Disclosure of HIV status to HIV-positive children and young adolescents attending a rural health centre in Malawi Esther Mgoli1*, Rebecca M. Coulborn1, Carol Metcalf2, Saar Baert3, Laura Trivino Duran1, Takondwa Kachola4, Dickson Kamwendo4, Parkson Bwanaisa4 1Medecins Sans Frontieres (MSF) Thyolo, Malawi; 2MSF, Southern Africa Medical Unit, Cape Town, South Africa; 3MSF, Brussels, Belgium; 4Ministry of Health, Thekerani Health Centre, Thekerani, Malawi Background
Methods
Results
Conclusions
• Among caretakers of HIV-positive children, disclosure of HIV status can be daunting due to:
• Retrospective record review of children eligible for disclosure counselling, starting in 2010 or 2011, and alive and in care in March 2012
• 42 children were eligible for disclosure counseling immediately at ART initiation.
• Offering disclosure counselling to HIV-positive children and their caretakers is a useful means of making children aware of their HIV-status.
o
Fear of negative reactions;
o
Lack of awareness of importance of disclosure;
o
Lack of information on how to disclose;
o
Fear that the child will disclose in the community.
• Evidence of a health benefit from disclosure (e.g., reduced mortality risk) • WHO recommends disclosure of their HIV status to HIV-positive children of school-going age. • We reviewed the outcomes of disclosure counselling among children attending Thekerani health centre in southern Malawi to evaluate coverage of our intervention in supporting disclosure.
• Practical barriers exist for children and their caretakers to complete the entire counselling package.
• Children on ART and aged 7 - 14 years and their caretakers were offered 3 group sessions of HIV disclosure counselling given at onemonth intervals. o
Full disclosure: 3 sessions completed
o
Partial disclosure: 1-2 sessions completed
• Sessions for children included: o
Gradual explanation of the action of the virus in the body;
o
HIV named in the last session.
• Caretakers received counselling on: o
Importance of disclosure;
o
How to communicate with children about HIV at home.
• Offering individual counselling to children that missed group counselling appointments could address some of these barriers.
Figure 3. Coverage of disclosure sessions
• Children aged 7 - 9 years were more likely to complete all 3 sessions (7/9, 77.8%), than those aged 10 - 14 years (11/15, 73.3%). • 16 children missed all appointments for disclosure counselling (Figure 4).
• Starting children on therapy earlier could reduce the risk of developing complications/illness after ART initiation. • Disclosure counselling should be included in paediatric ART programmes. • Health workers involved in ART programmes should be trained in child counselling.
Acknowledgements • Thekerani children and care givers • Thekerani Health Centre Health Surveillance Assistants (Child counselors) • MOH, District Health Office, Thyolo • MSF, Thyolo Patient Support Unit Figure 4. Reasons for not attending group disclosure counselling
Contact
Figure 1. Map of Malawi, Africa
Figure 2. A counsellor facilitating a disclosure session with children aged 10 - 13 years
• 11 (26.2%) children required referral to social welfare services (e.g. for shelter, education bursary, support for physical disabilities).
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