Rachel C Vreeman1,2,3, Winstone M Nyandiko3,4, Irene Marete3,4, Ann Mwangi3,5, Carole I McAteer6,3, Alfred Keter3,5, Michael L Scanlon1,2,3,7, Samuel O Ayaya3,4, Josephine Aluoch3, Joseph Hogan8. 1. Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai. 2. Arnhold Institute for Global Health, NY, NY, USA. 3. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. 4. Department of Child Health and Paediatrics. 5. Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. 6. Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA. 7. John W. McCormack Graduate School for Policy and Global Studies, University of Massachusetts, Boston, MA. 8. Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA.
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.
RCT Entities:
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.
Authors: Judith J Toromo; Edith Apondi; Winstone M Nyandiko; Mark Omollo; Salim Bakari; Josephine Aluoch; Rami Kantor; J Dennis Fortenberry; Kara Wools-Kaloustian; Batya Elul; Rachel C Vreeman; Leslie A Enane Journal: BMC Public Health Date: 2022-06-04 Impact factor: 4.135
Authors: Faustin Nd Kitetele; Gilbert M Lelo; Cathy E Akele; Patricia V M Lelo; Eric M Mafuta; Thorkild Tylleskär; Espérance Kashala-Abotnes Journal: Children (Basel) Date: 2022-08-17
Authors: Elijah Paintsil; Tassos C Kyriakides; Sampson Antwi; Lorna Renner; Justin S Nichols; Kofi Amissah; Jonas T Kusah; Amina Alhassan; Irene P Ofori; Ann C Catlin; Geliang Gan; Margaret Lartey; Nancy R Reynolds Journal: J Acquir Immune Defic Syndr Date: 2020-05-01 Impact factor: 3.771