Prevalence and predictors of pediatric disclosure among HIV-infected Nigerian children on treatment

Abstract

This cross-sectional, facility-based study aimed to determine the prevalence, age, and main agent of disclosure among Nigerian children on antiretroviral therapy. It also sought to elicit barriers to, and facilitators of disclosure; and any association between disclosure and health outcomes. A semi-structured questionnaire was administered to 110 parents/caregivers of children ≥6 years. CD4 count, viral load, opportunistic infections and adherence information were also extracted from medical records for all 110 children. The mean age of the children in the study was 10.15 years (SD = 2.97), with a median (range) of 9.50 (6-18) years. According to parents/caregivers' accounts, 34 (30.9%) children knew that they were living with HIV, while 74 (67.3%) did not know. Mean age at disclosure was 10.47 years (SD = 2.62), with a median (range) of 10.00 (6-17) years. Most children (79.4%) were disclosed at home by their parent(s)/caregiver. The rest were disclosed at the hospital: five were disclosed by a healthcare provider, while two were accidentally disclosed. The most common reasons for disclosure were related to adherence issues - either to help prepare the children to take their medicines or that the child had refused to take his/her medicines (39.4%). This was followed by the child asking a lot of questions related to his/her health, frequent visits to the hospital, or why s/he was taking a lot of medicines even though s/he did not feel ill (27.3%). Most parents/caregivers did not disclose because the child was considered too young (84.0%) or will not be able to keep their HIV status a secret (10.7%). Multivariate logistic regression showed that only child's age was a statistically significant predictor of status disclosure (OR 1.69, p = .002; 95% CI 1.21-2.34). There was no association between disclosure and self-reported adherence (p = .615).