-infected children in southwest Ethiopia. Methods A facility-based cross-sectional study design was employed among caregivers of HIV-positive children aged 6–15 in Bench sheko and West Omo zone Southwest Ethiopia, from March 1 to April 20, 2020. Study participants were included using a consecutive sampling technique. Data were collected using a pretested interviewer administered questionnaire and checklist. A multivariable logistic regressions model was used to identify independent predictors of disclosure. The significance of association was declared by AOR at 95% confidence and a p-value <0.05. Results A total of 327 participants were involved in the study yielding a 95% response rate. The prevalence of HIV-positive status disclosure was 45.6% (95% CI=41.01–51.02). Caregiver secondary education and above (AOR=3.16, 95% CI=1.07–9.34), caregiver discussed about disclosure with health professionals (AOR= 9.56, 95% CI=4.88–18.74), child age 10–15 year old (AOR=3.64, 95% CI=1.64–8.08), duration on ART >5 years (AOR=5.08, 95% CI=1.57–16.37), treatment follow-up at hospital (AOR=2.23, 95% CI=1.27–5.01) and having treatment support for Children (AOR=3.84, 95% CI=1.88–7.85) were independent predictors of HIV-positive status disclosure. Conclusion Disclosure of HIV status to children is low. Caregivers educational status, caregivers discussion with health professional, older child, duration on ART of more than 5 year, getting treatment service from hospital, and having a treatment support group are factors that enable disclosure. Therefore, concerted efforts based on the findings of this study will be required to improve the disclosure status among HIV-positive children.
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Affiliation(s)
- Walelign Atomsa Tucho
- Department of Disease Prevention and Control, Bench Sheko Zone Health Office, Mizan-Aman, Southwest Ethiopia
| | | | - Mahilet Berhanu Habte
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Mi T, Zhou G, Li X, Qiao S, Yang X, Shen Z, Zhou Y. The association between HIV disclosure to family members and quality of life among people living with HIV/AIDS: The indirect effects through social support. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01927-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dantuluri KL, Carlucci JG, Howard LM, Johnson DP, Spencer H, Desai NA, Garguilo KA, Wilson GJ. Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic. J Adolesc Health 2021; 68:713-718. [PMID: 33187819 DOI: 10.1016/j.jadohealth.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11 years who undergo developmentally appropriate disclosure about their HIV status. METHODS A quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11 years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data. RESULTS Before the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11 years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11 years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%. CONCLUSIONS Several interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.
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Affiliation(s)
- Keerti L Dantuluri
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee.
| | - James G Carlucci
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leigh M Howard
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Johnson
- Department of Pediatrics (Hospital Medicine), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hillary Spencer
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neerav A Desai
- Department of Pediatrics (Adolescent and Young Adult Health), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn A Garguilo
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory J Wilson
- Department of Pediatrics (Infectious Diseases), Vanderbilt University Medical Center, Nashville, Tennessee
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Knowlton AR, Nguyen TQ, Isenberg S, Tseng TY, Catanzarite Z, Mitchell MM, Cruz-Oliver D. Quality of Life Among Caregivers of a Vulnerable Population Living with HIV: Caregiving and Relationship Factors. AIDS Behav 2021; 25:360-376. [PMID: 32715410 PMCID: PMC10696639 DOI: 10.1007/s10461-020-02975-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature on health-related quality of life (HRQOL) has focused on people living with chronic conditions, with less attention given to HRQOL among informal caregivers. We used cross-sectional dyadic data from both care recipients (CR) living with HIV and the person they identified as their primary informal (unpaid) caregiver (CG) to identify psychosocial and caregiving relationship factors (including, CG role ambivalence and caregiving-related stress) associated with CG HRQOL. We conducted confirmatory factor analysis and structural equation modeling testing. The results highlight interdependent effects of the CG-CR relationship and reveal pathways whereby relationship interactions positively and negatively impact CGs' HRQOL. Affiliative stigma, CG-CR communication, CRs' reciprocity of support and other psychosocial factors indirectly and differentially affected physical and mental HRQOL through effects on secondary stress and role ambivalence. Dyad-focused intervention on interpersonal communication and support exchange may improve HRQOL and resilience of CGs of vulnerable people living with HIV.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, USA
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Vreeman RC, Scanlon ML, Tu W, Slaven J, McAteer C, Aluoch J, Ayaya S, Nyandiko WM. Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families. J Int Assoc Provid AIDS Care 2020; 18:2325958219880570. [PMID: 31581890 PMCID: PMC6900619 DOI: 10.1177/2325958219880570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There are few validated tools to measure stigma, particularly among children living with HIV and their families. METHODS This study was nested within a larger study that followed 240 child-caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child-caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. RESULTS Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. CONCLUSIONS The stigma instrument showed high validity when compared to emotional and behavioral outcomes.
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Affiliation(s)
- Rachel Christine Vreeman
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Michael Lawrence Scanlon
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carole McAteer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Lahai M, James PB, Wannang NN, Wurie HR, Conteh S, Bah AJ, Samai M. A cross-sectional study on caregivers' perspective of the quality of life and adherence of paediatric HIV patients to highly active antiretroviral therapy. BMC Pediatr 2020; 20:286. [PMID: 32517722 PMCID: PMC7282047 DOI: 10.1186/s12887-020-02194-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Poor compliance to highly active antiretroviral therapy (HAART) can result in the poor quality of life in children living with Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) because of low plasma drug concentration and the possibility of drug resistance. This study evaluates the response of caregivers for determination of adherence and the four quality of life domains in children (aged 14 years and under) on HAART. Methods We conducted a cross-sectional study of 188 children, each accompanied by their caregivers at Ola During Children’s Hospital and Makeni Government Hospital between September and November 2016. Adherence to HAART and Quality of life was assessed using the WHO Quality of life summary questionnaire (WHOQOL-BREF). We obtained ethical approval from the Sierra Leone Ethics and Scientific Review Committee. Results The study revealed 5.9% adherence amongst paediatric patients, and a strong association of adherent patients(p = 0.019*) to the physical health domain (mean = 64.61 SD = 8.1). Caregiver HIV status showed a strong association with the physical (mean = 58.3, SD = 11.7 and p = 0.024*), and psychological health domains (mean = 68.2, SD = 14.7 and p = 0.001). Caregiver type (mother/father/sibling) accompanying child to hospital also showed strong associated with the physical (mean = 58.0, SD = 10.6, p < 0.001), psychological (mean 68.2 SD = 14.81 p < 0.001) and environmental health domains (mean = 59.7, SD = 13.47, p < 0.001). Further regression analysis showed a strong association with physical health domain for HIV positive caregivers (p = 0.014) and adherent paediatric patients (p = 0.005). Nuclear family also showed a strong association with psychological (p < 0.001) and environmental (p = 0.001) health domains. Conclusion This study showed a strong association between the quality of life domains and the involvement of nuclear family caregiver, HIV-positive caregiver and adherence to HAART. Our study suggests that the involvement of any member of the nuclear family, HIV positive parents and patient adherence to therapy can improve the quality of life of paediatric HIV/AIDS patients on highly active antiretroviral therapy in the two hospitals.
