Disclosure of their HIV status to perinatally infected youth using the adapted Blasini disclosure model in Haiti and the Dominican Republic

Abstract

Objectives 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. Design 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. Conclusion Preliminary results suggest safety, acceptability, and possible effectiveness of the aBDM.

Brief Report: Disclosure, Consent, Opportunity Costs, and Inaccurate Risk Assessment Deter Pediatric HIV Testing: A Mixed-Methods Study

“…Task shifting pediatric testing discussions to peer mentors—other adults who have tested their children—may be effective [28]. Disclosure remains delayed in many settings [29-32] and family disclosure interventions may complement pediatric testing scale-up [27, 33-37]. …”

Models of support for disclosure of HIV status to HIV‐infected children and adolescents in resource‐limited settings

“…The resources available for training providers in these countries about paediatric HIV disclosure are largely based on the Western disclosure model and experience . While some models guiding disclosure have been implemented within research settings in LMICs , the depth of implementation of such models for HIV status disclosure in resource‐limited, routine clinical care is unclear. Documenting existing strategies for the HIV disclosure process in these settings would help to characterize the current limits and strengths to HIV disclosure process, so that these data could be used to develop supportive interventions.…”

HIV disclosure to children in low-and middle-income countries

“…Three studies address the design and evaluation of paediatric HIV status disclosure interventions. Beck-Sague et al [36] reported promising results of an ongoing quasi-experimental trial of a culturally adapted paediatric HIV disclosure intervention in Haiti, which included healthcare worker training, education for youth, capacity-strengthening for caregivers, a scheduled disclosure session and postdisclosure support for care-givers and youth. Equally reporting on an ongoing study, Reynolds et al [37] presented the background, process and methods of a collaborative approach to develop and evaluate a paediatric HIV disclosure intervention in Ghana; challenges and implications are also reported.…”