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Evaluating a patient-centred intervention to increase disclosure and promote resilience for children living with HIV in Kenya

Vreeman, Rachel C.a,b,c; Nyandiko, Winstone M.c,e; Marete, Irenec,e; Mwangi, Annc,f; McAteer, Carole I.d,c; Keter, Alfredc,f; Scanlon, Michael L.a,b,c,g; Ayaya, Samuel O.c,e; Aluoch, Josephinec; Hogan, Josephh

doi: 10.1097/QAD.0000000000002183
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Objective: We evaluated the impact of a patient-centred, culturally and age-appropriate disclosure counselling intervention on HIV disclosure rates among Kenyan children living with HIV.

Design: A prospective, clinic-cluster randomized trial.

Methods: We followed 285 child–caregiver dyads (children ages 10–14 years) attending eight HIV clinics (randomized to intervention or control) in Kenya. Participants at intervention clinics received intensive counselling with trained disclosure counsellors and culturally tailored materials, compared with control clinics with standard care. Disclosure was treated as a time-to-event outcome, measured on a discrete time scale, with assessments at 0, 6, 12, 18 and 24 months. Mental health and behavioural outcomes were assessed using standardized questionnaires.

Results: Mean age was 12.3 years [standard deviation (SD) 1.5], 52% were girls, with average time-on-treatment of 4.5 years (SD 2.4). Between 0 and 6 months, disclosure prevalence increased from 47 to 58% in the control group and from 50 to 70% in the intervention group. Differences in disclosure were not sustained over the following 18 months. The prevalence of depression symptoms was significantly higher in the intervention than in the control group at 6 months (odds ratio 2.07, 95% confidence interval 1.01–4.25); however, there was no evidence that these differences were sustained after 6 months.

Conclusion: The clinic-based intervention increased disclosure of HIV status to children living with HIV in the short-term, resulting in earlier disclosures, but had less clear impacts longer-term. Although well tailored interventions may support disclosure, children may still experience increased levels of depression symptoms immediately following disclosure.

aDepartment of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai

bArnhold Institute for Global Health, NY, NY, USA

cAcademic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

dRyan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA

eDepartment of Child Health and Paediatrics

fDepartment of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

gJohn W. McCormack Graduate School for Policy and Global Studies, University of Massachusetts, Boston, MA

hDepartment of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA.

Correspondence to Rachel C. Vreeman, Arnhold Institute for Global Health, 1216 Fifth Avenue, Rm 556, NY, NY 10029, USA; Tel: +1 212-824-7950; e-mail: rachel.vreeman@mssm.edu

Received 20 March, 2018

Revised 8 February, 2019

Accepted 11 February, 2019

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