Evaluating a patient-centred intervention to increase disclosure and promote resilience for children living with HIV in Kenya

Abstract

Objective: We evaluated the impact of a patient-centred, culturally and age-appropri- ate disclosure counselling intervention on HIV disclosure rates among Kenyan children living with HIV. Design: A prospective, clinic-cluster randomized trial. Methods: We followed 285 child–caregiver dyads (children ages 10–14 years) attend- ing eight HIV clinics (randomized to intervention or control) in Kenya. Participants at intervention clinics received intensive counselling with trained disclosure counsellors and culturally tailored materials, compared with control clinics with standard care. Disclosure was treated as a time-to-event outcome, measured on a discrete time scale, with assessments at 0, 6, 12, 18 and 24 months. Mental health and behavioural outcomes were assessed using standardized questionnaires. Results: Mean age was 12.3 years [standard deviation (SD) 1.5], 52% were girls, with average time-on-treatment of 4.5 years (SD 2.4). Between 0 and 6 months, disclosure prevalence increased from 47 to 58% in the control group and from 50 to 70% in the intervention group. Differences in disclosure were not sustained over the following 18 months. The prevalence of depression symptoms was significantly higher in the intervention than in the control group at 6 months (odds ratio 2.07, 95% confidence interval 1.01–4.25); however, there was no evidence that these differences were sustained after 6 months. Conclusion: The clinic-based intervention increased disclosure of HIV status to chil- dren living with HIV in the short-term, resulting in earlier disclosures, but had less clear impacts longer-term. Although well tailored interventions may support disclosure, children may still experience increased levels of depression symptoms immediately following disclosure.