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Affiliation(s)
- Michael Lahai
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, 00232, Sierra Leone.
| | - Peter Bai James
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, 00232, Sierra Leone
| | | | - Haja Ramatulai Wurie
- Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Conteh
- Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, 00232, Sierra Leone
| | - Mohamed Samai
- Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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14
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Dessie ZG, Zewotir T, Mwambi H, North D. Multivariate multilevel modeling of quality of life dynamics of HIV infected patients. Health Qual Life Outcomes 2020; 18:80. [PMID: 32209095 PMCID: PMC7092601 DOI: 10.1186/s12955-020-01330-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 03/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Longitudinal quality of life (QoL) is an important outcome in many chronic illness studies aiming to evaluate the efficiency of care both at the patient and health system level. Although many QoL studies involve multiple correlated hierarchical outcome measures, very few of them use multivariate modeling. In this work, we modeled the long-term dynamics of QoL scores accounting for the correlation between the QoL scores in a multilevel multivariate framework and to compare the effects of covariates across the outcomes. METHODS The data is from an ongoing prospective cohort study conducted amongst adult women who were HIV-infected and on the treatment in Kwazulu-Natal, South Africa. Independent and related QoL outcome multivariate multilevel models were presented and compared. RESULTS The analysis showed that related outcome multivariate multilevel models fit better for our data used. Our analyses also revealed that higher educational levels, middle age, stable sex partners and higher weights had a significant effect on better improvements in the rate of change of QoL scores of HIV infected patients. Similarly, patients without TB co-infection, without thrombocytopenia, with lower viral load, with higher CD4 cell count levels, with higher electrolytes component score, with higher red blood cell (RBC) component score and with lower liver abnormality component score, were associated with significantly improved the rate of change of QoL, amongst HIV infected patients. CONCLUSION It is hoped that the article will help applied researchers to familiarize themselves with the models and including interpretation of results. Furthermore, three issues are highlighted: model building of multivariate multilevel outcomes, how this model can be used to assess multivariate assumptions, involving fixed effects (for example, to examine the size of the covariate effect varying across QoL domain scores) and random effects (for example, to examine the rate of change in one response variable associated to changes in the other).
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Affiliation(s)
- Zelalem G. Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
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15
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Zielinska-Wieniawska A, Bielecki M, Wolanczyk T, Kruk M, Marczynska M, Srebnicki T, Brynska A. Health-related quality of life in Polish children and adolescents with perinatal HIV infection - short report. AIDS Care 2019; 32:1393-1399. [PMID: 31818123 DOI: 10.1080/09540121.2019.1699641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aims of the study were to assess health-related quality of life (HRQoL) in children and adolescents with perinatal HIV infection and to establish possible relationships with clinical and socio-demographic variables. About 56 children with perinatal HIV infection, aged 6-18 years (PHIV+ group), 24 healthy perinatally HIV-exposed but uninfected (PHEU) children, and 43 children HIV-unexposed uninfected (HUU) were assessed using the PedsQL 4.0. Generic Core. The perceptions of school functioning according to children and social functioning, according to parents, were worse in the PHIV+ group compared to those in the PHEU group. In comparison to the HUU group, PHIV+ children received lower total HRQoL scores in the caregivers' perception. Most of the life-quality indices increased systematically with age in PHIV+ group, whereas opposite trends were present in both control groups. Caregivers of children with a final CDC category C and caregivers of children diagnosed with encephalopathy perceived most domains of their children functioning as more problematic. A more serious course and more severe HIV infection before treatment were associated with worse multidimensional functioning and a worse total HRQoL score. Results highlight the importance of early diagnosis and treatment initiation as having significant implications for the quality of life.
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Affiliation(s)
| | - Maksymilian Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Tomasz Wolanczyk
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Kruk
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw's Hospital for Infectious Diseases, Warsaw, Poland
| | - Magdalena Marczynska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw's Hospital for Infectious Diseases, Warsaw, Poland
| | - Tomasz Srebnicki
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Anita Brynska
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
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16
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Evaluating a patient-centred intervention to increase disclosure and promote resilience for children living with HIV in Kenya. AIDS 2019; 33 Suppl 1:S93-S101. [PMID: 31397727 DOI: 10.1097/qad.0000000000002183] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated the impact of a patient-centred, culturally and age-appropriate disclosure counselling intervention on HIV disclosure rates among Kenyan children living with HIV. DESIGN A prospective, clinic-cluster randomized trial. METHODS We followed 285 child-caregiver dyads (children ages 10-14 years) attending eight HIV clinics (randomized to intervention or control) in Kenya. Participants at intervention clinics received intensive counselling with trained disclosure counsellors and culturally tailored materials, compared with control clinics with standard care. Disclosure was treated as a time-to-event outcome, measured on a discrete time scale, with assessments at 0, 6, 12, 18 and 24 months. Mental health and behavioural outcomes were assessed using standardized questionnaires. RESULTS Mean age was 12.3 years [standard deviation (SD) 1.5], 52% were girls, with average time-on-treatment of 4.5 years (SD 2.4). Between 0 and 6 months, disclosure prevalence increased from 47 to 58% in the control group and from 50 to 70% in the intervention group. Differences in disclosure were not sustained over the following 18 months. The prevalence of depression symptoms was significantly higher in the intervention than in the control group at 6 months (odds ratio 2.07, 95% confidence interval 1.01-4.25); however, there was no evidence that these differences were sustained after 6 months. CONCLUSION The clinic-based intervention increased disclosure of HIV status to children living with HIV in the short-term, resulting in earlier disclosures, but had less clear impacts longer-term. Although well tailored interventions may support disclosure, children may still experience increased levels of depression symptoms immediately following disclosure.
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The prevalence and process of pediatric HIV disclosure: A population-based prospective cohort study in Zimbabwe. PLoS One 2019; 14:e0215659. [PMID: 31116741 PMCID: PMC6530961 DOI: 10.1371/journal.pone.0215659] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/07/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to estimate the prevalence of pediatric HIV disclosure in rural Zimbabwe and track the process of disclosure over time. METHODS We recruited a population-based sample of 372 caregivers of HIV-positive children ages 9 to 15 to participate in a survey about disclosure. Using data from this cross-sectional sample, we then identified a prospective cohort of 123 caregivers who said their HIV-positive child did not know his or her HIV status, and we followed this non-disclosed cohort of caregivers through two additional waves of data collection over the next 12 months. At each wave, we inquired about the timing and process of disclosure and psychosocial factors related to HIV disclosure. RESULTS The overall prevalence of disclosure in the cross-sectional sample was 66.9% (95% CI 62.0 to 71.5%). Only 26.9% of children knew how they were infected and that they can transmit the virus to others (i.e. "full disclosure"). Older children were more likely to know their status. Among the non-disclosed caregivers at baseline, nearly 60% of these children learned their HIV status over the course of the 12-month study period, but only 17.1% learned how they were infected and that they can transmit the virus to others. Most caregivers were satisfied with their child's disclosure experience. Caregivers who had not disclosed their child's HIV status to the child worried that disclosure would lead to stigma in the community, provoke questions from their child they would not be able to answer, or cause the child to reject the caregiver in anger. CONCLUSIONS This study suggests that rates of pediatric HIV disclosure may be larger than typically reported, but also reinforces the idea that most children do not know key details about their illness, such as how they were infected and that they can infect others.
