Disclosure status of HIV-positive children and associated factors among children in public health facilities in East Arsi zone, Oromia regional state, South Eastern Ethiopia: A cross-sectional study

Objectives: This study aims to assess the disclosure status of HIV-positive children and its associated factors in selected hospitals in East Arsi zone, Oromia regional state, Ethiopia, 2020. Methods: Institutional-based cross-sectional study design was conducted on 410 sample size. Four hospitals were randomly selected among hospitals that currently gave service. Data were collected from caregivers/biological parents by interviewing from 30 July 2020 to 30 August 2020 using the systematic random sampling technique. In logistic regression analysis, the variables which had independent correlations with dependent variable were identified based on adjusted odds ratio and a p value <0.05 with 95% confidence interval was claimed as statistically significant. Results: Disclosure status of HIV-positive children was 59.8%, 95% confidence interval (54.9, 64.1). Children diagnosed at the age of <5 (adjusted odds ratio = 0.25, 95% confidence interval (0.126, 0.49)), antiretroviral therapy follow-up for 6–15 years (adjusted odds ratio = 2.08, 95% confidence interval (1.013, 4.29)), children diagnosed at the appropriate age of ⩾12 years (adjusted odds ratio = 1.95, 95% confidence interval (1.09, 3.49)), and children diagnosed at the age of <11 years (adjusted odds ratio = 4.5, 95% confidence interval (3.45, 8.38)) were positively associated factors to disclose status. Conclusion: The disclosure status of HIV-positive children was low in this study. Antiretroviral therapy follow-up for 6–15 years, children diagnosed at the appropriate age of ⩾12 years, children diagnosed at the age of <5 years, and children who aged below 11 years were positively associated with disclosure status. Thus, we recommended, health care providers and all stakeholders should give age-appropriate counseling regarding when and why to disclose their status.

Mediating Role of Loneliness on Stigma and Depressive Symptoms Among Older Persons Living With HIV

Studies have shown associations among stigma, loneliness, and depressive symptoms in older persons living with HIV (OPLWH) but research assessing the mediating pathway among these variables is lacking. As such, the aims of this study were to assess the association between stigma and depressive symptoms and to test the mediating effects of loneliness. A sample of 146 OPLWH (50 years of age and older) recruited from an outpatient HIV clinic in Atlanta, GA, completed a cross-sectional survey. Mediation analysis, guided by Baron and Kenny’s (1986) criteria, was conducted using Stata v14.2 to assess the direct and indirect effects of loneliness on the association between stigma and depressive symptoms while controlling for covariates (self-rated health [0=poor to fair, 1=good to excellent]; past unstable housing [0=No, 1=Yes]; and HIV disclosure status [0=to none; 1=to someone]). Loneliness mediated the association between stigma and depressive symptoms (β=0.79, SE=0.23, p &lt; .001). The model reflected a very good fit (χ2=0.09, p=.765; CFI=1.00, TLI=1.09, RMSEA &lt; 0.001) and explained 27% of the variance in loneliness and 33% of the variance in depressive symptoms. Stigma predicted higher loneliness, which in turn predicted more depressive symptoms. Findings suggest that addressing depressive symptoms in OPLWH may require multifaceted interventions targeting psychosocial and interpersonal factors including stigma and loneliness.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors’ experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

Characterizing Potential Conflicts of Interest Among UpToDate and DynaMed Content Contributors

BACKGROUND: Financial conflicts of interest among physicians have the potential to negatively impact patient care. Physicians contribute content to two popular, evidence-based websites, UpToDate and DynaMed; while other physicians use these websites to influence their clinical decision making. Each website maintains a conflict-of-interest policy, and contributors are required to self-report a disclosure status. This research investigated the occurrence for potential conflicts of interest among the self-reported statuses of UpToDate and DynaMed content contributors. METHODS: An initial list of contributors for each website was compiled using the Centers for Disease Control and Preventions 2017 Leading Causes of Death. The top 50 causes were used to determine a relevant article with clinical implications from each database. All named authors and editors of those articles comprised our list of investigated contributors. Contributor disclosure status was then compared with public records of financial remuneration as reported in the Open Payments database maintained by the Centers for Medicare and Medicaid Services and ProPublicas Dollar for Docs website from 2013 to 2018. Descriptive analysis and Fishers exact tests were performed on the data. RESULTS: Of 76 UpToDate contributors, 57.9% reported nothing to disclose but had a record of receiving a financial payment on Open Payments, which was found to be statistically significant (p = 0.0002). Of DynaMeds 42 contributors who reported nothing to disclose, 83.3% had an entry on Open Payments. However, this was not statistically significant. The sum total of industry payments between 2013-2018 made to UpToDate contributors was $68.1 million. The top ten UpToDate contributors who received the most financial remuneration earned approximately $56.1 million (82.4% of all UpToDate renumeration), were all male, and only one had a nothing-to-disclose status. The sum total of compensation reported for the discordant UpToDate contributors between 2013-2018 was approximately $4.81 million (or 7.07% of the total monies reported to UpToDate contributors.) In that same time frame, DynaMed contributors received a sum total of $9.58 million from industry, while the top ten DynaMed contributors earned $8.88 million (or 92.8%) of that. The top ten DynaMed contributors were 80% male and 20% female, and six individuals reported nothing to disclose, yet had an Open Payments entry. The sum total of money reported for all discordant DynaMed contributors between 2013-2018 was approximately $2.79 million (or 29.2% of the total monies reported to DynaMed contributors). CONCLUSIONS: While this research does not ascertain that a conflict of interest or anything untoward, it does provide evidence that there was a significant difference between having an Open Payment entry among those who did versus those who did not disclose a conflict of interest. Websites such as UpToDate and DynaMed should consider implementing a more stringent conflict of interest policy and employ an unbiased team to verify self-reported disclosure statuses among its content contributors. Similarly, physicians who use such informational websites to inform their clinical decision making should look beyond a contributors self-reported disclosure status and verify relevant financial remuneration from the healthcare industry via Open Payments or Dollars for Docs.

