Factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania.

INTRODUCTION: With the introduction of antiretroviral drugs HIV-infected children live longer. Disclosure of HIV diagnosis is increasingly an important and inevitable issue. Both healthcare providers and caregivers face challenges of disclosure to children. The objective of the study was to explore factors associated with HIV-status disclosure to HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC). METHODS: A cross-sectional hospital-based study was conducted from October 2011 to April 2012. Study population included HIV-infected children aged 5 to 14 years, their caregivers and healthcare providers. Structured questionnaires were used to collect information. Children were asked the reason for hospital visits. Outcome of interest was HIV disclosure status. Data was processed and analysed using SPSS version 16.0. Multivariate logistic regression at 5% margin error was used to account for confounders. RESULTS: A total of 211 children were enrolled with mean age of 9.7 (SD±2.6; range 5-14) years. Only 47 (22.3%) children knew their HIV-status. The mean age of disclosure was 10.6 years. Most of disclosed children were aged above 10 years (p). CONCLUSION: Most of children were not disclosed. Ages, self medication, getting other support and parents/caregivers prior discussion were strong predictors of disclosure status.

Adherence to antiretroviral therapy among HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania: A cross- sectional analytical study.

INTRODUCTION: Paediatric adherence to Highly Active Antiretroviral Therapy (HAART) is a dynamic process involving many factors. Adherence for the majority on therapy matters to prevent failure of 1(st) and 2(st) line therapy. The purpose of this study was to determine the rate of adherence to antiretroviral therapy in HIV infected children. METHODS: We conducted a cross-sectional hospital based analytical study, from October 2011 to April 2012. HIV-infected children aged 2 to 17 years who had been on treatment for at least six months were enrolled. Data were collected by a standard questionnaire. Two-day self-report, one month self-recall report, and pill count were used to assess adherence. RESULTS: One hundred and eighty three respondents participated in this research. There were 92 (51%) males and 91 (49%) females. Only 45 (24.6%) had good adherence to their drug regimen when subjected to all three methods of assessment. Males were more adherent to ART than females (OR= 2.26, CI 1.05-4.87, p = 0.04). Adherence was worse among children who developed ART side effects (OR= 0.19, CI 0.07- 0.56;p = 0.01), could not attend clinic on regular basis (OR= 3.4, CI 1.60- 7.36, p = 0.01) and missed drug doses in the six months period prior to interview (OR= 0.40, CI 0.18-0.82, p= 0.01). CONCLUSION: Only 24.6% of paediatric patients had good adherence to ART when subjected to all three measures. Drug side-effects, missing drug doses in the six months period prior to study start, monthly income and affording transportation to the clinic were strong predictors of adherence.