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18
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Kalembo FW, Kendall GE, Ali M, Chimwaza AF. Prevalence and factors associated with emotional and behavioural difficulties among children living with HIV in Malawi: a cross-sectional study. BMC Psychiatry 2019; 19:60. [PMID: 30736758 PMCID: PMC6368705 DOI: 10.1186/s12888-019-2046-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/31/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Approximately 84,000 children under the age of 15 years are living with HIV in Malawi. Although the survival rate of children living with HIV in Malawi has improved due to the increased availability of antiretroviral medications, these children continue to experience numerous challenges negatively impacting on their mental health. The aim of this study was to investigate the prevalence of, and factors associated with, emotional and behavioural difficulties in children aged between 6 and 12 years living with HIV in Malawi. METHODS A random sample of 429 primary caregivers of children living with HIV drawn from the three main administrative regions of Malawi was recruited in a cross-sectional study. They completed a questionnaire about family socio-demographic characteristics, HIV disclosure, and child demographic and clinical characteristics, as well as the Strengths and Difficulties Questionnaire, Life Stress Scale, Support Function Scale, and Impact on Family Scale which were pre-tested and translated into the local Chichewa language. Data were analysed using descriptive statistics and logistic regression. FINDINGS Using the newer band categorisations of the Strengths and Difficulties Questionnaire, parent version, 31% of primary caregivers reported that their child had a slightly raised to very high level of total difficulties. Factors that were associated with difficulties were: primary caregivers' young age (adjusted odds ratio [aOR] 3.6; 95% confidence interval [CI]: 1.4-9.5); low level of education (aOR 2.6; 95% CI: 1.2-5.7); lack of employment (aOR 2.7; 95% CI: 1.2-5.9); the report of a substantial impact of the child's illness on the family (3.1; 95% CI: 1.5-6.5); and a low level of family functional support (aOR 2.0; 95% CI: 1.1-4.1). Neither non-disclosure of HIV status nor any of the child demographic or clinical factors were significant in multivariate analysis (p > .0.05). CONCLUSION Close to one-third of children living with HIV in this study had high scores indicative of emotional and behavioural difficulties. Emotional and behavioural difficulties in children living with HIV were associated with family demographic and psychosocial factors, but not HIV disclosure. Effective policies and programs that promote the mental wellbeing of children living with HIV in Malawi are indicated.
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Affiliation(s)
- Fatch W. Kalembo
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
- Mzuzu University, Mzuzu, Malawi
| | - Garth E. Kendall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mohammed Ali
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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19
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Kodyalamoole NK, Badiger S, Kiran NU, Dodderi SK, Rewari BB. Pattern of paediatric HIV status disclosure in coastal Karnataka. Indian J Med Res 2018; 147:501-506. [PMID: 30082575 PMCID: PMC6094512 DOI: 10.4103/ijmr.ijmr_1821_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: Karnataka is a high HIV prevalent State in India. Although benefits have been shown by disclosing the HIV status to the child, information regarding HIV status disclosure in Karnataka is limited. Hence, this study was conducted to estimate the proportion of children who had been disclosed of their HIV status and its pattern among those who visited the district antiretroviral therapy (ART) centre in coastal Karnataka. Methods: A cross-sectional study was conducted in an ART centre in a district hospital in coastal Karnataka between October 2014 and July 2015. Caregivers of paediatric HIV patients were approached and willing participants were administered a pre-formed, pre-tested semi-structured questionnaire developed for the study. Results: A total of 185 caregivers of the HIV-positive children were interviewed. Mean age of the children was 11±4 years. Only 107 (57.8%) children were aware of their HIV status. Of these, 95 were disclosed fully. Counsellors in rehabilitation centres were the most probable person to disclose and planned events. Children were told of their HIV status for their knowledge and were more likely to be disclosed if they were around 11-15 yr of age and staying in rehabilitation centres. Interpretation & conclusions: Older children were more likely to be disclosed of their HIV status by counsellors. Steps need to be taken to counsel and encourage caregivers to fully disclose the HIV status to the children at least when they attain the age more than 11 years.
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Affiliation(s)
| | - Sanjeev Badiger
- Department of Community Medicine, K. S. Hegde Medical Academy, Nitte University, Mangaluru, India
| | - Nalam Udaya Kiran
- Department of Community Medicine, K. S. Hegde Medical Academy, Nitte University, Mangaluru, India
| | - Sunil Kumar Dodderi
- Karnataka State AIDS Prevention Society, National AIDS Control Organisation, Ministry of Health and Family Welfare, Bengaluru, India
| | - B B Rewari
- National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India
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Lencha B, Ameya G, Minda Z, Lamessa F, Darega J. Human immunodeficiency virus infection disclosure status to infected school aged children and associated factors in bale zone, Southeast Ethiopia: cross sectional study. BMC Pediatr 2018; 18:356. [PMID: 30442118 PMCID: PMC6236985 DOI: 10.1186/s12887-018-1336-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/06/2018] [Indexed: 11/23/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) positive status disclosure is an essential component of Pediatric care and long term disease management. Children have a right to know their HIV diagnosis result. However, Pediatric HIV disclosure is complex and varies in different communities. This study aimed to assess the prevalence of HIV-positive status disclosure to infected children and associated factors among caregivers of infected children. Methodology A facility based mixed methods research design study was conducted in Bale Zone of South East Ethiopia. Randomly selected caregivers of HIV-positive children were interviewed using structured questionnaires for quantitative study and 17 in-depth interviews of health care workers and caregivers were conducted for qualitative data. Content analysis was done for qualitative data and logistic regression analysis was used to see the association between different variables and HIV-positive disclosure status. Odds ratio with 95% CI was computed to determine the presence and strength of the associated factors. Results A total of 200 caregivers of school aged (6–14 years) children participated in the study. Only 57 (28.5%) of the care givers disclosed HIV-positive status to the child for whom they were caring. The main reason for disclosure delay was due to fear of negative consequences, perception on maturity of the child, and fear of social rejection and stigma. Having social support [AOR = 2.7, 95% CI: (1.1–6.4)], caring for a child between 10 and 14 years with HIV [AOR = 6.5, 95% CI: (2.1–20.2)], a child diagnosed with HIV at age > 5 years [AOR = 2.8, 95% CI: (1.1–7.1)], and children on antiretroviral therapy (ART) with follow-up for > 5 years [AOR = 4.7, 95% CI: (1.8–11.2)] had significant association with HIV- positive status disclosure to infected children. Conclusion The frequency of HIV infection disclosure to infected children was very low in our cohort. Having social support, having an older child with HIV, a long period of ART follow-up and HIV diagnosis after age of five years were positively associated with HIV-positive status disclosure to infected children. Giving age appropriate counselling to children, social support to the caregivers and working on related factors are very important to improve the observed low disclosure status. Electronic supplementary material The online version of this article (10.1186/s12887-018-1336-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bikila Lencha
- Department of Public Health, Goba Referral Hospital, Maddawalabu University, Bale-Goba, Addis Ababa, Ethiopia
| | - Gemehu Ameya
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, P.O. Box: 21, Arba Minch, Ethiopia.
| | - Zanebe Minda
- Department of Public Health, Goba Referral Hospital, Maddawalabu University, Bale-Goba, Addis Ababa, Ethiopia
| | - Feyissa Lamessa
- Department of Nursing, Goba Referral Hospital, Maddawalabu University, Bale-Goba, Addis Ababa, Ethiopia
| | - Jiregna Darega
- Department of Nursing, College of Medicine and Health sciences, Ambo University, Ambo, Ethiopia
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Orelly T, Welch H, Machine E, Pameh W, Duke T. Human immunodeficiency virus status disclosure and education for children and adolescents in Papua New Guinea. J Paediatr Child Health 2018; 54:728-734. [PMID: 29436053 DOI: 10.1111/jpc.13866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 01/07/2018] [Accepted: 01/14/2018] [Indexed: 11/28/2022]
Abstract
AIM How to provide human immunodeficiency virus (HIV) disclosure and awareness for children and young people has not been studied in Papua New Guinea or Pacific Island countries. We aimed to determine the current practices of HIV disclosure and evaluate whether an incremental disclosure education model, as recommended by World Health Organization (WHO), would increase children's knowledge about their condition and improve adherence to antiretroviral therapy (ART). METHODS We enrolled HIV-infected children on ART whose parents consented, and we identified whether they were aware that they were HIV positive or not. An incremental education model was used to teach the children about their illness and to disclose their HIV status if that was the parents' wishes. Knowledge of HIV and adherence to ART before and following education sessions was assessed. RESULTS A total of 138 children HIV-positive children were recruited. Only 7% had previously been made aware of their HIV test results; the mean disclosure age was 12.7 years. By 10 years of age, 25 of 34 participants (74%) had not been told they had HIV. The common reasons caregivers gave for not disclosing were that the child was too young and the potential psychosocial impacts on the child and the family. Using an education model of HIV disclosure, children's knowledge of HIV increased significantly, and ART adherence, which was good at 95%, increased to 99% an average of 9 months after education. CONCLUSION There is a low rate of disclosure for HIV-infected children in Papua New Guinea. This study underlines the importance and value of incorporating age-appropriate HIV education within HIV services.
