Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living With HIV in Ecuador

Abstract

Background: Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age. Methods: Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador. Results: In 250 children included, HIV diagnosis was revealed at a median age of 11 years (p25-p75 9-12). Children 12 years old or older (P < 0.0001), 10 or more years since HIV diagnosis (P = 0.001), antiretroviral initiation above 3 years of age (P = 0.018) and decease of the mother (P = 0.048) were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age (28.4%) than before (15.4%, P = 0.047). According to the simplified medication adherence questionnaire, 194 children (78.2%) were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 (67.7%). In multivariate analysis, variables associated with nonadherence were age ≥14 years (P < 0.001), taking ≥3 daily antiretroviral pills (P = 0.013) and the presence of adverse effects (P < 0.001), whereas nonadherence (P = 0.001) was the only variable significantly associated with an unsuppressed HIV-RNA viral load. Conclusions: Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.

Behavioral and Emotional Difficulties and HIV Treatment Outcomes among HIV-Infected Children in Rural Southwest China

“…The inconclusive result on this association needs to be further assessed in large and diverse samples in future studies. Further, the association between nonadherence and virological failure has been well proven in previous studies [32,34,35].…”

“…Some factors were found to be associated with virological failure, including age of 14-17, being female, and having missed doses in the past month. Some previous studies also found that older children had a higher risk of virological failure [32,33], which could be explained by the poorer adherence and higher likelihood of drug resistance in older children [34]. Future studies are still needed to further testify this association and verify the reasons between age and virological failure because other previous studies did not detect this association [35,36].…”

Behavioral and emotional difficulties and HIV treatment outcomes among HIV-infected children in rural southwestern China

“…The inconclusive result on this association needs to be further assessed in large and diverse samples in future studies. Further, the association between nonadherence and virological failure has been well proven in previous studies [ 39 , 41 , 42 ].…”

“…Some factors were found to be associated with virological failure, including age of 14–17, being female, and having missed doses in the past month. Some previous studies also found that older children had a higher risk of virological failure [ 39 , 40 ], which could be explained by the poorer adherence and higher likelihood of drug resistance in older children [ 39 , 41 ]. Future studies are still needed to further testify this association and verify the reasons between age and virological failure because other previous studies did not detect this association [ 42 , 43 ].…”

HIV Status Disclosure to Adolescents Who Are Perinatally Infected in Rustenburg Sub District Northwest Province

“…One of the elements linked to better adherence is the disclosure of HIV status. However, the prevalence of disclosure in children and adolescents varies depending on the environment and the age of the patients, ranging from 13 to 60% in children between the ages of 5 and 17 from Asia or Southern-Eastern Africa [ 1 ].…”