Clinic-Based Pediatric Disclosure Intervention Trial Improves Pediatric HIV Status Disclosure in Ghana. (1st May 2020)

• Record Type: Journal Article
• Authors: Paintsil, Elijah; Kyriakides, Tassos C.; Antwi, Sampson; Renner, Lorna; Nichols, Justin S.; Amissah, Kofi; Kusah, Jonas T.; Alhassan, Amina; Ofori, Irene P.; Catlin, Ann C.; Gan, Geliang; Lartey, Margaret; Reynolds, Nancy R.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 84:Number 1(2020)
• Publication Date: 2020-05-01
• Subjects: HIV -- pediatric -- disclosure -- Ghana -- site random assignment -- trial -- intervention; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002316
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Disclosing HIV status to HIV-positive children is a major challenge facing families and health care providers. Despite recommendations for disclosure, rates remain low. We tested whether a pediatric HIV disclosure intervention delivered as an integral component of routine HIV health care in Ghana would improve disclosure to children. Methods: Dyads of HIV-infected children aged 7–18 years and their caregivers were enrolled from 2 HIV clinics in Accra and Kumasi, Ghana. The sites were randomly assigned to one of the 2 intervention arms to avoid treatment contamination between intervention and control participants. Trained interventionist used theory-guided therapeutic communication and personalized interaction to promote disclosure. Disclosure outcomes were measured at 12-week intervals. All analyses were completed using a modified intention-to-treat approach. Results: We enrolled 446 child–caregiver dyads (N = 240 intervention group; N = 206 control group); 52% of the children were boys, mean age 9.78 (±2.27) years. For disclosure at 1 year, a better overall treatment effect was observed ( P < 0.001). Children in the treatment group had greater disclosure at each time point ( P < 0.001) and a higher proportion of them had been disclosed to by 1 year (51.4% vs. 16.2%; P < 0.001; un-adjusted hazard ratio = 3.98: 95% confidence interval: 2.63 to 6.03) and 3 years (71.3% vs. 34.0%; unadjusted hazard ratio = 4.21: 95% confidence interval: 3.09 to 5.72). In the multivariate Cox model, factors associated with disclosure were treatment group ( P < 0.001), children <11 years of age ( P < 0.001), HIV-infected caregivers ( P = 0.015), and caregiver's with greater education ( P = 0.022). Conclusions: This practical clinic-based disclosure intervention shows excellent promise as a means of improving HIV pediatric disclosure outcomes. Abstract : Supplemental Digital Content is Available in the Text.