Notification of HIV status disclosure and its related factors in HIV-infected adolescents in 2009 in the Aconda program (CePReF, CHU Yopougon) in Abidjan, Cote d'Ivoire, The PRADO-CI Study

Introduction: We studied the frequency of documentation of disclosure of HIV status in medical charts and its correlates among HIV-infected adolescents in 2009, in Abidjan, Cote d'Ivoire. Methods: The PRADO-CI is a cross-sectional study aimed at studying HIV-infected adolescents' social, psychological, and behavioural difficulties and their determinants in Abidjan, Cote d'Ivoire. In this study, we present specific analyses on disclosure. All HIV-infected adolescents aged 13-21 years and followed at least once in 2009 in two urban HIV-care centres in Abidjan (Cepref and Yopougon Teaching Hospital) were enrolled in the study. Standardized data were extracted from medical records to document if there was notification of disclosure of HIV status in the medical record. Frequency of notification of HIV disclosure was estimated with its 95% confidence interval (CI) and correlates were analyzed using logistic regression. Results: In 2009, 229 adolescents were included: 126 (55%) males; 93% on antiretroviral therapy (ART), 61% on cotrimoxazole prophylaxis. Their median age was 15 years at the time of the study. Among the 193 patients for whom information on HIV status disclosure was documented (84%), only 63 (32.6%; 95% CI = 26.0-39.3%) were informed of their status. The proportion of adolescents informed increased significantly with age: 19% for 13-15 years, 33% for 16-18 years and 86% for 19-21 years (p <0.0001). Adolescents on ART tended to be more likely to be informed of their HIV status (34.5%) than those not treated (13.3%) (p = 0.11). Those on cotrimoxazole were significantly more likely to be informed (39.6%) than those not (21.9%) (p = 0.01). Disclosure was significantly higher in adolescents with a history of ART regimen change (p = 0.003) and in those followed in the Cepref (48.4%) compared to the Yopougon Teaching Hospital (24.8%), (p = 0.001). In multivariate analyses, disclosed HIV status was significantly higher in those followed-up in the Cepref compared to the other centre: adjusted odds ratio (aOR) = 3.5 (95% CI: 1.1-10.9), and among older adolescents compared to those aged 13-15 years: [16-18 years] aOR = 4.2 (95% CI: 1.5-11.5) and [ > 18 years]: aOR = 22.1 (95% CI: 5.2-93.5). Conclusions: HIV disclosure rate was low among Ivoirian HIV adolescents and was site- and age-dependent. There is a need for practical interventions to support HIV disclosure to adolescents which provides age-appropriate information about the disease.