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Pediatrics HIV-positive status disclosure and its predictors in Ethiopia: a systematic review and meta-analysis
Getaneh Mulualem Belay1, Fikadu Ambaw Yehualashet2, Amare Wondim Ewunetie1
1Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia.
Insights
Pediatric HIV-positive status disclosure in Ethiopia is low at 31.2%. Caregiver HIV status, longer ART duration, and older child age predict disclosure, highlighting the need for targeted interventions.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Disclosure of Human Immunodeficiency Virus (HIV)-positive status to children is a critical yet challenging aspect of pediatric care.
- Limited systematic evidence exists on the prevalence and determinants of pediatric HIV-positive status disclosure in Ethiopia.
Approach:
- A systematic review and meta-analysis was conducted, searching major databases for relevant studies.
- Nine studies involving 2,442 children living with HIV in Ethiopia were included.
- Random-effects modeling was used to pool prevalence data and identify associated factors.
Key Points:
- The overall pooled prevalence of pediatric HIV-positive status disclosure in Ethiopia was found to be 31.2%.
- Factors significantly associated with disclosure included HIV-negative caregiver status, duration on Antiretroviral Therapy (ART) exceeding five years, and child age over 10 years.
Conclusions:
- The study highlights a low prevalence of pediatric HIV-positive status disclosure in Ethiopia.
- Interventions should focus on training healthcare professionals and caregivers to improve disclosure rates, particularly for older children and those with longer ART duration.
Introduction:
HIV-positive status disclosure for children is challenging for family members, guardians, and healthcare professionals. Disclosure is very challenging, particularly for children, yet no systematic synthesis of evidence accurately measures HIV-positive status disclosure in children. This systematic review and meta-analysis study aimed to quantify the national prevalence of pediatric HIV-positive status disclosure in Ethiopia and identify factors associated with HIV-positive status disclosure.
Method:
We systematically searched PubMed, EMBASE, Web of Science databases, and google scholar for relevant published studies. Studies published in the English language and conducted with cohort, case-control, and cross-sectional designs were eligible for the review. The primary and secondary outcomes of the study were HIV-positive status disclosure and factors associated with HIV-positive status disclosure, respectively. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. A random effect- model was used to estimate the pooled prevalence of HIV-positive status disclosure. Heterogeneity and publication bias of included studies was determined using I2 and Egger's test, respectively.
Result:
From 601 records screened, nine relevant studies consisting of 2,442 HIV-positive children were included in the analysis. The overall pooled prevalence of HIV-positive status disclosure among children living with HIV/AIDS in Ethiopia was 31.2% (95% CI [23.9-38.5]). HIV-negative status of caregivers (AOR: 2.01; 95% CI [1.28-3.18]), long duration on ART (greater than 5 years) (AOR: 3.2; 95% CI [1.77-5.78]) and older age of the child (>10 years) (AOR: 7.2; 95% CI [4.37-11.88]) were significantly associated with HIV-positive status disclosure.
Conclusion:
Low prevalence of pediatric HIV-positive status disclosure was observed in Ethiopia. The longer duration of ART, the HIV-negative status of the caregiver, and older age greater than 10 years were the predictors of pediatric HIV-positive status disclosure. Health system leaders and policymakers shall design training and counseling programs for healthcare professionals and caregivers to enhance their awareness about HIV-positive status disclosure.
Trial Registration:
This review was registered under PROSPERO and received a unique registration number, CRD42019119049.
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