Abstract
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.
Highlights
About 1.8 million children under the age of 15 years were living with HIV in 2019 [1], and most of whom were in eastern and southern Africa. e UNAIDS 90-90-90 target for 2020 aimed for 90% of all people living with HIV (PLHIV) to know their status, 90% of all people diagnosed with HIV to receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART to have viral suppression
Achieving the continuum of care can be difficult among HIV-infected children who are dependent on their parents, caregivers, or health workers to look after them. e literature shows that lower proportions of children in low- and middle-income countries know their status compared to their counterparts in higher-income countries [3]
A total of 9300 caregivers looked after the orphans and vulnerable children (OVC) included in this study, suggesting that there were some caregivers looking after multiple orphans and vulnerable children living with HIV (OVCLHIV) in their households
Summary
About 1.8 million children under the age of 15 years were living with HIV in 2019 [1], and most of whom were in eastern and southern Africa. e UNAIDS 90-90-90 target for 2020 aimed for 90% of all people living with HIV (PLHIV) to know their status, 90% of all people diagnosed with HIV to receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART to have viral suppression. It is recommended that adolescents and school-going children should know their HIV status, how HIV is spread, and how to stay healthy, in order to make them responsible for their own health and well-being [5, 6] Despite these guidelines, the disclosure rate among children in Tanzania remains low. Is communitybased five-year program (2016–2021) aims to provide opportunities for utilization of HIV services, reduce barriers to access and uptake of HIV services, and ensure tracking of beneficiaries at the household level and directly providing services such as treatment adherence, HIV prevention education, and status disclosure support and facilitating bidirectional referral for other HIV services through the national referral system for OVCLHIV and their caregivers. E program aims to improve other health, nutrition, education, protection, economic, and social outcomes for OVC and their caregivers, especially those affected by HIV
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