Development of a diagnosis disclosure model for perinatally HIV-infected children in Thailand

Abstract

While disclosure of HIV status to perinatally HIV-infected children has become an increasingly important clinical issue, specific disclosure guidelines are lacking. We developed a pediatric HIV diagnosis disclosure model to support caretakers. All HIV-infected children greater than 7-years-old at two participating hospitals in Bangkok, Thailand, and their caretakers, were offered disclosure according to the 4-step protocol: (1) screening; (2) readiness assessment; (3) disclosure; and (4) follow-up. Disclosure occurred after agreement of both providers and caretakers. Among 438 children who were screened, 398 (89%) were eligible. Readiness assessment was completed for 353 (91%) of eligible children and 216 (61%) were determined ready. Disclosure was done for 186 children. The mean age at eligibility screening was 10.5 years (range: 6.8–15.8 years); the mean age at disclosure was 11.7 years (range: 7.6–17.7 years). The mean duration between eligibility screening and disclosure was 15.2 months. There were no significant negative behavioral or emotional outcomes reported in children following disclosure. This HIV diagnosis disclosure model was feasible to implement and had no negative outcomes. As the time for preparation process was over 1 year for most cases, the disclosure process can be initiated as early as age 7 to allow enough time for disclosure to be completed by the age of adolescence.

Keywords:

• HIV
• diagnosis
• disclosure
• model
• children

Acknowledgments

This study was supported by the US CDC through the cooperative agreement 5U19GH000004-05 to the Ministry of Public Health, Thailand. The authors wish to thank the staff of the two participating hospitals (Siriraj Hospital and the QSNICH), and the US CDC Collaboration, Global AIDS Program for their support of this project. The authors also want to thank the children and families who participated in this project.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention. Use of trade names is for identification purposes only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the Department of Health and Human Services.