Page 354 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 10 Original Research

Provincial Research Policy (40/2009). Written informed high school education. Caregivers rated their own quality of
consent was obtained from all caregivers and assent from life index at 90.5% (mean). Caregivers who rated their
children older than 7 with normal cognitive functioning. quality of life higher were less likely to disclose the
child’s HIV status to the child (OR 0.31; 0.10–0.95). This
Results association attenuated in multivariate analyses (OR 0.64;
0.16–2.54). We did not find significant associations between
At the start of the study, 238 active paediatric patients on
ART aged 2–14 years attended the clinic. One caregiver disclosure and caregiver’s age, relationship with the child,
refused to participate and 42 patients were missed because cultural background, caregiver’s marital status or worry as
caregivers did not visit on the appointment date. With 5 indicators of caregiver functioning (extent of concern
about chil d’s treatment, side effects, reaction of others,
children younger than 3 years of age, this sub-analysis
included 190 children. For five households with two children child’s condition or effects of illness on family and future)
in the study, only the child enrolled first was considered for (Table 2).
SES analyses (n = 185).
Clinical characteristics
Disclosure of human immunodeficiency virus Clinical characteristics associated with disclosure included
status to the child suppressed viral load, formulation (tablet/syrup), non-
Most of the children (145 of 190, 76.3%) had not received nucleoside reverse transcriptase inhibitors (NNRTI) in
disclosure about their HIV status, 28 children (14.7%) had regimen, protease inhibitor (PI) in regimen with stavudine
received partial disclosure and 17 children (8.9%) had full and didanosine, regimens with efavirenz, longer duration
disclosure. None of the children in early childhood on treatment, start of treatment in the first year of life,
(3–5 years) received disclosure (n = 49), 11 of 89 children experiencing difficulties administering treatment and
(12.8%) aged 6–9 years and 34 of 52 (65.4%) young adolescents poor adherence to treatment. One-third (32.8%) of children
aged 10–14 years received disclosure. The youngest child had a detectable viral load and had less likely received
disclosed to about their HIV status was 6.6 years and the disclosure compared to those with a suppressed viral
oldest child who was not disclosed was 12.2 years. load (multivariate OR 0.21; 0.05–0.84). Most children were
on a regimen with a combination of three medicines
Child characteristics (86.3%), consisting of tablets only (62.2%). Children whose
regimen included syrups (syrups only or combined with
Child characteristics associated with disclosure were age tablets) had less likely received disclosure compared to
and HRQoL. The children were aged 3.2–12.9 years, the
majority (74.2%) were of school going age (6 years and children who were on tablets only (multivariate OR 0.28;
older) and 27.4% were young adolescents (10–14 years). 0.08–0.92).
Older children (young adolescents) were significantly more
likely to be disclosed compared to younger children (under Children on a regimen including an NNRTI (35.3%) more
10 years) (odds ratio [OR] 21.81; 9.41–50.52). Mean self- likely received disclosure compared to children on a
reported HRQoL index was 91.5%. Children who rated their regimen with no NNRTIs (OR 2.71; 1.37–5.38). This
HRQoL highly were less likely to have received disclosure association attenuated in multivariate analyses (OR 1.84;
compared to children who had low HRQoL (OR 0.29; 0.09– 0.78–4.31). Children on a PI-based regimen with stavudine
0.91). This association attenuated in multivariate analyses and didanosine (16.8%) less likely received disclosure
(OR 0.58; 0.15–2.30). We did not find significant associations compared to children who were on a non-PI-based regimen
between disclosure and sex of the child, overall HRQoL or (multivariate OR 0.19; 0.03–1.00). Children on a regimen
school functioning (caregiver proxy-report or self-report) including efavirenz more likely received disclosure than
(Table 1). those with no efavirenz (OR 2.90; 1.46–5.77). This
association attenuated in multivariate analyses (OR 1.91;
0.81–4.48). Children on a regimen of lopinavir/ritonavir
Caregiver characteristics syrup (79.5%) less likely received disclosure (OR 0.14;
Caregiver characteristics associated with disclosure were 0.03–0.59). This association attenuated in multivariate
sex, education and HRQoL. The minority of caregivers analyses (OR 0.54; 0.11–2.62). Children were on treatment
were males (7.9%). Young children (under 10 years) of for 1 month to 9.8 years (mean 5.2 years). Children with a
male caregivers were more likely to have received disclosure longer treatment duration more likely received disclosure
compared to young children of female caregivers (OR 5.58; compared to those more recently initiating treatment
1.24–25.19). Most caregivers had not completed high (OR3.02; 1.19–7.63). This association attenuated in
school education (87.3%). Caregivers who completed their multivariate analyses (OR 1.21; 0.38–3.91). Children who
high school education were more likely to disclose the started their treatment in the first year of their life (30.5%)
child’s HIV status to the child (multivariate OR 4.04; less likely received disclosure than those commencing
1.26–12.91) than those who had not completed their treatment later in life (OR 0.12; 0.04–0.40). This association

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