Models of support for disclosure of HIV status to HIV-infected children and adolescents in resource-limited settings
Models of support for disclosure of HIV status to HIV-infected children and adolescents in resource-limited settings
复制标题
DOI：
10.1002/jia2.25157
复制
发表时间：
2018-07-04
影响因子：
6
通讯作者：
Vreeman, Rachel C.
中科院分区：
文献类型：
--
作者：
Arrive, Elise;Ayaya, Samuel;Vreeman, Rachel C.
向感染艾滋病毒的儿童和青少年披露艾滋病毒状况是一项重大的护理挑战。我们描述了在国际艾滋病流行病学数据库评估（IeDEA）联盟中资源有限的儿科艾滋病护理机构中与艾滋病毒状况披露相关的当前站点特征。方法：在IeDEA全球六个区域的儿科HIV护理站点进行在线现场评估调查。通过REDCap平台对各网站进行标准化问卷调查。结果：2014年6月至2015年3月，31个国家的所有180个IeDEA联盟站点完成了在线调查：57%为城市，43%为保健中心，86%为综合诊所（为成人和儿童提供服务）。几乎所有网站（98%）都表示提供信息披露咨询服务。披露咨询最常由咨询师（87%）提供，但也由护士（77%）、医生（74%）、社会工作者（68%）或其他临床医生（65%）提供。在177个提供信息披露咨询的网站中，有92%的网站向照顾者和儿童提供了信息披露咨询。披露资源和程序因地理区域而异。每个区域的大多数站点报告了开展工作人员披露培训的情况（每个区域72%至96%的站点），定期收集艾滋病毒披露情况（50%至91%），并让护理人员参与披露过程（71%至100%）。14%到71%的网站有披露协议。在143个站点（79%）例行收集披露状况过程中，主要收集方法是询问照顾者或儿童（85%）儿童对其艾滋病毒状况的了解情况。63%的站点每三个月进行一次披露状态评估，71%的站点以电子方式存储披露状态数据。结论：大多数网站报告提供披露咨询服务，但教育和社会支持资源和数据收集能力因地区而异。世界各地的儿科艾滋病毒护理站点仍然需要对具体工作人员进行披露、制定和执行艾滋病毒披露准则以及关于这一关键问题的标准化数据收集方面的培训，以确保感染艾滋病毒的青年的长期健康和福祉。
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.