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Development of a diagnosis disclosure model for perinatally HIV-infected children in Thailand
Vitharon Boon-Yasidhi1, Kulkanya Chokephaibulkit, Michelle S McConnell
1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. itharon.boo@mahidol.ac.th
Insights
Disclosing HIV status to children with perinatal HIV infection is crucial. A 4-step model showed feasibility and no negative outcomes, supporting early disclosure initiation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Psychology
Background:
- Disclosure of Human Immunodeficiency Virus (HIV) status to perinatally infected children is a growing clinical concern.
- Existing guidelines for pediatric HIV diagnosis disclosure are limited, necessitating structured approaches.
Purpose of the Study:
- To develop and evaluate a pediatric HIV diagnosis disclosure model for caretakers of HIV-infected children.
- To assess the feasibility and outcomes of a structured, 4-step disclosure protocol.
Main Methods:
- A 4-step protocol (screening, readiness assessment, disclosure, follow-up) was implemented for HIV-infected children over 7 years old and their caretakers in Bangkok, Thailand.
- Disclosure proceeded upon agreement between providers and caretakers.
- Data collected on screening, readiness, and disclosure completion rates, along with child outcomes.
Main Results:
- Of 438 children screened, 398 were eligible, and 216 (61%) were deemed ready for disclosure.
- Disclosure was successfully completed for 186 children, with a mean age of 11.7 years.
- No significant negative behavioral or emotional outcomes were observed in children post-disclosure.
Conclusions:
- The developed pediatric HIV diagnosis disclosure model is feasible and safe for implementation.
- The model supports caretakers and indicates that disclosure can be initiated by age 7 to allow completion by adolescence.
- Early initiation of the disclosure process is recommended to accommodate the lengthy preparation time.
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.
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