title: The Prevalence of Disclosure of HIV Status to HIV-Infected Children in Western Kenya.
abstract: BACKGROUND
  As antiretroviral therapy (ART) allows the world's 2.3 million human immunodeficiency virus (HIV)-infected children to grow and thrive, these children need to be informed of their HIV status. Neither the prevalence of disclosure to children nor its impact has been evaluated in most resource-limited settings.
  
  
  METHODS
  We conducted a prospective assessment of a random sample of HIV-infected children ages 6-14 years enrolled in HIV care at a large referral clinic in Eldoret, Kenya. Clinicians administered questionnaires to children and caregivers independently at routine clinic visits to assess disclosure status, ART adherence, stigma, and depression. Children's demographic and clinical characteristics were extracted from chart review. We calculated descriptive statistics and performed logistic regression to assess the association between disclosure and other characteristics.
  
  
  RESULTS
  Two hundred seventy children-caregiver dyads completed questionnaires. The mean child age was 9.3 years (standard deviation 2.6); 49% were male, and 42% were orphans. 11.1% of children had been informed of their HIV status (N = 30). Of those under 10 years, 3.3% knew their status, whereas 9.2% of 10- to 12-year-olds and 39.5% of 13- to 14-year-olds knew they had HIV. Only age was significantly associated with disclosure status in both bivariate analyses (P < .0001) and multiple logistic regression (odds ratio 1.67, 95% confidence interval 1.36-2.05) when considering social demographics, disease stage variables, adherence, stigma measures, and depression.
  
  
  CONCLUSIONS
  Rates of informing children in western Kenya of their HIV status are low, even among older children. Guiding families through developmentally appropriate disclosure processes should be a key facet of long-term pediatric HIV management.
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Turissini
authors.affiliation: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership 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
authors.affiliation: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Ayaya
authors.affiliation: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership 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: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Ann
authors.initials: A
authors.lastname: Mwangi
authors.affiliation: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership.
authors.forename: Victor
authors.initials: V
authors.lastname: Chemboi
authors.affiliation: United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership.
authors.forename: Lucy
authors.initials: L
authors.lastname: Warui
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis United States Agency for International Development (USAID) Academic Model Providing Access to Healthcare (AMPATH) Partnership.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Vreeman
keywords: Africa; Disclosure; HIV; Pediatrics