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.

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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 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% GenderFemale10445 Age13-15 years years years2913 Cotrimoxazole prophylaxisYes11661 No7339 On ARTYes21192 Experienced ART modificationYes12273 Informed of their HIV status (N=194)Yes6333 No13167

Univariate logistic regression correlates of documented HIV disclosure (N=194) 10 Informed about their HIV status OR [95%CI]P Yes n ( %)No n ( %) GenderFemale25 (31)56 (69)0.9 [ ]0.68 Male38 (34)75 (66)Ref. Age (years) (18)93 (82)Ref (33)34 (67)2.2 [ ] (86)4 (14)26.6 [ ]<0.001 CTX prophylaxisYes40 (40)61 (60)2.3 [ ]0.02 No14 (22)50 (78)Ref. On ARTYes61 (35)116 (65)3.7 [ ]0.07 No2 (13)14 (87)Ref. > 1 ART modification Yes46 (42)63 (58)4.1 [ ]0.002 No6 (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 ( %) GenderFemale25 (31)56 (69)0.9 [ ]0.68 Male38 (34)75 (66)Ref. Age (years) (18)93 (82)Ref (33)34 (67)2.2 [ ] (86)4 (14)26.6 [ ]<0.001 CTX prophylaxisYes40 (40)61 (60)2.3 [ ]0.02 No14 (22)50 (78)Ref. On ARTYes61 (35)116 (65)3.7 [ ]0.07 No2 (13)14 (87)Ref. > 1 ART modification Yes46 (42)63 (58)4.1 [ ]0.002 No6 (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 15