“It’s a very, very thorny issue … ”: healthcare providers’ experiences, challenges, and insights on HIV status disclosure to children and adolescents living with HIV from across 12 African countries
Bibliographic record
Abstract
Knowing one's HIV status is associated with better outcomes for children and adolescents living with HIV (CALHIV). The World Health Organization (2021) recommends that adolescents be counselled about the potential benefits and risks of disclosing their HIV status. CALHIV who are fully disclosed to by an appropriate age have better retention in care and better psychosocial outcomes. Most disclosures occur in health system settings, with healthcare providers playing a key role in the disclosure process. This study draws on insights from participants in the Paediatric-Adolescent Treatment Africa (PATA) Summit - a convening of healthcare providers caring for CALHIV. The study explores disclosure-related experiences under three primary themes: (1) perspectives on managing patients and families; (2) healthcare provider skills in facilitating disclosure; and (3) foundations for healthy disclosure. Cross-cutting issues included the importance of developmentally appropriate communication, balancing risks and benefits, addressing stigma, and strengthening pre- and post-disclosure support. Findings were mapped onto a socioecological model that identified barriers and facilitators at the child/adolescent, caregiver/family, healthcare provider, and community levels. Stigma and the temporal nature of disclosure were cross-cutting across all levels. Findings highlight the multifaceted nature of disclosure and the necessity for a coordinated, multisectoral approach that extends beyond health facilities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.011 | 0.007 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.001 | 0.008 |
| Research integrity | 0.002 | 0.006 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".