Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in western Kenya.
Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in western Kenya.
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DOI：
10.1080/09540121.2015.1026307
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发表时间：
2015
期刊：
影响因子：
1.7
通讯作者：
Nyandiko WM
中科院分区：
文献类型：
--
作者：
Vreeman RC;Scanlon ML;Marete I;Mwangi A;Inui TS;McAteer CI;Nyandiko WM
了解自己的艾滋病毒状况对于长期疾病管理至关重要，但关于向撒哈拉以南非洲受感染的儿童和青少年披露艾滋病毒状况与临床和心理社会健康结果之间的关系，几乎没有数据。我们进行了一个详细的基线评估披露状态，服药依从性，艾滋病毒的耻辱，抑郁症，情绪和行为的困难，以及生活质量的一个队列的肯尼亚儿童参加了一项干预研究，以促进披露艾滋病毒的状态。在285名参与研究的双胞胎中，儿童的平均年龄为12.3岁。与儿童自我报告的披露（31%）相比，照顾者更有可能报告儿童知道他/她的诊断（41%）。与未披露儿童的照顾者相比，披露儿童的照顾者报告了对披露的积极看法，他们表示担心披露与儿童太小无法理解（75%），对儿童的潜在心理创伤（64%）以及如果儿童告诉其他人（56%）的耻辱和歧视。总体而言，绝大多数儿童在行为和情绪困难、抑郁和生活质量筛查中的得分都在正常范围内，并且无论儿童是否知道自己的艾滋病毒状况都没有差异。在多变量回归中，许多因素与儿童对其HIV诊断的了解相关，包括年龄较大（OR 1.8，95%CI 1.5-2.1），WHO疾病分期较好（OR 2.5，95%CI 1.4-4.4），以及报告的更少的HIV水平依从性障碍（OR 1.9，95%CI 1.1-3.4）。虽然这个队列中的少数儿童知道他们的艾滋病毒状况，并且照顾者报告了披露的重大障碍，包括对负面情绪影响的恐惧，但我们发现披露与更糟糕的心理社会结果无关。
Knowledge of one’s own HIV status is essential for long-term disease management, but there are few data on how disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver–child dyads enrolled in the study, children’s mean age was 12.3 years. Caregivers were more likely to report that the child knew his/her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child (64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ by whether or not the child knew his/her HIV status. A number of factors were associated with a child’s knowledge of his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5–2.1), better WHO disease stage (OR 2.5, 95% CI 1.4–4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1–3.4). While a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure including fears about negative emotional impacts, we found that disclosure was not associated with worse psychosocial outcomes.