title: Disclosure of their HIV status to perinatally infected youth using the adapted Blasini disclosure model in Haiti and the Dominican Republic: preliminary results.
abstract: OBJECTIVE
  To assess the safety, acceptability, and preliminary efficacy of a culturally-adapted disclosure intervention for perinatally HIV-infected combined antiretroviral therapy patients in Haiti and the Dominican Republic.
  
  
  METHODS
  A quasi-experimental trial was conducted comparing caregiver-youth pairs who completed the intervention [adapted Blasini disclosure model (aBDM)] to pairs who discontinued aBDM participation before disclosure. aBDM consists of five components: structured healthcare worker training; one-on one pre-disclosure intervention/education sessions for youth (describing pediatric chronic diseases including cancer, diabetes and HIV) and for caregivers (strengthening capacity for disclosure); a scheduled supportive disclosure session; and one-on-one postdisclosure support for caregivers and youth.
  
  
  METHODS
  Caregivers of nondisclosed combined antiretroviral therapy patients aged 10.0-17.8 years were invited to participate. Data were collected by separate one-on-one face-to-face interviews of caregivers and youth by study staff and medical record review by pediatricians at enrollment and 3 months after disclosure or after intervention discontinuation.
  
  
  RESULTS
  To date, 65 Dominican Republic and 27 Haiti caregiver-youth pairs have enrolled. At enrollment, only 46.4% of youth had viral suppression and 43.4% of caregivers had clinically significant depressive symptomatology. To date, two serious study-related adverse events have occurred. Seven of the 92 (7.6%, 6 in the Dominican Republic) enrolled pairs discontinued participation before disclosure and 39 had completed postdisclosure participation. Median plasma HIV-RNA concentration was lower in youth who completed aBDM than in youth who discontinued participation before aBDM disclosure (<40 versus 8673 copies/ml; P = 0.027). Completers expressed considerable satisfaction with aBDM.
  
  
  CONCLUSIONS
  Preliminary results suggest safety, acceptability, and possible effectiveness of the aBDM.
authors.affiliation: aRobert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA bClínica de Familia La Romana, Dominican Republic cRobert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic dGroupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centres, Port-au-Prince, Haïti eCornell University School of Medicine, New York fVoluntary Faculty, University of Miami Miller School of Medicine, Miami, Florida gColumbia University College of Physicians and Surgeons, New York, USA hUniversity of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Consuelo M
authors.initials: CM
authors.lastname: Beck-Sagué
authors.forename: Jessy
authors.initials: J
authors.lastname: Dévieux
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Pinzón-Iregui
authors.forename: Leonel
authors.initials: L
authors.lastname: Lerebours-Nadal
authors.forename: Rosa
authors.initials: R
authors.lastname: Abreu-Pérez
authors.forename: Rachel
authors.initials: R
authors.lastname: Bertrand
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rouzier
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gaston
authors.forename: Gladys
authors.initials: G
authors.lastname: Ibanez
authors.forename: Mina
authors.initials: M
authors.lastname: Halpern
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
authors.forename: Patricia
authors.initials: P
authors.lastname: Dorceus
authors.forename: Sharice M
authors.initials: SM
authors.lastname: Preston
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Dean
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Nicholas
authors.forename: Ileana
authors.initials: I
authors.lastname: Blasini
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology; D004293:Dominican Republic; D006205:Haiti; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D008960:Models, Psychological; D017060:Patient Satisfaction; D014342:Truth Disclosure
chemical_list: D044966:Anti-Retroviral Agents