The relationship between T-CD4 recovery and HIV disclosure status among HIV-infected patients on first-line antiretroviral therapy at the Hospital for Tropical Diseases in Ho Chi Minh City

Objective: Establishes a relationship between T-CD4 recovery and patient’s HIV disclosure status. Methods: Cross-section and clinical record review study on 151 HIV-infected patients who were 18 years old or above on first-line antiretroviral therapy (1) for 18 to 36 months at the Hospital for Tropical Diseases in Ho Chi Minh city (HCMC) in 2019. Participants are selected by convenient method. Research conducted face-to-face interviewing participants by structured questionnaire and collected data directly from each participant's respective medical record, including duration of ART, number of T-CD4 at the beginning of ART, number of current T-CD4. Results: The results showed that within patients who revealed HIV infection to other people, the patients who revealed to their brothers and sisters recovered T-CD4 were 1.45 times more effective (95% CI: 1.09 – 1.93) compared with patients who did not disclose to siblings (p = 0.010). Conclusion: Family members, especially siblings need to care and share so that HIV-infected patients can disclose their status. In particular, wife, husband or partners need to help and motivate patients more to make the patient's treatment better. Keywords: ART, T-CD4, recovery, HIV, disclosure.

Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania

Background. The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods. Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results. Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age p < 0.001 , school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers’ higher education level p < 0.001 , and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion. The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.

Factors associated with non-adherence to Antiretroviral Therapy among HIV infected adolescents at Guji zone Health Facilities, South Ethiopia

Background: Suboptimal adherence results in inadequate drug exposure and increases the likelihood of viral replication and resistance, limit future therapeutic options. A high level of adherence is very crucial to maximize the usefulness of antiretroviral therapy. This study aimed to examine factors associated with non-adherence to antiretroviral therapy among adolescents in Guji Zone, South Ethiopia.Methods: Institution based case-control study design was employed on adolescent clients on antiretroviral therapy in the ART clinic of Guji zone health facilities from 26 February to 20 April 2018. Cases and controls were recruited by a consecutive sampling method. Bivariate and multivariable logistic regression was done using SPSS version 20 at 95% Confidence Interval (CI) and a precision of 5%.Results: A total of 297(101 cases and 196 controls) adolescents on ART participated in this study. Being rural residents AOR 1.9(1.1-3.6), Living with unmarried/widowed and separated caregivers AOR 2.1(1.2-3.8), living with unemployed caregivers AOR 4.2(2.0-8.9), not disclosing HIV Status AOR 5(2.8-9.4), having symptom of depression for adolescents AOR 2.7(1.5-4.9), not using reminding methods AOR 2.4(1.2-4.8) and Uses of other drugs besides ART AOR 2.6(1.5-5.0) were found to be independent factors associated with non-adherence to ART among adolescents.Conclusion: -Residence area, caregiver marital status, sources of income for the family, disclosure status, depression status, uses of reminding methods, and uses of other drugs besides ART were factors associated with non-adherence to antiretroviral therapy among adolescents. Support from peers and family can promote adolescent's adherence, as it buffers the stress associated with the illness, encourages optimism, reduces depression, and improves healthful behaviors. The provision of health education on the importance of treatments and needs for adherence should be encouraged. Uses of reminding methods, continuous monitoring of clients on ART regarding the uses of medications other than antiretroviral therapy is important.

Sankofa pediatric HIV disclosure intervention did not worsen depression scores in children living with HIV and their caregivers in Ghana

Background The ‘Sankofa’ pediatric HIV disclosure study (2013–2017) was an intervention that aimed to address the low prevalence of disclosure of HIV status in Ghana. Methods We conducted a cross-sectional study at the intervention site in Kumasi, Ghana, in 2019, (2 years after study closure) and administered the 21-item Beck Depression Inventory (BDI) and the 10-item Child Depression Inventory (CDI) to caregiver-child dyads who received the intervention. Results We enrolled 65% (N = 157) of the original dyads in the present study. Between Sankofa enrollment baseline and the present study, both children and caregivers had significant (p < 0.0001) mean reductions in CDI scores and BDI scores, respectively. CDI scores of the children were significantly correlated with BDI scores of the caregivers (r = 0.019, p = 0.019). No statistically significant associations between disclosure status and either CDI score or BDI score were found. Conclusions Our findings did not support caregivers’ fears that disclosure leads to depression. Trial registration ClinicalTrials.gov Identifier: NCT01701635 (date of registration Oct 5, 2012).