Post on 22-Dec-2015
Disclosure of HIV test results in HIV-infected adolescents
in the Aconda program (CePReF, CHU Yopougon) in Abidjan, Côte d’Ivoire: The Project PRADO-CI Meless GD., Aka-Dago-Akribi H., Cacou C., Aka AE., Oga AC.,
Bouah B., Kouao L, Messou E., Tanoh FE, Moh C.,
Timité-Konan M. and Leroy V. for the PRADO-CI Group
23 BP 2485 ABIDJAN 23 Tel : 23-52-52-53 / 23-46-25-51 Fax : 23-52-52-53 Email : acondavs@aviso.ci
1
• With antiretroviral treatment (ART) access in HIV-infected children, HIV-infected adolescents are an emerging population
•
• Adolescence is a vulnerable period – Emotional and behavioral disorders– Problem of treatment adherence– Problem of program retention– Problem of mutiple previous ART regimens
2
Background (1)
• An HIV diagnosis is a life-changing event
• Especially in adolescents, the disclosure of the HIV test result – Is essential for HIV prevention– May accentuate behavioral disorders– May improve ART adherence– Could impact on ART outcomes
3
Background (2)
3
To study the prevalence of the disclosure of HIV test result and its association with their baseline characteristics in ART-treated adolescents in Abidjan, Côte d’Ivoire
4
Objective
4
Methods (1)
• Since 2004: Aconda Program in Côte d’Ivoire
– Pediatric care, with free HIV diagnosis and ART
access in HIV-infected children
– Funding: EGPAF/PEPFAR
– Collaboration: Inserm U897/ISPED, Bordeaux
– Current active file: 2244 HIV+ children (1000 on ART)
5
Methods (2)
• The PRADO-CI Study
– Cross-sectional study nested in the Aconda active file
– Psycho-social and behavioral difficulties and their
determinants in adolescents
– Funding: Sidaction
6
Methods (3)
• Inclusion criteria
– HIV-infected adolescents
– Aged 13 to 21 years,
– Seen at least once in 2009
– in two urban centers of the Aconda program in Abidjan
7
Methods (4)
• Data collection: medical records
– Demographic (age, sex ...)
– Drugs: Cotrimoxazole prophylaxis, ART
– HIV disclosure documented in chart
• Formal: provided by medical team
• Informal: through another source
– % and correlates of disclosure, logistic regression
8
9
Results (1)
9
Baseline description (N=230)
n %
Gender Female 104 45
Age 13-15 years 131 57
16-18 years 70 30
19-21 years 29 13
Cotrimoxazole prophylaxis Yes 116 61
No 73 39
On ART Yes 211 92
Experienced ART modification Yes 122 73
Informed of their HIV status (N=194) Yes 63 33
No 131 67
Univariate logistic regression correlates of documented HIV disclosure (N=194)
10
Informed about
their HIV status OR [95%CI] P
Yes n ( %) No n ( %)
Gender Female 25 (31) 56 (69) 0.9 [0.5-1.7] 0.68
Male 38 (34) 75 (66) Ref.
Age (years) 13-15 21 (18) 93 (82) Ref. ---
16-18 17 (33) 34 (67) 2.2 [0.9-5.0] 0.03
19-21 24 (86) 4 (14) 26.6 [7.6-102.1] <0.001
CTX prophylaxis Yes 40 (40) 61 (60) 2.3 [1.1-5.1] 0.02
No 14 (22) 50 (78) Ref.
On ART Yes 61 (35) 116 (65) 3.7 [0.8-24.3] 0.07
No 2 (13) 14 (87) Ref.
> 1 ART modification Yes 46 (42) 63 (58) 4.1 [1.5-12.0] 0.002
No 6 (15) 34 (85) Ref.
10
Univariate logistic regression correlates of documented HIV disclosure (N=194)
11
Informed about
their HIV status OR [95%CI] P
Yes n ( %) No n ( %)
Gender Female 25 (31) 56 (69) 0.9 [0.5-1.7] 0.68
Male 38 (34) 75 (66) Ref.
Age (years) 13-15 21 (18) 93 (82) Ref. ---
16-18 17 (33) 34 (67) 2.2 [0.9-5.0] 0.03
19-21 24 (86) 4 (14) 26.6 [7.6-102.1] <0.001
CTX prophylaxis Yes 40 (40) 61 (60) 2.3 [1.1-5.1] 0.02
No 14 (22) 50 (78) Ref.
On ART Yes 61 (35) 116 (65) 3.7 [0.8-24.3] 0.07
No 2 (13) 14 (87) Ref.
> 1 ART modification Yes 46 (42) 63 (58) 4.1 [1.5-12.0] 0.002
No 6 (15) 34 (85) Ref.
11
Discussion (1)
• Documented disclosure rate is low in this population
– 33%
• Proportion of adolescents informed of their HIV
infection increases with
– Age
– CTX prophylaxis
– ART
12
Discussion (2)
• HIV adolescents
– Frequent care centers regularly
– Take drugs daily
– Can read
– But, are not informed of their HIV status
What do they know exactly about their
serostatus ?
13
Conclusions
Need for …
– practical interventions to support HIV disclosure to
adolescents
• age-appropriate information about the disease
– systematic documentation in medical records
– further understand what this «lack of clear information»
means in the PRADO-CI study• Sociologic and psychologic interview• Psychologic test (GPPI, Rorschach)• Focus group
14
The PRADO-CI Study Group Investigators
Dr H. Aka Dago-Akribi (Université de Cocody, Abidjan), Dr V. Leroy (Inserm U897, ISPED, Bordeaux)
Abidjan Département de Psychologie, Université de Cocody :
H. Aka-Dago-Akribi, B. Bouah, MC. Cacou, C. Moh Programme PACCI : L. Kouao, M. Oga, D. Meless Service de pédiatrie, CHU de Yopougon : Pr Timité-
Konan Dr FE Tanoh CePReF : Dr EA Aka, Dr E. Messou Association CHIGATA
23 BP 2485 ABIDJAN 23 Tel : 23-52-52-53 / 23-46-25-51 Fax : 23-52-52-53 Email : acondavs@aviso.ci
15