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Research
HIV Status Disclosure and its associated factors among Children on Antiretroviral Therapy in West Shoa Zone, Ethiopia, 2019: A Mixed method cross-sectional study
Seifadn Ahmed Shallo
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6415-7515
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Evidences from previous studies claim that informing children about their HIV status has long term positive implications in the HIV disease management, children's quality of life and ART drug adherence. However, in many parts of the Sub-Saharan African Countries, the HIV status disclosure among children reaches from 0 to 69.2%. Since the issue of disclosure is complex and highly influenced by socio-cultural characters and perception of the community towards HIV disease, it is important to investigate the up to date evidence which will help in designing contextualized approaches for disclosure. The objective of the current study was to assess the HIV status disclosure and its associated factors among children on ART in West Shoa Zone, Ethiopia.
Methods Institutional based quantitative cross-sectional study supplemented by qualitative was conducted from February to April /2019 among 247 caregivers and or their children.
Results The mean age of the children was 11.11±SD2.8, and 43.6%, (95% CI: 37, 50.9) of the children were fully disclosed. The average age at disclosure was 11 ±SD2.12. The main reasons for the disclosure were for drug adherence and better self-care, while underage was the commonest reason for nondisclosure. Compared to the age (10-15) years, the child in the age (6-9) was 97% [AOR: 0.027, 95% CI: 0.003, 0.22, P<0.001] less likely to be disclosed. Female children were 2.7 times more likely to be disclosed compared to males children [AOR: 2.73, 95% CI: 1.24, 6, P<0.013].
Conclusion The current finding reveals that the HIV status disclosure is generally low, and the decision to disclose or not to do so is affected by many factors like child age, and child sex. This will affect directly or indirectly the child drug adherence, treatment outcome and also disease transmission.
Keywords
disclosure, Pediatrics age, West Shoa Zone
Study area and Design
This study was conducted in Health Facilities found in West Shoa Zone, Oromia Regional State, Ethiopia. There were eight hospitals and 92 Health centers in west Shoa Zone. Out of these, 24 sites (health centers and Hospitals) were delivering ART services for patients with HIV. According to the data obtained from the CDC branch of the West Shoa Zone Health Department, there were about 9156 HIV positive patients on ART. Out of these, children between 6-15 years were around 556. The number of children who fulfills the inclusion criteria in each ART site ranges from 1 to 218 (West Shoa Health Department, 2018).
The institutional-based cross-sectional study design was used. The study was conducted from February 15- April 15/2019.
By considering the WHO recommendation for the lowest age at which disclosure should be initiated, all HIV positive children age between 6 and 15 on ART for the last six months at the selected hospital or Health centers(Ambo General Hospital, Incini Health Center, Ginchi H/C, Holota H/C) were included in the study.
Sample size determination
To calculate the sample size for this study the following assumptions were considered:
The sample size for the first objective was calculated using the prevalence of HIV status disclosure (P=33%) among children in southern Ethiopia [17], 95% CI and 0.05 degree of precision.
Accordingly, the sample size was 339.
[Due to technical limitations, the formula could not be displayed here. Please see the supplementary files section to access the formula.]
The sample size for the second Objective:
The sample size for the second objective was calculated as follows: The power of the study to be 80%, the ratio of exposed to unexposed to be 1:1, 95% CI, % of outcome among exposed and unexposed were taken into account. Accordingly, the following sample size was calculated using open Epi info version TM7 computer software and the sample size for the second objective was 442(table 1).
Table 1: Sample size calculation using different works of literature as a baseline for study on HIV status disclosure and associated factors among Children on ART in West Shoa Zone, Ethiopia
|
Place of the study |
%outcome among exposed |
% outcome among non exposed |
Sample size |
Ref. |
|
Tikur Anbessa Hospital, Ethiopia |
29.2% |
42.3% |
442 |
[20] |
|
Hospitals in Addis Ababa |
13% |
73.8% |
24 |
[17] |
But, since the total study population was 556 (less than 10,000); the population correction formula was applied, and the final sample size was 247.
Sampling procedure and data collection tools
Since some health centers had only one case which fulfills the inclusion criteria, we decided to include all health centers with at least 20 and above cases. Accordingly, we selected four Health institutions. The study participants who fulfill the inclusion criteria were selected by simple random sampling technique. The samples for a qualitative study were selected purposively.
