Clinic-Based Pediatric Disclosure Intervention Trial Improves Pediatric HIV Status Disclosure in Ghana

BACKGROUND: Disclosing HIV status to HIV-positive children is a major challenge facing families and healthcare providers. Despite recommendations for disclosure, rates remain low. We tested whether a pediatric HIV disclosure intervention delivered as an integral component of routine HIV healthcare in Ghana would improve disclosure to children. METHODS: Dyads of HIV-infected children aged 7 to 18 years and their caregivers were enrolled from two HIV clinics in Accra and Kumasi, Ghana. The sites were randomly assigned to one of the two intervention arms to avoid treatment contamination between intervention and control participants. Trained interventionist employed theory-guided therapeutic communication and personalized interaction to promote disclosure. Disclosure outcomes were measured at 12-week intervals. All analyses were completed using a modified intention-to-treat approach. RESULTS: We enrolled 446 child-caregiver dyads (N=240 intervention group; N=206 control group); 52% of the children were male, mean age 9.78 (+/-2.27) years. For disclosure at 1 year, a better overall treatment effect was observed (p<0.001). Children in the treatment group had greater disclosure at each time point (p<0.001) and a higher proportion of them had been disclosed to by 1 year (51.4% vs 16.2%; p<0.001; un-adjusted HR=3.98: 95% CI, 2.63, 6.03) and 3 years (71.3% vs 34.0%; unadjusted HR=4.21: 95% CI, 3.09, 5.72). In the multivariate Cox model, factors associated with disclosure were treatment group (p<0.001), children <11 years of age (p<0.001), HIV-infected caregivers (p=0.015), and caregiver's with greater education (p=0.022). CONCLUSIONS: This practical clinic-based disclosure intervention shows excellent promise as a means of improving HIV pediatric disclosure outcomes.