Prevalence, facilitators and barriers of HIV disclosure among boarding school adolescents on ART: The Baylor Uganda experience

Abstract

Background An estimated 1.7 million adolescents are living with HIV worldwide, with about 85% (1.5 million) of these in sub-Saharan Africa (SSA). Adolescents account for about 10% of all the new HIV infections and again, most are in SSA. Despite efforts and regulation for disclosure, nondisclosure of HIV serostatus to others remains high, which contributes to the high rates of new infections, poor adherence to treatment and low retention in care. There are few studies reporting the magnitude and facilitators/barriers of self-disclosure of HIV status among adolescents on ART in boarding schools. Objective The study aimed to determine the prevalence, facilitators and barriers to self-disclosure of HIV serostatus among Adolescents on ART in boarding schools. Methodology: This was a mixed methods cross-sectional study. A total of 228 Adolescents Living with HIV (ALWH) attending Baylor- Uganda clinic and were in more than 80 boarding schools in Central Uganda were interviewed to determine the prevalence, facilitators and barriers to HIV disclosure. For qualitative data; 16 adolescents were randomly selected to do in depth interviews and 8 school staff provided key informant interviews. Ethical Approval were sought from the School of Medicine Research and Ethics Committee (SOMREC) of Makerere University and Baylor-Uganda Ethics Committee. The prevalence was determined and multivariable analysis conducted to determine the facilitators and barriers. Qualitative analysis was conducted using deductive context analysis approach. Results: Of the 228 adolescents, 109 (52.2%) were females, 65.3% (149/228) had disclosed their HIV status to at least one of the school staff or a peer and 71.9% (164/228) had good ART adherence. Of those who had disclosed, 81.1% (133/164) had a good ART adherence. The mean age was 16.7 (SD 1.8) years. Adolescents who were sexually active, presence school counselling programs and maintenance of the adolescent’s confidentiality were among the facilitators to selfdisclosure. The barriers on the other hand were stigma/rejection, parental discouragement and keeping medication for themselves. Adolescents who had disclosed had good ART adherence with percentage of 81.1%. compared to 25% (95% Confidence interval, CI: 0.20-0.48) among those that had not disclosed their HIV status. xv Conclusion: Two of three adolescents with HIV in boarding schools in central Uganda have disclosed their HIV status in the school. Disclosure is promoted by a conducive environment and is associated with good adherence. Recommendations Adolescents in boarding schools need to be supported to disclose their HIV status in order for them to achieve the benefits of self-disclosure, overcome stigma and thus improve ART adherence. Key words: HIV disclosure, ART adherence