Data Collection Methods and Procedure
Quantitative data was collected through face to face interview. For data collection, five degree holder nurses (one for each health institution except for Ambo Hospital where it was two) were recruited, and trained for two days on objectives of the study, how to interview the clients, and on how to take the consent from the caregivers or parents. Nine in-depth interviews (IDI) (four with health care providers and five with child caregivers) were conducted. The participants for IDI were purposively selected health care providers working on ART clinics from all health institutions and child caregivers, whose child was ever disclosed.
Full disclosure: Disclosure was considered as “full disclosure” when it involved the caregiver or health care providers or anyone else having disclosed to the child that he or she has HIV specifically. This was determined if the care givers claimed that he/she describes the term HIV in his/her explanation for the child during disclosure process.
Partial disclosure: Disclosure is considered “partial” when the illness is described in a way that is consistent with HIV although the term “HIV” is avoided. For insistence: when the child is informed/knows that he/she has chronic health problems but not told specifically that the disease is HIV.
No disclosure: When the caregiver reported telling the child nothing about his or her illness.
Deflected disclosure: The strategy of deceptive disclosure that caregivers often use, frequently out of concern for the child’s psychological well-being, telling their children only about an unrelated condition (e.g., asthma, cancer), and attributing all medical needs (e.g., appointments, medication) to that less-stigmatized condition[21].
Data management and analysis
The collected data were checked for completeness, coded, entered into Epi data software version 4.5 statistical packages and exported to SPSS version 20 for statistical analysis. Descriptive statistics such as frequency distribution with percentage was computed. To assess the association between dependent and independent variables, first bi-variate analysis was done. Independent variables those were associated with the dependent variable at P-value<0.25 were included in the Multiple Logistic regression analysis. With an odd ratio of 95% CI, the level of statistical significance was declared at P-value<0.05.
The in-depth interview was tape-recorded and transcribed. The qualitative data analysis was done through a thematic analysis approach. The patterns of experiences were derived from the transcripts, either from direct quotes or through paraphrasing common ideas. Data from all the transcripts relating to the classified patterns were identified and placed under the relevant theme where it complements the quantitative findings.
STROBE compliance
This study is reported in compliance with the STROBE guidelines[26].
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Research
HIV Status Disclosure and its associated factors among Children on Antiretroviral Therapy in West Shoa Zone, Ethiopia, 2019: A Mixed method cross-sectional study
Seifadn Ahmed Shallo
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6415-7515
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 18 Dec, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Evidences from previous studies claim that informing children about their HIV status has long term positive implications in the HIV disease management, children's quality of life and ART drug adherence. However, in many parts of the Sub-Saharan African Countries, the HIV status disclosure among children reaches from 0 to 69.2%. Since the issue of disclosure is complex and highly influenced by socio-cultural characters and perception of the community towards HIV disease, it is important to investigate the up to date evidence which will help in designing contextualized approaches for disclosure. The objective of the current study was to assess the HIV status disclosure and its associated factors among children on ART in West Shoa Zone, Ethiopia.
Methods Institutional based quantitative cross-sectional study supplemented by qualitative was conducted from February to April /2019 among 247 caregivers and or their children.
Results The mean age of the children was 11.11±SD2.8, and 43.6%, (95% CI: 37, 50.9) of the children were fully disclosed. The average age at disclosure was 11 ±SD2.12. The main reasons for the disclosure were for drug adherence and better self-care, while underage was the commonest reason for nondisclosure. Compared to the age (10-15) years, the child in the age (6-9) was 97% [AOR: 0.027, 95% CI: 0.003, 0.22, P<0.001] less likely to be disclosed. Female children were 2.7 times more likely to be disclosed compared to males children [AOR: 2.73, 95% CI: 1.24, 6, P<0.013].
Conclusion The current finding reveals that the HIV status disclosure is generally low, and the decision to disclose or not to do so is affected by many factors like child age, and child sex. This will affect directly or indirectly the child drug adherence, treatment outcome and also disease transmission.
Study area and Design
This study was conducted in Health Facilities found in West Shoa Zone, Oromia Regional State, Ethiopia. There were eight hospitals and 92 Health centers in west Shoa Zone. Out of these, 24 sites (health centers and Hospitals) were delivering ART services for patients with HIV. According to the data obtained from the CDC branch of the West Shoa Zone Health Department, there were about 9156 HIV positive patients on ART. Out of these, children between 6-15 years were around 556. The number of children who fulfills the inclusion criteria in each ART site ranges from 1 to 218 (West Shoa Health Department, 2018).
