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J Int AIDS Soc. 2018 Jul;21(7):e25157. doi: 10.1002/jia2.25157.

Models of support for disclosure of HIV status to HIV-infected children and adolescents in resource-limited settings.

Author information

1
ISPED, Centre INSERM U1219- Epidémiologie-Biostatistique, Université de Bordeaux, Bordeaux, France.
2
INSERM U1219, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France.
3
School of Medicine, College of Health Science, Moi University, Eldoret, Kenya.
4
University of Cape Town, Cape Town, South Africa.
5
Newlands Clinic, Harare, Zimbabwe.
6
Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
7
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
8
Hospital Likas, Kota Kinabalu, Malaysia.
9
Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
10
CIRBA, Abidjan, Cote D'Ivoire.
11
Vanderbilt University School of Medicine, Nashville, TN, USA.
12
Inserm U1027, Université de Toulouse 3, Toulouse, France.
13
Indiana University School of Medicine, Indianapolis, IN, USA.
14
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.

Abstract

INTRODUCTION:

Disclosure of HIV status to HIV-infected children and adolescents is a major care challenge. We describe current site characteristics related to disclosure of HIV status in resource-limited paediatric HIV care settings within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

METHODS:

An online site assessment survey was conducted across the paediatric HIV care sites within six global regions of IeDEA. A standardized questionnaire was administered to the sites through the REDCap platform.

RESULTS:

From June 2014 to March 2015, all 180 sites of the IeDEA consortium in 31 countries completed the online survey: 57% were urban, 43% were health centres and 86% were integrated clinics (serving both adults and children). Almost all the sites (98%) reported offering disclosure counselling services. Disclosure counselling was most often provided by counsellors (87% of sites), but also by nurses (77%), physicians (74%), social workers (68%), or other clinicians (65%). It was offered to both caregivers and children in 92% of 177 sites with disclosure counselling. Disclosure resources and procedures varied across geographical regions. Most sites in each region reported performing staff members' training on disclosure (72% to 96% of sites per region), routinely collecting HIV disclosure status (50% to 91%) and involving caregivers in the disclosure process (71% to 100%). A disclosure protocol was available in 14% to 71% of sites. Among the 143 sites (79%) routinely collecting disclosure status process, the main collection method was by asking the caregiver or child (85%) about the child's knowledge of his/her HIV status. Frequency of disclosure status assessment was every three months in 63% of the sites, and 71% stored disclosure status data electronically.

CONCLUSION:

The majority of the sites reported offering disclosure counselling services, but educational and social support resources and capacities for data collection varied across regions. Paediatric HIV care sites worldwide still need specific staff members' training on disclosure, development and implementation of guidelines for HIV disclosure, and standardized data collection on this key issue to ensure the long-term health and wellbeing of HIV-infected youth.

KEYWORDS:

adolescents; counselling; disclosure; low- and middle-income countries; site assessment; vertical HIV infection

PMID:
29972632
PMCID:
PMC6031071
DOI:
10.1002/jia2.25157
[Indexed for MEDLINE]
Free PMC Article

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