Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living with HIV in Ecuador: A Cross-Sectional Study

Abstract

Background: Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age. Methods: Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador. Results: In 250 children included, HIV diagnosis was revealed at a median age of 11 years p25-p75 9-12. Children 12 years old or older P < 0.0001, 10 or more years since HIV diagnosis P = 0.001, antiretroviral initiation above 3 years of age P = 0.018 and decease of the mother P = 0.048 were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age 28.4% than before 15.4%, P = 0.047. According to the simplified medication adherence questionnaire, 194 children 78.2% were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 67.7%. In multivariate analysis, variables associated with nonadherence were age ≥14 years P < 0.001, taking ≥3 daily antiretroviral pills P = 0.013 and the presence of adverse effects P < 0.001, whereas nonadherence P = 0.001 was the only variable significantly associated with an unsuppressed HIV-RNA viral load. Conclusions: Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.