The institutional-based cross-sectional study design was used. The study was conducted from February 15- April 15/2019.
By considering the WHO recommendation for the lowest age at which disclosure should be initiated, all HIV positive children age between 6 and 15 on ART for the last six months at the selected hospital or Health centers(Ambo General Hospital, Incini Health Center, Ginchi H/C, Holota H/C) were included in the study.
Sample size determination
To calculate the sample size for this study the following assumptions were considered:
The sample size for the first objective was calculated using the prevalence of HIV status disclosure (P=33%) among children in southern Ethiopia [17], 95% CI and 0.05 degree of precision.
Accordingly, the sample size was 339.
[Due to technical limitations, the formula could not be displayed here. Please see the supplementary files section to access the formula.]
The sample size for the second Objective:
The sample size for the second objective was calculated as follows: The power of the study to be 80%, the ratio of exposed to unexposed to be 1:1, 95% CI, % of outcome among exposed and unexposed were taken into account. Accordingly, the following sample size was calculated using open Epi info version TM7 computer software and the sample size for the second objective was 442(table 1).
Table 1: Sample size calculation using different works of literature as a baseline for study on HIV status disclosure and associated factors among Children on ART in West Shoa Zone, Ethiopia
|
Place of the study |
%outcome among exposed |
% outcome among non exposed |
Sample size |
Ref. |
|
Tikur Anbessa Hospital, Ethiopia |
29.2% |
42.3% |
442 |
[20] |
|
Hospitals in Addis Ababa |
13% |
73.8% |
24 |
[17] |
But, since the total study population was 556 (less than 10,000); the population correction formula was applied, and the final sample size was 247.
Sampling procedure and data collection tools
Since some health centers had only one case which fulfills the inclusion criteria, we decided to include all health centers with at least 20 and above cases. Accordingly, we selected four Health institutions. The study participants who fulfill the inclusion criteria were selected by simple random sampling technique. The samples for a qualitative study were selected purposively.
Data Collection Methods and Procedure
Quantitative data was collected through face to face interview. For data collection, five degree holder nurses (one for each health institution except for Ambo Hospital where it was two) were recruited, and trained for two days on objectives of the study, how to interview the clients, and on how to take the consent from the caregivers or parents. Nine in-depth interviews (IDI) (four with health care providers and five with child caregivers) were conducted. The participants for IDI were purposively selected health care providers working on ART clinics from all health institutions and child caregivers, whose child was ever disclosed.
Full disclosure: Disclosure was considered as “full disclosure” when it involved the caregiver or health care providers or anyone else having disclosed to the child that he or she has HIV specifically. This was determined if the care givers claimed that he/she describes the term HIV in his/her explanation for the child during disclosure process.
Partial disclosure: Disclosure is considered “partial” when the illness is described in a way that is consistent with HIV although the term “HIV” is avoided. For insistence: when the child is informed/knows that he/she has chronic health problems but not told specifically that the disease is HIV.
No disclosure: When the caregiver reported telling the child nothing about his or her illness.
Deflected disclosure: The strategy of deceptive disclosure that caregivers often use, frequently out of concern for the child’s psychological well-being, telling their children only about an unrelated condition (e.g., asthma, cancer), and attributing all medical needs (e.g., appointments, medication) to that less-stigmatized condition[21].
Data management and analysis
The collected data were checked for completeness, coded, entered into Epi data software version 4.5 statistical packages and exported to SPSS version 20 for statistical analysis. Descriptive statistics such as frequency distribution with percentage was computed. To assess the association between dependent and independent variables, first bi-variate analysis was done. Independent variables those were associated with the dependent variable at P-value<0.25 were included in the Multiple Logistic regression analysis. With an odd ratio of 95% CI, the level of statistical significance was declared at P-value<0.05.
The in-depth interview was tape-recorded and transcribed. The qualitative data analysis was done through a thematic analysis approach. The patterns of experiences were derived from the transcripts, either from direct quotes or through paraphrasing common ideas. Data from all the transcripts relating to the classified patterns were identified and placed under the relevant theme where it complements the quantitative findings.
STROBE compliance
This study is reported in compliance with the STROBE guidelines[26].