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Affiliation(s)
- Thyna Orelly
- Department of Paediatrics, Port Vila Central Hospital, Port Vila, Vanuatu
| | - Henry Welch
- Discipline of Child Health, University of PNG School of Medicine and Health Sciences, Port Moresby, Papua New Guinea.,Global Health, Baylor College of Medicine, Houston, Texas, United States
| | - Edwin Machine
- Discipline of Child Health, University of PNG School of Medicine and Health Sciences, Port Moresby, Papua New Guinea.,Global Health, Baylor College of Medicine, Houston, Texas, United States
| | - Wendy Pameh
- Discipline of Child Health, University of PNG School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - Trevor Duke
- Discipline of Child Health, University of PNG School of Medicine and Health Sciences, Port Moresby, Papua New Guinea.,Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
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Factors Associated with HIV Status Disclosure and Its Effect on Treatment Adherence and Quality of Life among Children 6-17 Years on Antiretroviral Therapy in Southern Highlands Zone, Tanzania: Unmatched Case Control Study. Int J Pediatr 2018; 2018:8058291. [PMID: 30046314 PMCID: PMC6038591 DOI: 10.1155/2018/8058291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) recommends that children should be informed of their HIV status at ages 6 to 12 years and full disclosure of HIV and AIDS be offered in a caring and supportive manner at about 8 to 10 years. The objective of this study was to determine factors associated with HIV status disclosure and its effect on treatment adherence and health-related quality of life among children between 6 and 17 years of age living with HIV/AIDS in the Southern Highlands Zone, Tanzania, 2017. Methods A hospital based unmatched case control study was conducted between April and September 2017. A total of 309 children between 6 and 17 years on ART for at least six months were enrolled in this study. Simple random sampling was employed in selecting the children from existing treatment registers. Data were collected using a structured questionnaire which included the WHO Quality of Life standard tool (WHOQOL-BREF 2012 tool) and treatment adherence manual. Multiple logistic regression was used to test for the independent effect of HIV status disclosure on treatment adherence and quality of life at p value less than 0.05. Results Out of 309 children, only 102 (33%) had their HIV status disclosed to them. The mean age at HIV status disclosure was 12.39 (SD=3.015). HIV status disclosure was high among girls (51%), children aged 10-13 years (48.3%), and those living with their biological parents (59.8%). After adjusting for confounders, being aged between 10-13 and 14-17 years was associated with HIV status disclosure (AOR 19.178, p<0.05 and AOR=65.755, p<0.001, respectively). HIV status disclosure was associated with ART adherence (AOR=8.173, p<0.05) and increased the odds of having good quality of life (AOR=3.283, p<0.001). Conclusions HIV status disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS.
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Vreeman RC, Scanlon ML, Marete I, Mwangi A, Inui TS, McAteer CI, Nyandiko WM. Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in western Kenya. AIDS Care 2018; 27 Suppl 1:6-17. [PMID: 26616121 PMCID: PMC4685612 DOI: 10.1080/09540121.2015.1026307] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Knowledge of one's own HIV status is essential for long-term disease management, but there are few data on how disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver-child dyads enrolled in the study, children's mean age was 12.3 years. Caregivers were more likely to report that the child knew his/her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child (64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ by whether or not the child knew his/her HIV status. A number of factors were associated with a child's knowledge of his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5-2.1), better WHO disease stage (OR 2.5, 95% CI 1.4-4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1-3.4). While a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure including fears about negative emotional impacts, we found that disclosure was not associated with worse psychosocial outcomes.
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Affiliation(s)
- Rachel C Vreeman
- a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya
| | - Michael L Scanlon
- a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Irene Marete
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya
| | - Ann Mwangi
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,d Department of Behavioral Sciences , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya
| | - Thomas S Inui
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,e Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Carole I McAteer
- a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.,b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya
| | - Winstone M Nyandiko
- b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.,c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya
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Ramos JV, Mmbaga BT, Turner EL, Rugalabamu LL, Luhanga S, Cunningham CK, Dow DE. Modality of Primary HIV Disclosure and Association with Mental Health, Stigma, and Antiretroviral Therapy Adherence in Tanzanian Youth Living with HIV. AIDS Patient Care STDS 2018; 32:31-37. [PMID: 29323556 DOI: 10.1089/apc.2017.0196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Disclosing HIV status to children before adolescence is a major challenge facing families and healthcare providers. This study used a mixed methods approach to explore the youth perspective of how youth living with HIV (YLHIV) found out their status and to quantify the association of disclosure modality with mental health, stigma, adherence, and HIV outcomes in adolescence. Youth 11-24 years of age attending adolescent HIV clinic in Moshi, Tanzania were included. Adolescents answered questions, including when and how they found out they had HIV, mental health surveys (nine-item Patient Health Questionnaire, Strengths and Difficulties Questionnaire, and modified University of California Los Angeles trauma screen), modified Berger's stigma scale, and self-reported adherence. HIV-1 RNA and latest CD4 were obtained. In-depth interviews were conducted using a convenience sample. The majority of youth reported that they found out their HIV status on their own (80%). Youth attending the government site were less likely to be purposefully told their HIV status compared with those attending the referral site (p < 0.01). Depressive and emotional/behavioral symptoms, internal stigma, and incomplete adherence were significantly more likely among those who figured out their HIV status on their own as compared with those who were purposefully told. Youth discussed how they figured out their HIV status on their own during in-depth interviews. These findings demonstrated that youth who figured out their HIV status on their own had increased mental health symptoms and worse adherence to antiretroviral therapy (ART). It is imperative to implement disclosure protocols in early childhood to reduce mental health difficulties, internal stigma, and promote ART adherence in YLHIV.
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Affiliation(s)
- Julia V. Ramos
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | - Severa Luhanga
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
| | - Coleen K. Cunningham
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Pediatrics, Infectious Diseases, Duke University, Durham, North Carolina
| | - Dorothy E. Dow
- Kilimanjaro Christian Medical Center, KCMC-Duke Collaboration, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Pediatrics, Infectious Diseases, Duke University, Durham, North Carolina
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Odiachi A. The Impact of Disclosure on Health and Related Outcomes in Human Immunodeficiency Virus-Infected Children: A Literature Review. Front Public Health 2017; 5:231. [PMID: 28913332 PMCID: PMC5582203 DOI: 10.3389/fpubh.2017.00231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
This review explores the association between pediatric human immunodeficiency virus (HIV) disclosure and health and related outcomes among children living with HIV. A multi-stage process was used to search for relevant articles on the ISI Web of Knowledge database. Fifteen articles met the inclusion criteria. Five major outcomes emerged from children’s knowledge of their HIV-seropositive status: physical/physiological outcomes; adherence to antiretroviral therapy; psychosocial outcomes; sexual and reproductive health, including HIV prevention outcomes; and disclosure of status by the children. Disclosure of a child’s HIV status to the child has value in terms of positive health outcomes for the child, such as better adherence and slower disease progression—albeit the different studies did not always reach the same conclusions, and some suggest negative health outcomes, such as increased psychiatric hospitalization. Yet, there does not seem to be a systematic or coherent system for child disclosure. One recommendation from this review, therefore, is for government and program policies and guidelines that will promote child HIV disclosure in order to address the current low rates of disclosure in sub-Saharan Africa (SSA). More rigorous and longitudinal studies on the outcomes of disclosure, with larger sample sizes, and in SSA, are also needed.
