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Impact of HIV-Status Disclosure on Adherence to Antiretroviral Therapy Among HIV-Infected Children in Resource-Limited Settings: A Systematic Review

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Abstract

Pediatric HIV remains a significant global health dilemma, especially in resource-constrained nations. As access to ART increases around the world, areas of concern in pediatric HIV treatment include age-appropriate disclosure of HIV status to children and development of adherence habits over time. This review was conducted to synthesize quantitative associations reported between disclosure and adherence among children living with HIV in resource-limited settings. An electronic database search of PubMed, MEDLINE and Cochrane returned 1348 results after removal of duplicates, 14 of which were found to meet inclusion criteria. Review of these reports showed conflicting results regarding the impact of disclosure on adherence, with 5 showing no association, 4 showing a negative impact of disclosure on adherence, and 5 showing positive benefits of disclosure for adherence habits. Thus, there was no clear consensus on the effect, if any, that disclosure has on medication adherence. Longitudinal, prospective research needs to be conducted to evaluate further impacts that disclosure may have on adherence habits over time, and interventions must be structured to link the two processes together in order to maximize health benefit to the child or adolescent.

Resumen

A medida que el acceso a tratamiento anti-retroviral aumenta alrededor del mundo, la revelación a un niño de su diagnóstico de VIH y el cumplimiento con el tratamiento anti-retroviral continúan siendo un reto. Esta revisión de literatura resume las asociaciones cuantitativas reportadas entre la revelación del diagnóstico y el cumplimiento del tratamiento anti-retroviral en niños viviendo con VIH en un entorno de recursos limitados. Una búsqueda en la base de datos electrónica de PubMed, MEDLINE y Cochrane, luego de descartar resultados duplicados, arrojó 1348 resultados de los cuales 14 cumplían con los criterios de inclusión. Estos estudios reportaron resultados conflictivos con respecto al impacto de la revelación del diagnóstico sobre el cumplimiento del tratamiento: 5 reportes demostraron no asociación, 4 demostraron un impacto negativo de la revelación del diagnóstico sobre el cumplimiento del tratamiento, y 5 demostraron beneficios positivos de la revelación sobre el cumplimiento. Por tanto, no hay un consenso en el efecto que tiene la revelación del diagnóstico sobre el cumplimiento del tratamiento. Se necesitan estudios prospectivos para evaluar a fondo el impacto que la revelación del diagnóstico podría tener a través del tiempo en los hábitos de cumplimiento del tratamiento y las intervenciones deben ser estructuradas para enlazar estos dos procesos, maximizando así el beneficio a la salud del niño o adolescente.

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Acknowledgments

This work was support in part by the Doris Duke Charitable Foundation, through a grant supporting the Doris Duke International Research Fellows Program at Yale University School of Medicine to JN, and National Institute of Child Health and Development grant R01HD074253 to EP.

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Authors and Affiliations

  1. Departments of Pediatrics, Pharmacology & Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT, 06520, USA

    Justin Nichols & Elijah Paintsil

  2. University of Loyola School of Medicine, Chicago, IL, USA

    Alexis Steinmetz

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Correspondence to Elijah Paintsil.

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Author JN declares that he has no conflict of interest. Author AS declares that he has no conflict of interest. Author EP declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the studies used for the review.

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Nichols, J., Steinmetz, A. & Paintsil, E. Impact of HIV-Status Disclosure on Adherence to Antiretroviral Therapy Among HIV-Infected Children in Resource-Limited Settings: A Systematic Review. AIDS Behav 21, 59–69 (2017). https://doi.org/10.1007/s10461-016-1481-z

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