Effectiveness of HIV Status Disclosure Interventions Among Children and Adolescents in Low and Middle-Income Countries: A Systematic Review.

Background: Appropriate pediatric HIV status disclosure remains a public health challenge in low- and middle-income countries (LMICs). This review aims to describe the existing pediatric HIV disclosure interventions in LMICs and their efficacy. Methods: Literature search was conducted in Medline, Embase, PsychInfo, Cochrane Central Register of Controlled Trials databases, and Google Scholar following PICOS framework to identify interventional studies aimed at improving HIV status disclosure among children and adolescents. Retrieved studies were screened, data were extracted using a piloted tool, and a narrative synthesis and methodological quality assessment were conducted. Results: A total of 260 studies were retrieved and after the screening, 6 studies fulfilled the eligibility criteria, three of which were randomized clinical trials (RCTs) while others were quasi-experimental designs. Only two interventions were based on pre-existing theory. Four interventions were delivered by Health Care Workers (HCWs) only, one by HCWs and peer supporters and one by trained research assistants. The main components of the interventions included education/training, media/videos, books, disclosure counseling, and disclosure support and half of the studies applied multiple components. The commonly assessed disclosure-related intervention outcomes were safety, acceptability, prevalence of disclosure, perceptions, and experiences. Only two studies reported significant changes in outcome (prevalence of disclosure) between control and intervention groups. However, there was marked variation in the methods used to assess outcomes across studies. Conclusion and Recommendations: This review highlights that there are limited interventions addressing pediatric HIV status disclosure in LMICs, targeting different stakeholders in the disclosure process and assessing different outcomes. Additionally, most studies were not grounded pre-existing theories, frameworks and models. There is a need to develop standardized tools to assess disclosure and related outcomes in different contexts, compare the effectiveness of single-component and multi-component pediatric disclosure interventions.