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.
