Page 359 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 8 of 10 Original Research

80 Disclosed (par cial/full)

70 65.4

60

50 45.8
Percentage 40 32.7 35.0

30 27.3 29.8 31.3 26.6 30.4
20.6 20.0 19.5
20
12.4 12.2
10 6.3 5.6 6.3
0.0 0.0
0
3–5 years 6–9 years 10–14 years Female Male No highschool Highschool Not married Married Suppressed Detectable Tablets only Syrups No PI base PI with D4T DDI Adherent Non–adherent Adherent Non–adherent

Age child Sex Educa on Maritals Status Viral load Formula on Regimen Self–report Pill count
caregiver† caregiver caregiver 3 day recall 95–105%
Predictors of paediatric disclosure
Percentage (%) disclosed by predictor variable. †, presented for children under 10 years; PI, protease inhibitor; D4T, stavudine; DD1, didanosine.
FIGURE 1: Predictors of paediatric disclosure.

Discussion themselves are HIV-positive. While some studies have
26
confirmed our finding that caregivers with higher education
Only 17 children (8.9%) in this cohort of 3–14-year-olds are more likely to disclose the child’s HIV status to their
received full disclosure. In multivariate analyses, we found child, other studies have not. Caregivers feeling worried
27
14
that increased age of the child and higher education of the and unprepared for the process of disclosure and answering
caregiver were strongly associated with disclosure of HIV questions prevent actual disclosure. 22,28 The association we
status to the child. In addition, sex of the caregiver, detectable found between educational level and disclosure might be
viral load, syrup formulation, PI regimens with stavudine explained by better educated caregivers feeling more
and didanosine, and self-reported non-adherence were equipped to start this process. Our finding that caregivers
strongly associated with non-disclosure. The prediction with better HRQoL are a predictor of non-disclosure is not
model identified age of the child, caregiver’s marital status, reported in other literature, although the child’s family
viral load, regimen and non-adherence defined by pill count situation and caregiver disclosure-related anxiety are
(95% – 105%) as predictors of disclosure. described to affect disclosure.
28
Similar to other studies, we found older age of the child to be We found a strong association between detectable viral load
strongly associated with increased probability of disclosure and non-disclosure. A detectable viral load is an indicator of
of the HIV status to the child. 14,22,23 Literature does not failure of treatment. Conversely, addressing disclosure
29
specifically associate better HRQoL of the child with non- could positively affect adherence and viral suppression. 6,23
disclosure; however, health-related factors and a child’s Non-adherence was associated with non-disclosure. Most
family situation are reported as predictors of disclosure. 10 likely, this association was reversed where non-disclosure
contributed to difficulties remaining adherent. Similarly,
4
Male caregiver, level of education and HRQoL were caregivers experiencing difficulties administering medication
associated with disclosure. While some studies have had less likely disclosed the child’s HIV status. Non-
described not having a biological father as a predictor of disclosure may have contributed to difficulties administering
disclosure, 24,25 we found that children had more likely medication. We did not find an association between CD4
received disclosure when their main caregiver was their count and disclosure. Some literature described that children
father. Both the events of the demise of one’s father and the with a CD4 percentage over 15% are more likely to receive
absence of the mother in the household indicate major life disclosure, where others did not confirm this association for
24
events that are possibly related to HIV. This could explain the CD4 percentage or CD4 count. Children on regimens
14
association between caregiver’s gender and disclosure, as including syrups were less likely to receive disclosure.
disclosure is more likely to happen when the caregivers Although young children were generally on syrup

http://www.sajhivmed.org.za 352 Open Access