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Disclosure of HIV status to infected children in Ghana: a north-south comparison of enablers and barriers
Disclosure of HIV status to infected children in Ghana: a north-south comparison of enablers and barriers
Background Understanding the living experiences of HIV+ children of disclosed status is necessary for intervention design. This study examined the living context of HIV status disclosed children and compared the barriers and facilitators to HIV disclosure across the Upper East, Northern and Ashanti regions of Ghana. Methods A concurrent mixed method design guided the interviewer-administered collection of data from 180 caregivers of HIV+ children 5-18 years from 12 antiretroviral treatment (ART) centres. A bivariate and binary multiple logistic regression analysis tested child and caregiver related variables associated with disclosure. A total of 30 HIV+ disclosed children 9-19 years were purposively selected for an interpretative phenomenological qualitative design and analysis. Results A total of 42 (23.3%) of the children knew their HIV status. The median age at disclosure of HIV status to the children was 9.5 (IQR=6-11) years. The median age of undisclosed children (n=138) was 7 (IQR=5-11). Caregivers of undisclosed children proposed age 16 as the intended age of disclosure, though children with disclosed status preferred 10 years as ideal age. Child age, age at ART start and caregiver resident region showed significant association with disclosure. Preference for disclosing child‟s HIV status to only child‟s family differed significantly between caregivers from Northern and Southern Ghana (17% vs 83%, p<0.03). In the multivariate binary logistic regression, a child questioning caregiver frequently about continuous medication intake (AOR = 19.0, p< 0.01) increased the odds of disclosure. From the qualitative evidence, disclosure often occurred with little or no preparation. It was either deliberately delayed or pro- longed due to caregiver dilemma or took place based on the illness severity. Despite improved medication experiences post disclosure, the children reported financial difficulty and food insecurity. Conclusions Understanding the experiences of post-disclosed HIV+ children to inform the development of a national culturally sensitive and age specific disclosure guideline remains timely.
Disclosure, HIV/AIDS, Paediatric, Children, Adolescents, Barriers, Southern and Northern Ghana, Experience, Phenomenology
Appiah, Seth Christopher Yaw
2021
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Appiah, Seth Christopher Yaw (2021): Disclosure of HIV status to infected children in Ghana: a north-south comparison of enablers and barriers. Dissertation, LMU München: Faculty of Medicine
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Abstract

Background Understanding the living experiences of HIV+ children of disclosed status is necessary for intervention design. This study examined the living context of HIV status disclosed children and compared the barriers and facilitators to HIV disclosure across the Upper East, Northern and Ashanti regions of Ghana. Methods A concurrent mixed method design guided the interviewer-administered collection of data from 180 caregivers of HIV+ children 5-18 years from 12 antiretroviral treatment (ART) centres. A bivariate and binary multiple logistic regression analysis tested child and caregiver related variables associated with disclosure. A total of 30 HIV+ disclosed children 9-19 years were purposively selected for an interpretative phenomenological qualitative design and analysis. Results A total of 42 (23.3%) of the children knew their HIV status. The median age at disclosure of HIV status to the children was 9.5 (IQR=6-11) years. The median age of undisclosed children (n=138) was 7 (IQR=5-11). Caregivers of undisclosed children proposed age 16 as the intended age of disclosure, though children with disclosed status preferred 10 years as ideal age. Child age, age at ART start and caregiver resident region showed significant association with disclosure. Preference for disclosing child‟s HIV status to only child‟s family differed significantly between caregivers from Northern and Southern Ghana (17% vs 83%, p<0.03). In the multivariate binary logistic regression, a child questioning caregiver frequently about continuous medication intake (AOR = 19.0, p< 0.01) increased the odds of disclosure. From the qualitative evidence, disclosure often occurred with little or no preparation. It was either deliberately delayed or pro- longed due to caregiver dilemma or took place based on the illness severity. Despite improved medication experiences post disclosure, the children reported financial difficulty and food insecurity. Conclusions Understanding the experiences of post-disclosed HIV+ children to inform the development of a national culturally sensitive and age specific disclosure guideline remains timely.