title: "If I take my medicine, I will be strong: " evaluation of a pediatric HIV disclosure intervention in Namibia.
abstract: BACKGROUND
  Despite known benefits, only a small proportion of HIV-infected children in sub-Saharan Africa know their status and limited disclosure interventions exist. Namibia's Ministry of Health and Social Services developed and implemented a multipronged intervention to support health care workers (HCWs) and caregivers in the disclosure process.
  
  
  METHODS
  The intervention included a staged disclosure cartoon book, child and caregiver readiness assessment tools, a monitoring form to track progress over visits, and HCW training curriculum. We conducted qualitative interviews with 35 HCWs and 46 caregivers of HIV-positive children at 4 high volume HIV clinics. Interviews elicited detailed information about intervention uptake and impact. HCWs also participated in a self-efficacy survey.
  
  
  RESULTS
  The intervention improved HCW and caregiver confidence and communication skills in pediatric disclosure. The most valuable intervention component was the disclosure cartoon book, which provided structure, language, and guidance for a gradual disclosure process. HCWs reported it greatly reduced caregiver resistance to disclosure. Both caregivers and HCWs reported improved knowledge and ability to support the pediatric patient, improved child understanding of how HIV medications work, increased child hopefulness for their future, and improved child adherence to care and treatment. HCW self-efficacy surveys found that HCWs who received training felt more confident in their ability to engage in the disclosure process.
  
  
  CONCLUSIONS
  HCWs and caregivers highly endorsed the intervention. Given the urgency to address pediatric HIV disclosure in Africa, and the utility and low cost of the locally-produced disclosure tool, this approach may be useful in other similar settings.
authors.affiliation: *Department of Global Health, University of Washington, Seattle, WA; †International Training and Education Center for Health-Namibia, University of Washington, Windhoek, Namibia; ‡Namibian Ministry of Health and Social Services, Windhoek, Namibia; and Departments of §Medicine; ‖Pediatrics; ¶Epidemiology, University of Washington, Seattle, WA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: OʼMalley
authors.forename: Kristin
authors.initials: K
authors.lastname: Beima-Sofie
authors.forename: Larissa
authors.initials: L
authors.lastname: Feris
authors.forename: Mark
authors.initials: M
authors.lastname: Shepard-Perry
authors.forename: Ndapewa
authors.initials: N
authors.lastname: Hamunime
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.forename: Francina
authors.initials: F
authors.lastname: Kaindjee-Tjituka
authors.forename: Laura
authors.initials: L
authors.lastname: Brandt
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009276:Namibia; D012650:Self Disclosure
chemical_list: D019380:Anti-HIV Agents