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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
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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)
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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
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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 4 Objective 4
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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) 5
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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 6
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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 7
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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 8
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9 Results (1) 9 Baseline description (N=230) n% GenderFemale10445 Age13-15 years13157 16-18 years7030 19-21 years2913 Cotrimoxazole prophylaxisYes11661 No7339 On ARTYes21192 Experienced ART modificationYes12273 Informed of their HIV status (N=194)Yes6333 No13167
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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 [0.5-1.7]0.68 Male38 (34)75 (66)Ref. Age (years)13-1521 (18)93 (82)Ref.--- 16-1817 (33)34 (67)2.2 [0.9-5.0]0.03 19-2124 (86)4 (14)26.6 [7.6-102.1]<0.001 CTX prophylaxisYes40 (40)61 (60)2.3 [1.1-5.1]0.02 No14 (22)50 (78)Ref. On ARTYes61 (35)116 (65)3.7 [0.8-24.3]0.07 No2 (13)14 (87)Ref. > 1 ART modification Yes46 (42)63 (58)4.1 [1.5-12.0]0.002 No6 (15)34 (85)Ref. 10
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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 [0.5-1.7]0.68 Male38 (34)75 (66)Ref. Age (years)13-1521 (18)93 (82)Ref.--- 16-1817 (33)34 (67)2.2 [0.9-5.0]0.03 19-2124 (86)4 (14)26.6 [7.6-102.1]<0.001 CTX prophylaxisYes40 (40)61 (60)2.3 [1.1-5.1]0.02 No14 (22)50 (78)Ref. On ARTYes61 (35)116 (65)3.7 [0.8-24.3]0.07 No2 (13)14 (87)Ref. > 1 ART modification Yes46 (42)63 (58)4.1 [1.5-12.0]0.002 No6 (15)34 (85)Ref. 11
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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 12
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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 ? 13
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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 14
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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 15
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