Factors associated with HIV/AIDS diagnostic disclosure to HIV infected children receiving HAART: A multi-center study in Addis Ababa, Ethiopia

Department of Epidemiology and Biostatistics, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia.
PLoS ONE (Impact Factor: 3.23). 03/2011; 6(3):e17572. DOI: 10.1371/journal.pone.0017572
Source: PubMed


Diagnostic disclosure of HIV/AIDS to a child is becoming an increasingly common issue in clinical practice. Nevertheless, some parents and health care professionals are reluctant to inform children about their HIV infection status. The objective of this study was to identify the proportion of children who have knowledge of their serostatus and factors associated with disclosure in HIV-infected children receiving HAART in Addis Ababa, Ethiopia.
A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18, 2008-April 28, 2008. The study populations were parents/caretakers and children living with HIV/AIDS who were receiving Highly Active Antiretroviral Therapy (HAART) in selected hospitals in Addis Ababa. Univariate and multivariate logistic regression analysis were carried out using SPSS 12.0.1 statistical software.
A total of 390 children/caretaker pairs were included in the study. Two hundred forty three children (62.3%) were between 6-9 years of age. HIV/AIDS status was known by 68 (17.4%) children, 93 (29%) caretakers reported knowing the child's serostatus two years prior to our survey, 180 (46.2%) respondents said that the child should be told about his/her HIV/AIDS status when he/she is older than 14 years of age. Children less than 9 years of age and those living with educated caregivers are less likely to know their results than their counterparts. Children referred from hospital's in-patient ward before attending the HIV clinic and private clinic were more likely to know their results than those from community clinic.
The proportion of disclosure of HIV/AIDS diagnosis to HIV-infected children is low. Strengthening referral linkage and health education tailored to educated caregivers are recommended to increase the rate of disclosure.

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Available from: Sibhatu Biadgilign, Oct 04, 2015
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    • "We found a prevalence of full disclosure of 31% among children attending a pediatric HIV clinic in a rural, Ugandan clinic. This rate is close to that reported from an earlier study done in Kampala, Uganda of 29% (Bikaako-Kajura et al., 2006), although studies in other African settings have reported somewhat lower overall rates of 17–21% (Biadgilign et al., 2011; Biobele et al., 2011; Kallem et al., 2011). The differences in disclosure rates may be at least partially explained by age, as two of the other studies involved younger children of 0–14 years (Biobele et al., 2011) and 1–14 (Kallem et al., 2011) compared to the 5-to 17-year-olds in our study. "
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    ABSTRACT: Highly active antiretroviral therapy has enabled HIV-infected children to survive into adolescence and adulthood, creating need for their own HIV diagnosis disclosure. Disclosure has numerous social and medical benefits for the child and family; however, disclosure rates tend to be low, especially in developing countries, and further understanding of the barriers is needed. This study describes the patterns and correlates of disclosure among HIV-infected children in southwestern Uganda. A cross-sectional study was conducted in a referral hospital pediatric HIV clinic between February and April 2012. Interviews were administered to caregivers of HIV-infected children aged 5-17 years. Data collected included socio-demographic characteristics of the child and caregiver, reported disclosure status, and caregivers' reasons for full disclosure or non-full disclosure of HIV status to their children. Bivariate and multivariate analysis was done to establish the socio-demographic correlates of disclosure. Caregivers provided data for 307 children; the median age was eight years (interquartile range [IQR] 7-11) and 52% were males. Ninety-five (31%) children had received full disclosure (48% of whom were >12 years), 22 children (7%) had received partial disclosure, 39 (13%) misinformation, and 151 (49%) no disclosure. Full disclosure was significantly more prevalent among the 9-11 and 12- to 17-year-olds compared to 5- to 8-year-olds (p-value < 0.001). The most frequently stated reason for disclosure was the hope that disclosure would improve medication adherence; the most frequently stated reason for nondisclosure was the belief that the child was too young to understand his/her illness. There was an inverse relationship between age and full disclosure and partial disclosure was rare across all age groups, suggesting a pattern of rapid, late disclosure. Disclosure programs should emphasize the importance of gradual disclosure, starting at younger ages, to maximize the benefits to the child and caregiver.
    AIDS Care 11/2014; 27(4):1-7. DOI:10.1080/09540121.2014.978735 · 1.60 Impact Factor
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    • "| CC-BY 4.0 Open Access | received: 2 Jun 2014, published: 2 Jun 2014 PrePrints disclosure of illness before they reach adolescence where more negative impacts have been noted (American Academy of Pediatrics, 1999; Blasini et al., 2004; Lester et al., 2002; Siripong et al., 2007). Other researchers have also reported similar suitable age ranges for full disclosure of 11-12 years in South Africa (Moodley et al., 2006); and 14 years in Ethiopia (Biadgilign et al., 2011) and Thailand (Oberdorfer et al., 2006). Additionally, this study revealed that important life events such as completion of a national examination should be incorporated into full disclosure planning and delivery. "
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    ABSTRACT: HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews. Data were analyzed using the Van Kaam method; NVivo 8 software was used to assist data analysis. We present data on the process of disclosure based on how participants recommended full disclosure be approached to HIV-positive and negative children. Participants recommended disclosure as a process starting at five years with full disclosure delivered at 10 years when the child was capable of understanding the illness, or by 14 years when the child was mature enough to receive the news if full disclosure had not been conducted earlier. Important considerations at the time of full disclosure included the parent's and/or child's health statuses, number of infected family members' illnesses to be disclosed to the child, child's maturity and understanding level, and the person best suited to deliver full disclosure to the child. The results also revealed it was important to address important life events such as taking a national school examination during disclosure planning and delivery. Recommendations are made for inclusion into HIV disclosure guidelines, manuals, and programs in resource-poor nations with high HIV prevalence.
    PeerJ 07/2014; 2(1):e486. DOI:10.7717/peerj.486 · 2.11 Impact Factor
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    • "However, current data from resource-limited settings show typically low rates of disclosure to children, ranging between 10–38% [7], [18], [20]–[22]. In a recent study conducted in the Mbarara Regional Referral Hospital in Uganda, caregivers reported that only 31% of children between 5 and 17 years had received full disclosure of their HIV status [23]. "
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    ABSTRACT: 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. 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. 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. 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.
    PLoS ONE 03/2014; 9(3):e93276. DOI:10.1371/journal.pone.0093276 · 3.23 Impact Factor
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