Understanding the role of age in HIV disclosure rates and patterns for HIV-infected children in southwestern Uganda
Understanding the role of age in HIV disclosure rates and patterns for HIV-infected children in southwestern Uganda
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DOI：
10.1080/09540121.2014.978735
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发表时间：
2015-04-03
影响因子：
1.7
通讯作者：
Haberer, Jessica E.
中科院分区：
文献类型：
--
作者：
Atwiine, Barnabas;Kiwanuka, Julius;Haberer, Jessica E.
高效抗逆转录病毒疗法使感染艾滋病毒的儿童能够存活到青春期和成年期，这就需要披露他们自己的艾滋病毒诊断。披露对儿童和家庭有许多社会和医疗好处;然而，披露率往往很低，特别是在发展中国家，需要进一步了解这些障碍。本研究描述了乌干达西南部艾滋病毒感染儿童的披露模式和相关因素。2012年2月至4月，在一家转诊医院的儿科HIV诊所进行了一项横断面研究。对5-17岁感染艾滋病毒儿童的照顾者进行了访谈。收集的数据包括儿童和照顾者的社会人口特征、报告的披露状况以及照顾者向其子女充分披露或不充分披露艾滋病毒状况的原因。进行了双变量和多变量分析，以建立披露的社会人口统计学相关性。护理人员提供了307名儿童的数据;中位年龄为8岁（四分位数范围[IQR] 7-11），52%为男性。95名（31%）儿童接受了完全披露（其中48%年龄>12岁），22名儿童（7%）接受了部分披露，39名（13%）错误信息，151名（49%）未披露。9-11岁和12- 17岁的孩子比5- 8岁的孩子更倾向于完全披露（p值< 0.001）。最常提及的披露原因是希望披露将改善药物依从性;最常提及的不披露原因是认为孩子太小，不了解他/她的疾病。年龄与充分披露之间呈反比关系，在所有年龄组中，部分披露都很少见，这表明了一种快速、迟披露的模式。披露计划应强调逐步披露的重要性，从年轻时开始，以最大限度地提高儿童和照顾者的利益。
Highly active antiretroviral therapy has enabled HIV-infected children to survive into adolescence and adulthood, creating need for their own HIV diagnosis disclosure. Disclosure has numerous social and medical benefits for the child and family; however, disclosure rates tend to be low, especially in developing countries, and further understanding of the barriers is needed. This study describes the patterns and correlates of disclosure among HIV-infected children in southwestern Uganda. A cross-sectional study was conducted in a referral hospital pediatric HIV clinic between February and April 2012. Interviews were administered to caregivers of HIV-infected children aged 5-17 years. Data collected included socio-demographic characteristics of the child and caregiver, reported disclosure status, and caregivers' reasons for full disclosure or non-full disclosure of HIV status to their children. Bivariate and multivariate analysis was done to establish the socio-demographic correlates of disclosure. Caregivers provided data for 307 children; the median age was eight years (interquartile range [IQR] 7-11) and 52% were males. Ninety-five (31%) children had received full disclosure (48% of whom were >12 years), 22 children (7%) had received partial disclosure, 39 (13%) misinformation, and 151 (49%) no disclosure. Full disclosure was significantly more prevalent among the 9-11 and 12- to 17-year-olds compared to 5- to 8-year-olds (p-value < 0.001). The most frequently stated reason for disclosure was the hope that disclosure would improve medication adherence; the most frequently stated reason for nondisclosure was the belief that the child was too young to understand his/her illness. There was an inverse relationship between age and full disclosure and partial disclosure was rare across all age groups, suggesting a pattern of rapid, late disclosure. Disclosure programs should emphasize the importance of gradual disclosure, starting at younger ages, to maximize the benefits to the child and caregiver.