Effect of pediatric HIV disclosure training on art adherence by HIV positive children aged 6-10 years in Homa Bay County, Kenya by 2018

Abstract

Anti-retroviral therapy (ART) adherence by school-aged children is highly dependent on them knowing their HIV status, which can only happen by a disclosure process facilitated by their caregivers. Homa Bay County is among counties with the highest HIV prevalence currently at 19.6%. The number of HIV positive children with disclosed HIV status and those adhering to their ART were not known. Similarly, caregivers of the HIV positive children were also not trained on pediatric HIV disclosure process which was impeding pediatric HIV status disclosure. The goal of this study was to assess the effect of pediatric HIV disclosure training on ART adherence by HIV positive children in Homa Bay County. Specifically, the study aimed at comparing the ART adherence of children before and after training of caregivers on the disclosure process, determine the effect of HIV disclosure training on caregiver’s knowledge of HIV disclosure process and establish the socio-demographic factors associated with ART adherence. This intervention longitudinal study had a sample size of 860 non-HIV status disclosed children from a sampling frame of 924 in ten health facilities. Eligible participants were randomly selected and assigned to either control (430) or intervention (430) groups. Caregivers in the intervention were trained on HIV disclosure process whereas control group caregivers not trained. Thereafter, caregivers in both groups performed HIV disclosure to their HIV positive children. Before the training, baseline information was gathered on children’s ART adherence. Adherence to ART was measured in terms of consistencies in taking ARVs, keeping clinic appointments and viral load monitoring. Chi-square test compared adherence between the groups. Logistic regression determined the effect of disclosure training on ART adherence. Multivariate logistic regression estimated the associations between viral suppression and individual-level factors, NVivo analysed FGDs and KIIs data and Relative Risk of ART adherence calculated. Trained caregivers were 2 times (OR=2.369) more likely to disclose children’s HIV status. Disclosure training had significant effect p<0.05) on children’s adherence. Children of trained caregivers were nine times (OR=9.145) more likely to have good adherence. Caregiver’s education (p=0.035), disclosure knowledge (p=<0.05) and age of caregiver (p=0.04) were significantly associated with ART adherence. Disclosure knowledge, HCW attitude, dosage patterns, nature of drugs and environmental factors were attributed to RT adherence from FGDs & KIIs. In conclusion, HIV disclosure training increases disclosure and subsequently improves ART adherence in children 6-10 years. The study recommends caregiver’s training on HIV disclosure in order to improve ART adherence in HIV positive children.