"I have never talked to anyone to free my mind" - challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya.
"I have never talked to anyone to free my mind" - challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya.
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DOI：
10.1186/s12889-022-13519-9
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发表时间：
2022-06-04
影响因子：
4.5
通讯作者：
Enane, Leslie A.
中科院分区：
文献类型：
--
作者：
Toromo, Judith J.;Apondi, Edith;Nyandiko, Winstone M.;Omollo, Mark;Bakari, Salim;Aluoch, Josephine;Kantor, Rami;Fortenberry, J. Dennis;Wools-Kaloustian, Kara;Elul, Batya;Vreeman, Rachel C.;Enane, Leslie A.
感染艾滋病毒的青少年（ALHIV，10-19岁）在参与护理方面遇到复杂的障碍。围绕艾滋病毒状态披露或不披露给青少年的挑战可能会导致青少年脱离艾滋病毒护理或不遵守ART。我们进行了一项定性研究，调查披露的挑战，青少年脱离艾滋病毒护理的贡献。这是一项定性研究，在肯尼亚西部的学术模式提供医疗保健（AMPATH）计划中，与脱离ALHIV及其护理人员以及医疗保健工作者（HCW）进行。ALHIV的入选标准是在两个临床研究中心之一的数据收集前18个月内≥1次访视，并且在末次计划预约后≥60天未出席。HCW从10个诊所招募。由多个独立的编码器进行分析，并仔细询问披露和护理脱离的叙述。会议阐述并总结了主要主题。访谈进行了42个脱离ALHIV，32个照顾者，28 HCW。ALHIV的平均年龄为17.0岁（范围12.9-20.9），95%的人表示知道他们的HIV诊断。围绕向ALHIV披露的问题是参与艾滋病毒护理的重要障碍。主题集中在艾滋病毒状况披露的延迟;照顾者之间的犹豫和不愿披露;青少年的斗争，以科普被欺骗的感觉之前，充分披露;普遍存在的艾滋病毒的耻辱内化在学校和社区设置之前披露;和披露后，包括青少年的心理健康负担和照顾者的关系和沟通不足和非结构化的支持。HCW和护理人员都描述了感觉准备不足，无法最佳地处理披露和管理披露后可能出现的挑战。围绕向青少年披露艾滋病毒状况的复杂挑战促成了护理脱离。有必要加强对HCW的培训和资源，并使护理人员能够在艾滋病毒状况披露之前、期间和之后为儿童和青少年提供支持。这应该包括咨询照顾者如何从幼年起就为儿童提供有关其健康的发展适当和准确的信息，并支持照顾者之间的沟通和关系。最佳整合同侪支持可以进一步促进ALHIV的福祉和保留护理。在线版本包含补充材料，可通过10.1186/s12889-022-13519-9获得。
Adolescents living with HIV (ALHIV, ages 10–19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care. This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized. Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9–20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure. Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care. The online version contains supplementary material available at 10.1186/s12889-022-13519-9.
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影响因子：
3.7
作者：
Enane LA;Mokete K;Joel D;Daimari R;Tshume O;Anabwani G;Mazhani L;Steenhoff AP;Lowenthal ED
通讯作者：
Lowenthal ED
影响因子：
6
作者：
Arrive, Elise;Ayaya, Samuel;Vreeman, Rachel C.
通讯作者：
Vreeman, Rachel C.
影响因子：
3.2
作者：
Mkwanazi, Ntombizodumo B.;Rochat, Tamsen J.;Bland, Ruth M.
通讯作者：
Bland, Ruth M.
DOI：
10.3390/children7120261
发表时间：
2020-11-28
期刊：
Children (Basel, Switzerland)
影响因子：
--
作者：
Maseko Y;Madiba S
通讯作者：
Madiba S
影响因子：
7.4
作者：
Einterz, Robert M.;Kimaiyo, Sylvester;Mamlin, Joseph J.
通讯作者：
Mamlin, Joseph J.