Should children know their HIV status? Prevalence, caregiver's perspectives and barriers to disclosure at the National Hospital Abuja, Nigeria.

BACKGROUND: Nigeria ranks second globally with a HIV/AIDS prevalence of 3.2%. HIV infected children are surviving to adolescence because of anti-retroviral therapy, but many do not know why they need to take these medicines. Disclosure is critical to long-term disease management, yet, if, how and when caregivers and or health professionals disclose to children is not well known in resource-limited settings. The barriers to disclosure remain largely undocumented. OBJECTIVES: To determine the prevalence and age of HIV disclosure to children in Abuja, Nigeria and identify caregivers perspectives as well as barriers to disclosure. METHODS: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV-positive children aged 5-16 years receiving antiretroviral therapy for at least 1 year were enrolled. RESULTS: Prevalence of full disclosure was 24.5%, partial disclosure 22.7%, with overall prevalence of 47.2%. Mean age at full disclosure was 11.87 years. Bivariate analysis showed significant difference between disclosure and child's level of education (χ2 for trend 26.710, P < 0.001), support for disclosure (χ2 4.399, P = 0.036) and if caregiver held the opinion that children should have disclosure done (Pearson's χ2 30.174, P < 0.001). However, on logistic regression, only the age of the child (P < 0.001, 95% CI 1.176-1.499) and the caregiver's opinion (P = < 0.001, 95% CI 4.914-2.542) remained significant. Various barriers to disclosure were identified. CONCLUSION: The prevalence of full disclosure is low and several barriers prevent early disclosure. Caregiver's and HCWs need empowerment with culturally appropriate skills and platforms to increase disclosure rates, which may help improve adherence.

Barriers and impact of disclosure of HIV status to children at the National Hospital, Abuja Nigeria

Background: HIV infected children survive to adolescence because of anti retroviral therapy, however, only a small proportion know their diagnosis.Disclosure is critical to long-term disease management, yet little is known about if, how, and when disclosure takes place and the barriers associated with it, and its impact on children in resource limited settings. Objective: This study set out to determine the process of and barriers to HIV disclosure in children as well as the immediate impact of this on children and their caregivers. Methods: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV positive children aged 5 to 16 years receiving antiretroviral therapy for at least one year were enrolled. Results: Prevalence of full disclosure was 24.5%, partial 22.7% with overall prevalence of 47.2%. Main barrier to disclosure was child's age and fear of informing others. The impact of disclosure on caregivers was relief in 45.5% but emotional and difficult for others. Immediate reactions by children were sadness; tearfulness and worry in 28.6%, some showed no reaction while others even expressed relief. On a longer term, disclosure had several effects. Main predictors of disclosure on regression were the child's age and caregiver's opinion on disclosure. Conclusion: The prevalence of full disclosure is low and several barriers affect disclosure. Caregiver's and HCWs need empowerment and support with culturally appropriate skills and platforms to deal with the barriers, process and impact of disclosure

Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: audit of patient outcomes in surgery.

OBJECTIVE: To compare characteristics of patients and outcomes after elective surgery in independent sector treatment centres (ISTCs) and NHS providers. DESIGN: Follow-up study with outcomes reported by patients three to six months after surgery. SETTING: 25 ISTCs and 72 NHS providers in England. Population Consecutive patients undergoing hip or knee replacement (5671 in ISTCs and 14,292 in NHS), inguinal hernia repair (640 and 2023, respectively), or surgery for varicose veins (248 and 1336, respectively). MAIN OUTCOMES: Symptoms and disability reported by patients (Oxford hip and knee scores on a 48 point scale; Aberdeen varicose vein questionnaire) and quality of life (EuroQol EQ-5D score). RESULTS: Patients in ISTCs were healthier than those in NHS providers, had less severe preoperative symptoms, and were more affluent, though the differences were small. With adjustment, patients undergoing joint replacements in NHS providers had poorer outcomes: difference of -1.7 (95% confidence interval -2.5 to -0.9) on the Oxford hip score and -0.9 (-1.6 to -0.2) on the Oxford knee score. They more often reported complications: odds ratio 1.3 (95% confidence interval 1.1 to 1.5) for hip and 1.4 (1.2 to 1.6) for knee. There were no significant differences in outcomes after surgery for hernia or varicose veins, except that NHS patients more often reported poor results after hernia repair (1.4, 1.0 to 1.9) and additional surgery after varicose vein surgery (2.8, 1.2 to 6.8). CONCLUSION: Patients undergoing surgery in ISTCs were slightly healthier and had less severe conditions than those undergoing surgery in NHS providers. Some outcomes were better in ISTCs, but differences were small compared with the impact ISTCs could have on the provision of elective services.