title: Development of a diagnosis disclosure model for perinatally HIV-infected children in Thailand.
abstract: While disclosure of HIV status to perinatally HIV-infected children has become an increasingly important clinical issue, specific disclosure guidelines are lacking. We developed a pediatric HIV diagnosis disclosure model to support caretakers. All HIV-infected children greater than 7-years-old at two participating hospitals in Bangkok, Thailand, and their caretakers, were offered disclosure according to the 4-step protocol: (1) screening; (2) readiness assessment; (3) disclosure; and (4) follow-up. Disclosure occurred after agreement of both providers and caretakers. Among 438 children who were screened, 398 (89%) were eligible. Readiness assessment was completed for 353 (91%) of eligible children and 216 (61%) were determined ready. Disclosure was done for 186 children. The mean age at eligibility screening was 10.5 years (range: 6.8-15.8 years); the mean age at disclosure was 11.7 years (range: 7.6-17.7 years). The mean duration between eligibility screening and disclosure was 15.2 months. There were no significant negative behavioral or emotional outcomes reported in children following disclosure. This HIV diagnosis disclosure model was feasible to implement and had no negative outcomes. As the time for preparation process was over 1 year for most cases, the disclosure process can be initiated as early as age 7 to allow enough time for disclosure to be completed by the age of adolescence.
authors.affiliation: Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. itharon.boo@mahidol.ac.th
authors.forename: Vitharon
authors.initials: V
authors.lastname: Boon-Yasidhi
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
authors.forename: Nirun
authors.initials: N
authors.lastname: Vanprapar
authors.forename: Pimsiri
authors.initials: P
authors.lastname: Leowsrisook
authors.forename: Wasana
authors.initials: W
authors.lastname: Prasitsurbsai
authors.forename: Yuitiang
authors.initials: Y
authors.lastname: Durier
authors.forename: Kanyarat
authors.initials: K
authors.lastname: Klumthanom
authors.forename: Alpa
authors.initials: A
authors.lastname: Patel
authors.forename: Wichuda
authors.initials: W
authors.lastname: Sukwicha
authors.forename: Thananda
authors.initials: T
authors.lastname: Naiwatanakul
authors.forename: Tawee
authors.initials: T
authors.lastname: Chotpitayasunond
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000367:Age Factors; D017028:Caregivers / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D003376:Counseling; D003661:Decision Support Techniques; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology