The effect of HIV status disclosure and non-disclosure on the psychosocial wellbeing, adherence levels and treatment outcomes of adolescents on Highly Active Anti-Retroviral Therapy (HAART) at Katututra State Hospital, Namibia

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University of Namibia
Background: With the advent and wide availability of highly active antiretroviral therapy (HAART), HIV- infected children are currently living health lives and growing into adulthood. There has been mounting evidence on the benefits of appropriate HIV disclosure to adolescents. However, various researches reported contradicting results as disclosure having both negative and positive social and psychological impacts on children. This study aimed to determine the effect of HIV status disclosure on the psychosocial wellbeing, adherence to treatment and HIV treatment outcome of adolescents who are taking ART at Katutura State Hospital, pediatric HIV Clinic. The study also aimed to determine the risk of Psycho social “deviations” in HIV status disclosed adolescents as compared to undisclosed adolescent on HAART and to compare the adherence level, CD4 count, and viral load of disclosed and non-disclosed adolescent children also on HAART at the same clinic. The newly implemented Pediatric HIV disclosure program in Namibia prompted this study. The program is guided by the World Health Organization which reported mixed effects after HIV status disclosure on the adolescents and it was deemed necessary to assess whether HIV status disclosure results in a better psychosocial wellbeing, higher CD4 count and lower viral load among adolescent children put on HAART. Methods: A Cross-sectional Analytic research design was employed where the prevalence of being psychosocially unwell and the level of HIV treatment adherence, CD4 count and viral load was compared in two groups of HIV positive adolescents enrolled in HIV care and put on HAART at Katutura Hospital for at least 12 months. Results: Two-hundred HIV-infected adolescents took part in the study, data was analyzed, 99 (49.5%) were disclosed and 101(50.5%) were undisclosed. The mean age of the study participants was 12 years. The findings revealed no association between disclosure status and psychosocial well-being; as 97 (98%) and 98 (97%) of the participants from the disclosed and undisclosed groups were assessed to have been psychosocially well. It was also noted that both groups scored high on adherence to anti-retroviral therapy with an adherence level of above 98%. The results show no difference in viral load suppression between the disclosed and undisclosed group. In addition, the result did not show significant difference in CD4 count between the two groups of adolescents which concludes that disclosure of HIV status is not associated with decreased CD4 count for adolescent living with HIV. The results suggest that disclosure doesn’t affect the psychosocial wellbeing of adolescents, neither does it affect the treatment outcomes of HIV positive adolescents on HAART.
A thesis submitted in partial fulfilment of the requirements for the Degree of Master of Public Health
HIV status, Adolescents, Anti-retroviral therapy