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Affiliation(s)
- Angela Odiachi
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Ndongmo TN, Ndongmo CB, Michelo C. Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study. Pan Afr Med J 2017; 26:71. [PMID: 28451048 PMCID: PMC5398862 DOI: 10.11604/pamj.2017.26.71.11312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/26/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. Methods This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. Results A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). Conclusion The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.
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Affiliation(s)
| | - Clement Bertin Ndongmo
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Lichtenstein B, Rodgers C, Marefka LEB, Hinson MD, Cook-Heard D, Rygiel SD, Sturdevant MS. Two vignettes of adolescent sexual disclosure: guidance for HIV clinical practice. J Infect Prev 2017; 18:10-16. [PMID: 28989498 PMCID: PMC5298377 DOI: 10.1177/1757177416666399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022] Open
Abstract
HIV-positive adolescents are required by law to notify sexual partners, but can find it difficult to achieve this goal. This article offers practice guidance for counselling HIV-positive adolescents about sexual disclosure in clinical settings and for building confidence in managing sexual lives with HIV. We use two vignettes to illustrate key differences between perinatally and sexually infected adolescents in terms of readiness to disclose, and include a set of strategies for both groups that can be tailored to individual circumstances and contexts. The toolbox of strategies we describe include pre-counselling, focused counselling, social support groups and technical support. Pre-counselling helps to identify barriers and motivations to sexual disclosure and is followed by counselling sessions in which the focus is on role playing and sexual scripts for disclosure. Peer-led support groups are designed to boost adolescent confidence, and pre-paid cell phones, text messaging, ready-dial phone numbers and a private Facebook page provide back-up support and out-of-hours contact. Since sexual disclosure can be a risky proposition, safety plans, such as having an emergency contact person, should always be in place. These strategies are designed to empower vulnerable adolescents, foster trust between patient and provider, and reduce HIV transmission to sexual partners.
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Affiliation(s)
| | - Cynthia Rodgers
- The Family Clinic, The University of Alabama at Birmingham, AL, Birmingham, USA
| | - Lauren EB Marefka
- The Family Clinic, The University of Alabama at Birmingham, AL, Birmingham, USA
| | - Marla D Hinson
- The Family Clinic, The University of Alabama at Birmingham, AL, Birmingham, USA
| | - Dayna Cook-Heard
- The Family Clinic, The University of Alabama at Birmingham, AL, Birmingham, USA
| | | | - Marsha S Sturdevant
- The Adolescent Health Center, The University of Alabama-Birmingham, Birmingham, AL, USA
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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
BACKGROUND Limited empirical investigation exists into longitudinal changes in cognition, behavior or quality of life (QOL) in children with perinatal HIV who are prescribed stimulants. METHODS This study was an analysis of longitudinal data from children age 3-19 years, with perinatal HIV infection, with and without prescriptions for stimulant medications [prescription (PG) and comparison (CG) groups, respectively], matched on age, availability of CD4% and outcome measures of cognition, behavior and QOL. Generalized estimating equation models were used to evaluate effects of stimulant exposure on change in measured outcomes over 3 years of follow-up, adjusting for baseline levels of outcomes and relevant covariates. RESULTS Children in both the PG (n = 132) and the CG (n = 392) obtained mean verbal and performance (nonverbal) intelligence quotients (VIQ and PIQ, respectively) in the low-average range for age. At baseline, those in PG demonstrated more frequent signs of hyperactivity, impulsivity and conduct and learning problems than those in CG (P ≤ 0.003 in unadjusted analyses). At follow-up, after adjustment for baseline functioning and other relevant covariates, there were no significant changes from baseline in VIQ or PIQ. Stimulant prescription use, however, was associated with worsening symptoms of hyperactivity (P = 0.01), impulsivity (P = 0.04), learning problems (P < 0.001) and worsening of perceived health status (P < 0.001). CONCLUSIONS The results suggest expectations for behavioral improvement may not align well with long-term effects of stimulant prescription use on behavior and QOL in children with HIV. Further research is necessary to determine if there are subsets of children who may benefit from stimulant therapy.
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Brum CND, Paula CCD, Padoin SMDM, Zuge SS. EXPERIENCE OF DIAGNOSIS DISCLOSURE FOR TEENAGERS WITH HIV. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016001760015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Phenomenological study with the objective of understanding the existential movement of teenagers in their experience of the disclosure of the human immunodeficiency virus diagnosis. The field research was undertaken at a university hospital in the South of Brazil, including phenomenological interviews with 12 teenagers. The analysis was based on Martin Heidegger's reference framework. The results appointed that the teenagers showed they have rules and limits for having something that the others do not have and accept taking their medication. They keep busy with their treatment due to family members' dominant solicitude. Over time, they learn to take care of themselves. By understanding the reasons for the treatment, based on the liberating request of their relatives and/or health professionals, they are concerned with taking care of themselves. Professional actions need to contemplate the biological and subjective dimension, with a view to going beyond the prescription, in order to commit the teenagers to their care.
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Enimil A, Nugent N, Amoah C, Norman B, Antwi S, Ocran J, Kwara A, Barker DH. Quality of life among Ghanaian adolescents living with perinatally acquired HIV: a mixed methods study. AIDS Care 2015; 28:460-4. [PMID: 26643735 DOI: 10.1080/09540121.2015.1114997] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In Sub-Saharan Africa, increasing numbers of children with perinatally acquired HIV (PAHIV) are living into adolescence. These adolescents face numerous unique challenges such as parent illness/death and years of medication use. Optimizing care for these youth requires an understanding of the factors that contribute to physical health, psychological well-being, social relationships, and quality of life (QOL). This mixed methods study collected quantitative questionnaire data from 40 Ghanaian adolescents with PAHIV (50% female, 12-19 years old) who received care through an adolescent HIV clinic in Kumasi, Ghana. The study also presents results from qualitative interviews conducted with 20 adolescents. Results from quantitative analyses suggested that a significant number of participants were not virally suppressed (67%) and participants reported barriers to treatment adherence, limited social support, concerns about disclosure and HIV-related stigma, limited resources, and lower than expected QOL. Salient themes from the qualitative analyses included limited understanding of how HIV is transmitted, the interplay between food insecurity and treatment adherence and the need for developing safe relationships through which adolescents can discuss their illness without fear of accidental disclosure of their HIV status.
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Affiliation(s)
- Anthony Enimil
- a Directorate of Child Health , Komfo Anokye Teaching Hospital , Kumasi , Ghana.,b Department of Child Health , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Nicole Nugent
- c Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,d Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA
| | - Christian Amoah
- e Psychiatry Department , Komfo Anokye Teaching Hospital , Kumasi , Ghana.,f Department of Behavioural Sciences , School of Medical Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Betty Norman
- g Directorate of Medicine , Komfo Anokye Teaching Hospital , Kumasi , Ghana.,h Department of Medicine , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Sampson Antwi
- a Directorate of Child Health , Komfo Anokye Teaching Hospital , Kumasi , Ghana.,b Department of Child Health , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Joseph Ocran
- i Department of Sociology , University of Ghana , Accra , Ghana
| | - Awewura Kwara
- j Department of Medicine , The Miriam Hospital , Providence , RI , USA.,k Department of Medicine , Alpert Medical School, Brown University , Providence , RI , USA
| | - David H Barker
- c Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,d Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , 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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Madiba S, Mokgatle M. Health care workers' perspectives about disclosure to HIV-infected children; cross-sectional survey of health facilities in Gauteng and Mpumalanga provinces, South Africa. PeerJ 2015; 3:e893. [PMID: 25893147 PMCID: PMC4400876 DOI: 10.7717/peerj.893] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/25/2015] [Indexed: 12/03/2022] Open
Abstract
The perspectives and practices of health care workers (HCWs) regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART). The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2%) were nurses, 44 (21.5%) were lay counsellors, and 4 (2%) were doctors. The majority (n = 183, 89.3%) felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4%) recommended 11–18 years as the appropriate age to disclose. Half (n = 99, 48.5%) said that caregivers should take the lead to disclose, 87 (42.7%) said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8%) said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations’ disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.
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Affiliation(s)
- Sphiwe Madiba
- Department of Environmental and Occupational Heath, School of Public Health, Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Mathildah Mokgatle
- Department of Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University , Pretoria , South Africa
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Boon-Yasidhi V, Naiwatanakul T, Chokephaibulkit K, Lolekha R, Leowsrisook P, Chotpitayasunond T, Wolfe M. Effect of HIV diagnosis disclosure on psychosocial outcomes in Thai children with perinatal HIV infection. Int J STD AIDS 2015; 27:288-95. [PMID: 25829519 DOI: 10.1177/0956462415579590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/24/2015] [Indexed: 11/15/2022]
Abstract
A provider-assisted, counselling-based, paediatric HIV disclosure model was developed and implemented at two tertiary-care hospitals in Bangkok, Thailand. All undisclosed perinatally acquired HIV-infected children, aged 7-18 years, and their caretakers were offered the four-step disclosure service, including: screening, readiness assessments and preparation, disclosure sessions, and follow-up evaluations. To assess psychosocial outcomes of disclosure, we compared the scores of the Children Depression Inventory and the PedsQL 4.0™ at baseline and at two-month and six-month follow-up visits, and compared the scores of the Child Behavioral Checklist at baseline and at six-month follow-up. Disclosure was made to 186 children, 160 of whom completed post-disclosure assessments. The median Children's Depression Inventory score in 135 children decreased significantly from 11 at baseline to 8 at two-month and six-month follow-up (p < 0.01). The median PedsQL 4.0™ scores in 126 children increased significantly from 78 at baseline to 80 at two-month and 84 at six-month follow-up (p = 0.04). The median Child Behavioral Checklist scores were not significantly changed. In conclusion, paediatric HIV diagnosis disclosure using this model was found to have positive effect on the children's mood and quality of life, and no negative effect on children's behaviours. This disclosure programme should be expanded to improve the psychosocial health of HIV-infected children.
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Affiliation(s)
- V Boon-Yasidhi
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Naiwatanakul
- Global AIDS Program Thailand/Asia Regional Office, Thailand MOPH-US CDC Collaboration, Bangkok, Thailand
| | - K Chokephaibulkit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - R Lolekha
- Global AIDS Program Thailand/Asia Regional Office, Thailand MOPH-US CDC Collaboration, Bangkok, Thailand
| | - P Leowsrisook
- Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - M Wolfe
- Global AIDS Program Thailand/Asia Regional Office, Thailand MOPH-US CDC Collaboration, Bangkok, Thailand US Centers for Disease Control and Prevention, Atlanta, GA, USA
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"If I take my medicine, I will be strong: " evaluation of a pediatric HIV disclosure intervention in Namibia. J Acquir Immune Defic Syndr 2015; 68:e1-7. [PMID: 25296096 PMCID: PMC4262649 DOI: 10.1097/qai.0000000000000387] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite known benefits, only a small proportion of HIV-infected children in sub-Saharan Africa know their status and limited disclosure interventions exist. Namibia's Ministry of Health and Social Services developed and implemented a multipronged intervention to support health care workers (HCWs) and caregivers in the disclosure process. METHODS The intervention included a staged disclosure cartoon book, child and caregiver readiness assessment tools, a monitoring form to track progress over visits, and HCW training curriculum. We conducted qualitative interviews with 35 HCWs and 46 caregivers of HIV-positive children at 4 high volume HIV clinics. Interviews elicited detailed information about intervention uptake and impact. HCWs also participated in a self-efficacy survey. RESULTS The intervention improved HCW and caregiver confidence and communication skills in pediatric disclosure. The most valuable intervention component was the disclosure cartoon book, which provided structure, language, and guidance for a gradual disclosure process. HCWs reported it greatly reduced caregiver resistance to disclosure. Both caregivers and HCWs reported improved knowledge and ability to support the pediatric patient, improved child understanding of how HIV medications work, increased child hopefulness for their future, and improved child adherence to care and treatment. HCW self-efficacy surveys found that HCWs who received training felt more confident in their ability to engage in the disclosure process. CONCLUSIONS HCWs and caregivers highly endorsed the intervention. Given the urgency to address pediatric HIV disclosure in Africa, and the utility and low cost of the locally-produced disclosure tool, this approach may be useful in other similar settings.
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Bamford A, Turkova A, Lyall H, Foster C, Klein N, Bastiaans D, Burger D, Bernadi S, Butler K, Chiappini E, Clayden P, Della Negra M, Giacomet V, Giaquinto C, Gibb D, Galli L, Hainaut M, Koros M, Marques L, Nastouli E, Niehues T, Noguera-Julian A, Rojo P, Rudin C, Scherpbier HJ, Tudor-Williams G, Welch SB. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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Affiliation(s)
- A Bamford
- Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK
| | - A Turkova
- Medical Research Council Clinical Trials Unit, London, UK
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - D Bastiaans
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - D Burger
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - S Bernadi
- University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy
| | - K Butler
- Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland
| | - E Chiappini
- Meyer University Hospital, Florence University, Florence, Italy
| | | | - M Della Negra
- Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - V Giacomet
- Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - C Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
| | - D Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - L Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - M Hainaut
- Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - M Koros
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - L Marques
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal
| | - E Nastouli
- Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK
| | - T Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - P Rojo
- 12th of October Hospital, Madrid, Spain
| | - C Rudin
- University Children's Hospital, Basel, Switzerland
| | - H J Scherpbier
- Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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Li X, Qiao S, de Wit J, Sherr L. What's in the telling? Understanding social, psychological and clinical aspects of HIV disclosure. AIDS Care 2015; 27 Suppl 1:1-5. [PMID: 26616120 PMCID: PMC4685618 DOI: 10.1080/09540121.2015.1102687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaoming Li
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - John de Wit
- Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lorraine Sherr
- Research Department of Infection & Population Health, University College London, London, UK
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Mumburi LP, Hamel BC, Philemon RN, Kapanda GN, Msuya LJ. Factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Pan Afr Med J 2014; 18:50. [PMID: 25368739 PMCID: PMC4215360 DOI: 10.11604/pamj.2014.18.50.2307] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/02/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION With the introduction of antiretroviral drugs HIV-infected children live longer. Disclosure of HIV diagnosis is increasingly an important and inevitable issue. Both healthcare providers and caregivers face challenges of disclosure to children. The objective of the study was to explore factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC). METHODS A cross-sectional hospital-based study was conducted from October 2011 to April 2012. Study population included HIV-infected children aged 5 to 14 years, their caregivers and healthcare providers. Structured questionnaires were used to collect information. Children were asked the reason for hospital visits. Outcome of interest was HIV disclosure status. Data was processed and analysed using SPSS version 16.0. Multivariate logistic regression at 5% margin error was used to account for confounders. RESULTS A total of 211 children were enrolled with mean age of 9.7 (SD±2.6; range 5-14) years. Only 47 (22.3%) children knew their HIV-status. The mean age of disclosure was 10.6 years. Most of disclosed children were aged above 10 years (p). CONCLUSION Most of children were not disclosed. Ages, self medication, getting other support and parents/caregivers prior discussion were strong predictors of disclosure status.
