Kitetele Faustin Nd, Lelo Gilbert M, Akele Cathy E, Lelo Patricia V M, Aketi Loukia, Mafuta Eric M, Tylleskär Thorkild, Kashala-Abotnes Espérance
Department of Infectious Diseases, Kalembelembe Pediatric Hospital, Kinshasa 012, Democratic Republic of the Congo.
Centre for International Health (CIH), Faculty of Medicine, University of Bergen, 5020 Bergen, Norway.
Children (Basel). 2022 Dec 13;9(12):1955. doi: 10.3390/children9121955.
HIV status disclosure to children remains a challenge in sub-Saharan Africa. For sociocultural reasons, parents often delay disclosure with subsequent risks to treatment compliance and the child’s psychological well-being. This article assesses the effects of HIV disclosure on second-line ART compliance after first-line failure. We conducted a retrospective study of 52 HIV-positive children at Kalembelembe Pediatric Hospital in Kinshasa who were unaware of their HIV status and had failed to respond to the first-line ART. Before starting second-line ART, some parents agreed to disclosure. All children were followed before and during the second-line ART. Conventional usual descriptive statistics were used. For analysis, the children were divided into two groups: disclosed to (n = 39) and not disclosed to (n = 13). Before starting the second-line ART, there was no difference in CD4 count between the two groups (p = 0.28). At the end of the first year of second-line ART, the difference was statistically significant between the two groups with regard to CD4% (p < 0.001) and deaths (p = 0.001). The children disclosed to also reported fewer depressive symptoms post-disclosure and had three times fewer clinic visits. HIV status disclosure to children is an important determinant of ART compliance and a child’s psychological well-being.
在撒哈拉以南非洲地区，向儿童披露艾滋病毒感染状况仍然是一项挑战。出于社会文化原因，父母往往会推迟披露，这随后会给治疗依从性和儿童的心理健康带来风险。本文评估了在一线治疗失败后披露艾滋病毒感染状况对二线抗逆转录病毒治疗（ART）依从性的影响。我们对金沙萨卡伦贝勒姆贝勒儿童医院的52名艾滋病毒呈阳性儿童进行了一项回顾性研究，这些儿童此前不知道自己的艾滋病毒感染状况，且对一线ART治疗无反应。在开始二线ART治疗前，一些家长同意披露。所有儿童在二线ART治疗前和治疗期间都受到了跟踪观察。采用了常规的描述性统计方法。为进行分析，将儿童分为两组：已被告知组（n = 39）和未被告知组（n = 13）。在开始二线ART治疗前，两组之间的CD4细胞计数没有差异（p = 0.28）。在二线ART治疗的第一年末，两组在CD4%（p < 0.001）和死亡情况（p = 0.001）方面的差异具有统计学意义。已被告知的儿童在披露后报告的抑郁症状也较少，门诊就诊次数减少了三分之二。向儿童披露艾滋病毒感染状况是ART依从性和儿童心理健康的一个重要决定因素。
