A cross-sectional study of disclosure of HIV status to children and adolescents in western Kenya.
BACKGROUND
Disclosure of HIV status to children is essential for disease management but is not well characterized in resource-limited settings. This study aimed to describe the prevalence of disclosure and associated factors among a cohort of HIV-infected children and adolescents in Kenya.


METHODS
We conducted a cross-sectional study, randomly sampling HIV-infected children ages 6-14 years attending 4 HIV clinics in western Kenya. Data were collected from questionnaires administered by clinicians to children and their caregivers, supplemented with chart review. Descriptive statistics and disclosure prevalence were calculated. Univariate analyses and multivariate logistic regression were performed to assess the association between disclosure and key child-level demographic, clinical and psychosocial characteristics.


RESULTS
Among 792 caregiver-child dyads, mean age of the children was 9.7 years (SD = 2.6) and 51% were female. Prevalence of disclosure was 26% and varied significantly by age; while 62% of 14-year-olds knew their status, only 42% of 11-year-olds and 21% of 8-year-olds knew. In multivariate regression, older age (OR 1.49, 95%CI 1.35-1.63), taking antiretroviral drugs (OR 2.27, 95%CI 1.29-3.97), and caregiver-reported depression symptoms (OR 2.63, 95%CI 1.12-6.20) were significantly associated with knowing one's status. Treatment site was associated with disclosure for children attending one of the rural clinics compared to the urban clinic (OR 3.44, 95%CI 1.75-6.76).


CONCLUSIONS
Few HIV-infected children in Kenya know their HIV status. The likelihood of disclosure is associated with clinical and psychosocial factors. More data are needed on the process of disclosure and its impact on children.
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America ; USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Rachel C
RC
Vreeman
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America ; USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Michael L
ML
Scanlon
USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Department of Behavioral Science, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Ann
A
Mwangi
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America ; USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Matthew
M
Turissini
USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Samuel O
SO
Ayaya
USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Constance
C
Tenge
USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Winstone M
WM
Nyandiko
D000293:Adolescent; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D030881:Disclosure / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011795:Surveys and Questionnaires