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Affiliation(s)
- Livin Peter Mumburi
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania
| | | | | | | | - Levina January Msuya
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania
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Smith R, Wilkins M. Perinatally acquired HIV infection: long-term neuropsychological consequences and challenges ahead. Child Neuropsychol 2014; 21:234-68. [PMID: 24697320 DOI: 10.1080/09297049.2014.898744] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Over the past three decades, perinatal HIV infection in the United States has evolved from a fatal disease to a manageable chronic illness. As the majority of youth with perinatal HIV infection age into adolescence and adulthood, management of this stigmatizing, transmittable disease in the backdrop of a cadre of environmental stressors presents challenges beyond those of other chronic illnesses. The neurologic and neuropsychological consequences of this neurotropic virus have important implications for the successful navigation of responsibilities related to increasingly independent living of this aging population. This article will review the neurologic and neuropsychological consequences of perinatal HIV infection and concomitant factors in the era of highly active antiretroviral therapy and will provide an overview of the neuropathology, pathogenesis, neuroimaging findings, and treatment of perinatal HIV infection, as well as recommendations for service provision and future research.
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Affiliation(s)
- Renee Smith
- a Department of Pediatrics , University of Illinois at Chicago , Chicago IL , USA
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Caregiver perceptions and motivation for disclosing or concealing the diagnosis of HIV infection to children receiving HIV care in Mbarara, Uganda: a qualitative study. PLoS One 2014; 9:e93276. [PMID: 24667407 PMCID: PMC3965550 DOI: 10.1371/journal.pone.0093276] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background Disclosure of the diagnosis of HIV to HIV-infected children is challenging for caregivers. Despite current recommendations, data suggest that levels of disclosure of HIV status to HIV-infected children receiving care in resource-limited settings are very low. Few studies describe the disclosure process for children in these settings, particularly the motivators, antecedent goals, and immediate outcomes of disclosure to HIV-infected children. This study examined caregivers' perception of the disclosure concept prior to disclosure, their motivation towards or away from disclosure, and their short- and long-term intentions for disclosure to their HIV-infected children. Methods In-depth interviews were conducted with primary caregivers of 40 HIV-infected children (ages 5–15 years) who were receiving HIV care but did not know their HIV status. Results Caregivers of HIV-infected children mainly perceived disclosure as a single event rather than a process of gradual delivery of information about the child's illness. They viewed disclosure as potentially beneficial both to children and themselves, as well as an opportunity to explain the parents' role in the transmission of HIV to the children. Caregivers desired to personally conduct the disclosure; however, most reported being over-whelmed with fear of negative outcomes and revealed a lack of self-efficacy towards managing the disclosure process. Consequently, most cope by deception to avoid or delay disclosure until they perceive their own readiness to disclose. Conclusions Interventions for HIV disclosure should consider that caregivers may desire to be directly responsible for disclosure to children under their care. They, however, need to be empowered with practical skills to recognize opportunities to initiate the disclosure process early, as well as supported to manage it in a phased, developmentally appropriate manner. The potential role for peer counselors in the disclosure process deserves further study.
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Sirikum C, Sophonphan J, Chuanjaroen T, Lakonphon S, Srimuan A, Chusut P, Do TC, Prasitsuebsai W, Puthanakit T, Ananworanich J, Bunupuradah T. HIV disclosure and its effect on treatment outcomes in perinatal HIV-infected Thai children. AIDS Care 2014; 26:1144-9. [PMID: 24625136 DOI: 10.1080/09540121.2014.894614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The World Health Organization guideline recommends informing children of their HIV status between the ages of 6-12 years. Primary caregivers of perinatal HIV-infected Thai children ≥6 years were interviewed in order to assess the HIV status disclosure rate. In addition, pill counts of antiretroviral therapy (ART) were performed every three months. CD4 and HIV-RNA were performed every six months. Of the 260 children/adolescents included, the median age of disclosure was 14.8 years. The disclosure rate among those from 6 to 12 years was 21% and for those greater than 12 years of age was 84%. When comparing children aged 6-12 years whose HIV status had been disclosed to them, to children whose HIV had yet to be disclosed, no difference was noted in median ART adherence by pill count, CD4 count, or proportion of HIV-RNA <50 copies/ml (p > 0.05). Factors associated with HIV disclosure were an age of ≥12 years (OR 17.8, 95% CI 8.86-35.79) and a current CD4 ≤ 30% (OR 2.09, 95% CI 1.20-3.62). In conclusion, although the majority of adolescents ≥12 years were aware of their HIV status only one-fifth of children aged 6-12 years were aware. Moreover, the child's/adolescent's disclosure status had no bearing on ART adherence by pill count or immunological and virological outcomes.
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Affiliation(s)
- Chompoonoot Sirikum
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Center , Bangkok , Thailand
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Mburu G, Hodgson I, Kalibala S, Haamujompa C, Cataldo F, Lowenthal ED, Ross D. Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes. J Int AIDS Soc 2014; 17:18866. [PMID: 24629845 PMCID: PMC3956312 DOI: 10.7448/ias.17.1.18866] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/07/2014] [Accepted: 01/20/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS In 2010, we conducted a qualitative study among adolescents aged 10-19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents' disclosure of their status to others; and the impact of both forms of disclosure on adolescents. RESULTS Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents' disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents' sexual relationships, although it did not always lead to rejection. CONCLUSIONS There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.
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Affiliation(s)
- Gitau Mburu
- International HIV/AIDS Alliance, Hove, UK; Division of Health Research, Lancaster University, UK;
| | - Ian Hodgson
- Center for Global Health, Trinity College, Dublin, Ireland, UK
| | | | | | - Fabian Cataldo
- Research Department, Dignitas International, Zomba, Malawi
| | - Elizabeth D Lowenthal
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, PA, USA; Children's Hospital of Philadelphia, PA, USA
| | - David Ross
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Bunupuradah T, Panthong A, Kosalaraksa P, Wongsabut J, Puthanakit T, Lumbiganon P, Chuanjaroen T, Sopharak C, Udompanit T, Prasitsuebsai W, Pancharoen C, Ananworanich J. Simplifying antiretroviral therapy to lopinavir/ritonavir monotherapy did not improve quality of life and therapy adherence in pretreated HIV-infected children. AIDS Res Hum Retroviruses 2014; 30:260-5. [PMID: 24274723 DOI: 10.1089/aid.2013.0204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We reported quality of life (QOL) and adherence in HIV-infected children after simplifying the antiretroviral regimen by switching to lopinavir/ritonavir monotherapy (mLPV/r). HIV-infected children with HIV-RNA <50 copies/ml while using second-line double boosted protease inhibitors were switched to mLPV/r. Primary caregivers completed PACTG QOL questionnaires at weeks 0, 48, 96, and 144. Adherence by pill count was performed at every visit. Thirty-eight pretreated HIV-infected Thai children were enrolled. The median (IQR) age was 11.5 (10.2-13.2) years and 53% were female. At enrollment, 34 used LPV/r+saquinavir and four used LPV/r+indinavir. The median (IQR) CD4% was 27 (23-30)%. At week 144, QOL scores were similar to baseline for all domains. A transient increase in the symptoms domain score was seen at week 96 (p=0.01), whereas the physical resilience domain score was decreased at weeks 48 and 96 (both p<0.05). Despite the mean number of pills decreasing from 7.9 pills/day before and 3.7 pills/day after mLPV/r (p<0.001), there were no differences over time in adherence rates by pill count and proportion of children with poor adherence (all p>0.05). Our study did not demonstrate improvement of QOL scores and adherence rates by pill count in pretreated HIV-infected children after simplification of the antiretroviral regimen to lopinavir/ritonavir monotherapy.
