HIV Positive Status Disclosure and Its Associated Factors Among Children on Antiretroviral Therapy in West Shoa Zone, Western Ethiopia, 2019: A Mixed Method Cross-Sectional Study

Disclosure of HIV status and associated clinical outcomes of children and adolescents living with HIV in Asia

Disclosure of HIV status is an important part of pediatric care. We studied disclosure and clinical outcomes in a multi-country Asian cohort of children and adolescents with HIV. Those 6-19 years of age who initiated combination antiretroviral therapy (cART) between 2008 and 2018, and who had at least one follow-up clinic visit were included. Data up to December 2019 were analyzed. Cox and competing risk regression analyses were used to assess the effect of disclosure on disease progression (WHO clinical stage 3 or 4), loss to follow-up (LTFU; > 12 months), and death. Of 1913 children and adolescents (48% female; median [IQR] age 11.5 [9.2-14.7] years at last clinic visit), 795 (42%) were disclosed to about their HIV status at a median age of 12.9 years (IQR: 11.8-14.1). During follow-up, 207 (11%) experienced disease progression, 75 (3.9%) were LTFU, and 59 (3.1%) died. There were lower hazards of disease progression (adjusted hazard ratio [aHR] 0.43 [0.28-0.66]) and death (aHR 0.36 [0.17-0.79]) for those disclosed to compared with those who were not. Disclosure and its appropriate implementation should be promoted in pediatric HIV clinics in resource-limited settings.

Lessons Learned from the Impact of HIV Status Disclosure to Children after First-Line Antiretroviral Treatment Failure in Kinshasa, DR Congo

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.

Prevalence, socio-demographics and service use determinants associated with disclosure of HIV/AIDS status to infected children: a systematic review and meta-analysis by 1985-2021

BACKGROUND

Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a public health issue of global importance. To our knowledge, no previous meta-analysis documenting the prevalence, socio-demographic, and service use determinants associated with HIV/AIDS disclosure to infected children has been conducted. The present study aimed to determine the prevalence, socio-demographics and service use determinants associated with the disclosure of HIV/AIDS status to infected children.

METHODS

Studies in English published between 01 January 1985 and 01 November 2021, and available on PubMed, Scopus, Web of Science, and Cochrane electronic databases were searched. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals.

RESULTS

After article duplicates were excluded, assessments of abstracts were completed, and full-text papers evaluated, 37 studies were included in this meta-analysis. The prevalence of the disclosure of HIV status to children was measured to be 41% in this research. The odds that a child of 10 years and older is informed that they are HIV-positive is 3.01 time the odds that younger children are informed. Those children who had primary or lower schooling level were 2.41 times more likely to be informed of their HIV-positive status than children with higher levels of schooling. Children who had a non-biological parents were 3.17 times more likely to have been disclose being HIV-positive; social support (OR = 8.29, 95%CI = 2.34, 29.42), children who had higher levels of social supports were 8.29 times more likely to disclose HIV-positive; the primary educational level of caregivers (OR = 2.03, 95%CI = 1.43, 2.89), respondents who had caregivers with primary education level were 2.03 times more likely to disclose HIV-positive; antiretroviral treatment (ART) adherence (OR = 2.59, 95%CI = 1.96, 3.42), participants who adhered to ART were 2.59 times more likely to disclose HIV-positive and hospital follow-up (OR = 2.82, 95%CI = 1.85, 4.29), those who had hospital follow-up were 2.82 times more likely to disclose HIV-positive; were all significantly associated with the disclosure of HIV/AIDS status to infected children.

CONCLUSION

Such data are of importance for healthcare pediatrics HIV care professionals. Facilitating HIV diagnosis and disclosure to the infected children and ensuring access to HIV treatment will likely prevent secondary HIV transmission. Healthcare professionals are expected to provide age-appropriate counseling services to this population.

Factors associated with children's HIV- positive status disclosure in Wolaita Zone, Southern Ethiopia: a cross-sectional study

Background

Children’s HIV-positive status disclosure is an essential component of chronic care & long-term disease management. The modalities of status disclosure are complex and vary across different communities. Although data from various settings are necessary to overcome this problem, evidence is limited, specifically in the in the study areas. Therefore, this study aimed to assess the prevalence of HIV-positive status disclosure and associated factors among children on antiretroviral therapy (ART).

Methods

A mixed-method, facility-based study was conducted: among 203 caregivers with children in Wolaita Zone, Southern Ethiopia. We used in-depth interviews for qualitative data in addition to structured questionnaires. Simple random sampling for quantitative and purposive sampling for qualitative parts was applied. We used Content or Thematic analysis for qualitative and Binary logistic regression for quantitative.

Results

All the caregivers were interviewed and majorities (84.7%) of them were female. One hundred twelve children (55.2%) were below 12 years of age. In this study, the overall prevalence of children with HIV-positive status disclosure was 46.8%. Being 12 or more years of age (AOR = 7.5, 95% CI: 2.9–15.6), duration on ART 72 or more months (AOR = 3.8, 95% CI: 1.7–6.7), death of the parent (AOR = 2.0, 95% CI: 1.1- 3.8), and having follow up in the hospital (AOR = 2.1, 95% CI: 1.3–4.7) were associated with disclosure. Being an immature child was the commonest reason cited by caregivers for non-disclosure. Frequent questions by the child about why they are taking drugs, for better self-care, and treatment adherence were the commonest reason of caregivers for disclosing their children’s HIV-positive status.

Conclusion

In our study, children’s HIV-positive status disclosure was significantly low. This study identified different factors (Health facility, children, and caregivers-related factors) as the main reason for disclosing children’s HIV-positive status. Hence, health care workers should give special attention to children’s HIV-positive status disclosure, which helps to increase the effectiveness of treatment and prevent further HIV transmission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01287-6.

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

Background

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

Methods and Materials

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

Results

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

Conclusions

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

Systematic Review Registration

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

Disclosure Status and Associated Factors Among Children on Antiretroviral Therapy in Ethiopia

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.