HIV-1 diagnosis disclosure to infected children on antiretroviral therapy in Kenya: Prevalence, correlates and caregivers’ perspectives

Abstract

Background: HIV-1 status disclosure to children is key to comprehensive paediatric HIV care. Increased access to antiretroviral drugs (ART) has led to survival of infected children posing a new challenge to parents on whether, when or how to disclose.
Objective: To understand the prevalence, correlates and caregivers’ perspectives on disclosure to HIV-1 infected children on ART.
Methodology: A mixed methods study with a cross-sectional design for the quantitative aspect of the study was done. The target population was caregivers to HIV-1 infected children aged 6 to 14 years receiving HIV care at Mbagathi Hospital, Kenya. Data was collected using questionnaires and interview guides. Chi-square and logistic regression were used to determine predictors of disclosure while thematic analysis was done for qualitative data.
Results: Disclosure prevalence was 36% (n=254). Age 10-14 compared to 6-9 years (aOR=10.97; 95% CI=5.7-21.2; p<0.0001), longer duration on HIV care (aOR=1.91; 95% CI=1.02-1.97; p<0.0001) for >5 years compared to <1 year, which was similar to 1-5years duration (aOR=1.03; 95% CI=0.36-1.97; p=0.233) and perceived importance of disclosure (aOR=2.58; 95% CI=1.36-4.90; p=0.004) were significantly associated with disclosure. Fear of stigma and discrimination was associated with low disclosure (OR=0.931; 95% CI=0.44-151; p<0.0001). Caregiver’s perceptions of importance of disclosure and influence of socio-cultural factors influenced disclosure.
Conclusion: Disclosure prevalence was low despite high caregivers’ perception of disclosure as important. Age of child, child’s duration on care, caregivers perceptions importance of disclosure and socio-cultural factors were associated with increased disclosure.