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Affiliation(s)
- Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Apirudee Panthong
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Jiratchaya Wongsabut
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Thanyawee Puthanakit
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
| | | | - Thongsuai Chuanjaroen
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Wasana Prasitsuebsai
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Jintanat Ananworanich
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Abstract
This clinical report provides guidance for the pediatrician in addressing the psychosocial needs of adolescents and young adults living with HIV, which can improve linkage to care and adherence to life-saving antiretroviral (ARV) therapy. Recent national case surveillance data for youth (defined here as adolescents and young adults 13 to 24 years of age) revealed that the burden of HIV/AIDS fell most heavily and disproportionately on African American youth, particularly males having sex with males. To effectively increase linkage to care and sustain adherence to therapy, interventions should address the immediate drivers of ARV compliance and also address factors that provide broader social and structural support for HIV-infected adolescents and young adults. Interventions should address psychosocial development, including lack of future orientation, inadequate educational attainment and limited health literacy, failure to focus on the long-term consequences of near-term risk behaviors, and coping ability. Associated challenges are closely linked to the structural environment. Individual case management is essential to linkage to and retention in care, ARV adherence, and management of associated comorbidities. Integrating these skills into pediatric and adolescent HIV practice in a medical home setting is critical, given the alarming increase in new HIV infections in youth in the United States.
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A cross-sectional study of disclosure of HIV status to children and adolescents in western Kenya. PLoS One 2014; 9:e86616. [PMID: 24475159 PMCID: PMC3903588 DOI: 10.1371/journal.pone.0086616] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Disclosure of HIV status to children is essential for disease management but is not well characterized in resource-limited settings. This study aimed to describe the prevalence of disclosure and associated factors among a cohort of HIV-infected children and adolescents in Kenya. Methods We conducted a cross-sectional study, randomly sampling HIV-infected children ages 6–14 years attending 4 HIV clinics in western Kenya. Data were collected from questionnaires administered by clinicians to children and their caregivers, supplemented with chart review. Descriptive statistics and disclosure prevalence were calculated. Univariate analyses and multivariate logistic regression were performed to assess the association between disclosure and key child-level demographic, clinical and psychosocial characteristics. Results Among 792 caregiver-child dyads, mean age of the children was 9.7 years (SD = 2.6) and 51% were female. Prevalence of disclosure was 26% and varied significantly by age; while 62% of 14-year-olds knew their status, only 42% of 11-year-olds and 21% of 8-year-olds knew. In multivariate regression, older age (OR 1.49, 95%CI 1.35–1.63), taking antiretroviral drugs (OR 2.27, 95%CI 1.29–3.97), and caregiver-reported depression symptoms (OR 2.63, 95%CI 1.12–6.20) were significantly associated with knowing one’s status. Treatment site was associated with disclosure for children attending one of the rural clinics compared to the urban clinic (OR 3.44, 95%CI 1.75–6.76). Conclusions Few HIV-infected children in Kenya know their HIV status. The likelihood of disclosure is associated with clinical and psychosocial factors. More data are needed on the process of disclosure and its impact on children.
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Foster C, Fidler S. Optimizing antiretroviral therapy in adolescents with perinatally acquired HIV-1 infection. Expert Rev Anti Infect Ther 2014; 8:1403-16. [DOI: 10.1586/eri.10.129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Bunupuradah T, Kosalaraksa P, Vibol U, Hansudewechakul R, Sophonphan J, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Luesomboon W, Vonthanak S, Ananworanich J, Ruxrungtham K, Puthanakit, on behalf of the PREDIC T. Impact of antiretroviral therapy on quality of life in HIV-infected Southeast Asian children in the PREDICT study. AIDS Patient Care STDS 2013; 27:596-603. [PMID: 24191673 DOI: 10.1089/apc.2013.0203] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N=149) versus deferred groups (ART when at CD4 <15%, N=150) and also compared with QOL data from age-matched healthy controls (N=275). Primary caregivers completed PACTG QOL questionnaires at week 0 and every 24 weeks until 144 weeks. Children were enrolled during March 2006 to September 2008. Mean (SD) age of children was 6.3 (2.8) years, 58% were female, 60% were Thai, %CDC N:A:B:C was 2:62:36:0%. During 144 weeks, all children in the early-group and 69 (46%) of deferred-group children started ART. There was no significant difference of QOL scores between treatment groups at baseline (all p>0.05) and at week 144 (all p>0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception (p=0.04), physical resilience (p=0.02), psychosocial well-being (p=0.04), social and role functioning (p<0.01), and symptoms (p=0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p<0.05) and 5 of 7 domains at weeks 144 (p<0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.
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Affiliation(s)
- Torsak Bunupuradah
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Ung Vibol
- National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | | | - Jiratchaya Sophonphan
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | | | - Jurai Wongsawat
- Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand
| | | | - Saphonn Vonthanak
- National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | - Jintanat Ananworanich
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kiat Ruxrungtham
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit, on behalf of the PREDIC
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
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Mabugu T, Revill P, van den Berg B. The Methodological Challenges for the Estimation of Quality of Life in Children for Use in Economic Evaluation in Low-Income Countries. Value Health Reg Issues 2013; 2:231-239. [PMID: 29702870 DOI: 10.1016/j.vhri.2013.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The assessment of quality of life (QOL) in children has been underresearched in high- and low-income countries alike. This is partly due to practical and methodological challenges in characterizing and assessing children's QOL. This article explores these challenges and highlights considerations in developing age-specific instruments for children affected by HIV and other health conditions in Africa and other low-income settings. METHODS A literature search identified works that have 1) developed, 2) derived utilities for, or 3) applied QOL tools for use in economic evaluations of HIV interventions for children. We analyzed the existing tools specifically in terms of domains considered, variations in age bands, the recommended respondents, and the relevance of the tools to African and also other low-income country contexts. RESULTS Only limited QOL research has been conducted in low-income settings on either adults or children with HIV. A few studies have developed and applied tools for children (e.g., in Thailand, Brazil, and India), but none have been in Africa. The existing methodological literature is inconclusive on the appropriate width or depth by which to define pediatric QOL. The existing instruments include QOL domains such as "physical functioning," "emotional and cognitive functioning," "general behavior (social, school, home)," "health perception," "coping and adaptation," "pain and discomfort," "extended effects," "life perspective," and "autonomy." CONCLUSIONS QOL assessment in children presents a series of practical and methodological challenges. Its application in low-income settings requires careful consideration of a number of context-specific factors.
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Affiliation(s)
- Travor Mabugu
- Clinical Research Centre, University of Zimbabwe, Harare, Zimbabwe.
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
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Cantrell K, Patel N, Mandrell B, Grissom S. Pediatric HIV disclosure: a process-oriented framework. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:302-314. [PMID: 23837808 DOI: 10.1521/aeap.2013.25.4.302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As children with vertically transmitted human immunodeficiency virus (HIV) infection live into adulthood, caregivers face the stressful process of informing their children about their infection. Although developmentally guided disclosure of HIV status is widely recommended, there are few specific frameworks to guide caregivers, families, and health care providers through the disclosure process. The authors propose a process-oriented framework for the disclosure of HIV in children and adolescents. This educational framework incorporates Piaget's cognitive development theory in an attempt to disclose and assist children and adolescents in understanding their HIV status. The framework is organized into 10 sequential stages of disclosure and three assessment stages in which health care providers discuss HIV health concepts with the child and caregiver, based on the child's developmental readiness. The described framework can be easily replicated by health care providers in disclosing disease status to children with HIV.
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Affiliation(s)
- Kathryn Cantrell
- Child Life Program, St. Jude Children's Research Hospital, Memphis, TN, USA.
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