title: Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in western Kenya.
abstract: Knowledge of one's own HIV status is essential for long-term disease management, but there are few data on how disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver-child dyads enrolled in the study, children's mean age was 12.3 years. Caregivers were more likely to report that the child knew his/her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child (64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ by whether or not the child knew his/her HIV status. A number of factors were associated with a child's knowledge of his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5-2.1), better WHO disease stage (OR 2.5, 95% CI 1.4-4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1-3.4). While a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure including fears about negative emotional impacts, we found that disclosure was not associated with worse psychosocial outcomes.
authors.affiliation: a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.|b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.|c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Vreeman
authors.affiliation: a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.|b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Scanlon
authors.affiliation: b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.|c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya.
authors.forename: Irene
authors.initials: I
authors.lastname: Marete
authors.affiliation: b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.|d Department of Behavioral Sciences , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya.
authors.forename: Ann
authors.initials: A
authors.lastname: Mwangi
authors.affiliation: b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.|e Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
authors.affiliation: a Department of Pediatrics , Children's Health Services Research, Indiana University School of Medicine , Indianapolis , IN , USA.|b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.
authors.forename: Carole I
authors.initials: CI
authors.lastname: McAteer
authors.affiliation: b Academic Model Providing Access to Healthcare (AMPATH) , Eldoret , Kenya.|c Department of Child Health and Paediatrics , School of Medicine, College of Health Sciences, Moi University , Eldoret , Kenya.
authors.forename: Winstone M
authors.initials: WM
authors.lastname: Nyandiko
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017028:Caregivers / Q000523:psychology; D002648:Child; D002669:Child Welfare; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D011788:Quality of Life; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
keywords: HIV; adolescents; disclosure; mental health; resource-limited setting