Madiba Sphiwe, Mokgatle Mathildah
Department of Environmental and Occupational Heath, School of Public Health, Sefako Makgatho Health Sciences University , Pretoria , South Africa.
Department of Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University , Pretoria , South Africa.
PeerJ. 2015 Apr 14;3:e893. doi: 10.7717/peerj.893. eCollection 2015.
The perspectives and practices of health care workers (HCWs) regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART). The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2%) were nurses, 44 (21.5%) were lay counsellors, and 4 (2%) were doctors. The majority (n = 183, 89.3%) felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4%) recommended 11-18 years as the appropriate age to disclose. Half (n = 99, 48.5%) said that caregivers should take the lead to disclose, 87 (42.7%) said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8%) said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations' disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.
在儿科抗逆转录病毒疗法（ART）推行十年后，医护人员（HCWs）向感染艾滋病毒儿童披露病情的观点和做法尚未得到充分调查。本研究的目的是调查医护人员对向感染艾滋病毒儿童披露病情的看法，并确定他们在南非各医疗中心向接受抗逆转录病毒治疗儿童披露病情过程中的作用。这是一项横断面调查，采用半结构化问卷对南非两个省份的三家医院和48个初级卫生机构的抗逆转录病毒治疗中心的医护人员进行调查。在206名医护人员中，140名（68.2%）是护士，44名（21.5%）是外展辅导员，4名（2%）是医生。大多数人（n = 183，89.3%）认为披露病情对儿童有益，应该告知他们自己感染艾滋病毒的状况。超过一半（n = 93，51.4%）的人建议11至18岁是披露病情的合适年龄。一半（n = 99，48.5%）的人表示应该由照顾者带头披露病情，87名（42.7%）的人表示披露病情是照顾者和医护人员的共同责任，18名（8.8%）的人表示医护人员应该带头披露病情。医护人员认为他们的角色是帮助照顾者为披露病情做好准备，并让孩子了解这种疾病。然而，缺乏针对儿童披露咨询的指导方针和培训影响了他们充分参与向儿童披露病情的能力。有必要采用世界卫生组织针对儿童的披露指导方针，并使其适应当地文化和社区背景，同时培训医护人员指导、支持和协助照顾者向感染艾滋病毒儿童披露病情。
