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

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• With antiretroviral treatment (ART) access in HIV-infected children, HIV-infected adolescents are an emerging population

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• Adolescence is a vulnerable period – Emotional and behavioral disorders– Problem of treatment adherence– Problem of program retention– Problem of mutiple previous ART regimens

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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

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Background (2)

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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

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Objective

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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)

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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

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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

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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

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Results (1)

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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)

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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.

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Univariate logistic regression correlates of documented HIV disclosure (N=194)

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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.

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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

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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 ?

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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

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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

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