Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America ; USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Department of Behavioral Science, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
PLoS One. 2014 Jan 27;9(1):e86616. doi: 10.1371/journal.pone.0086616. eCollection 2014.
Disclosure of HIV status to children is essential for disease management but is not well characterized in resource-limited settings. This study aimed to describe the prevalence of disclosure and associated factors among a cohort of HIV-infected children and adolescents in Kenya.
We conducted a cross-sectional study, randomly sampling HIV-infected children ages 6-14 years attending 4 HIV clinics in western Kenya. Data were collected from questionnaires administered by clinicians to children and their caregivers, supplemented with chart review. Descriptive statistics and disclosure prevalence were calculated. Univariate analyses and multivariate logistic regression were performed to assess the association between disclosure and key child-level demographic, clinical and psychosocial characteristics.
Among 792 caregiver-child dyads, mean age of the children was 9.7 years (SD = 2.6) and 51% were female. Prevalence of disclosure was 26% and varied significantly by age; while 62% of 14-year-olds knew their status, only 42% of 11-year-olds and 21% of 8-year-olds knew. In multivariate regression, older age (OR 1.49, 95%CI 1.35-1.63), taking antiretroviral drugs (OR 2.27, 95%CI 1.29-3.97), and caregiver-reported depression symptoms (OR 2.63, 95%CI 1.12-6.20) were significantly associated with knowing one's status. Treatment site was associated with disclosure for children attending one of the rural clinics compared to the urban clinic (OR 3.44, 95%CI 1.75-6.76).
Few HIV-infected children in Kenya know their HIV status. The likelihood of disclosure is associated with clinical and psychosocial factors. More data are needed on the process of disclosure and its impact on children.
向儿童披露 HIV 状况对于疾病管理至关重要，但在资源有限的环境中并未得到很好的描述。本研究旨在描述肯尼亚一个 HIV 感染儿童和青少年队列中披露的流行率及其相关因素。
我们进行了一项横断面研究，随机抽取了在肯尼亚西部 4 个 HIV 诊所就诊的年龄在 6-14 岁的 HIV 感染儿童。数据来自临床医生对儿童及其照顾者进行的问卷调查，辅以图表审查。计算了描述性统计数据和披露率。进行了单变量分析和多变量逻辑回归，以评估披露与儿童的关键人口统计学、临床和心理社会特征之间的关联。
在 792 对照顾者-儿童对中，儿童的平均年龄为 9.7 岁（SD=2.6），51%为女性。披露率为 26%，且随年龄显著变化；虽然 14 岁的儿童中有 62%知道自己的状况，但只有 11 岁的儿童中有 42%，8 岁的儿童中有 21%知道。在多变量回归中，年龄较大（OR 1.49，95%CI 1.35-1.63）、服用抗逆转录病毒药物（OR 2.27，95%CI 1.29-3.97）和照顾者报告的抑郁症状（OR 2.63，95%CI 1.12-6.20）与知晓自己的状况显著相关。与城市诊所相比，在农村诊所就诊的儿童的治疗地点与披露有关（OR 3.44，95%CI 1.75-6.76）。
肯尼亚的 HIV 感染儿童中，很少有人知道自己的 HIV 状况。披露的可能性与临床和心理社会因素有关。需要更多关于披露过程及其对儿童影响的数据。
