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EFFECT OF CAREGIVERS’ HIV DISCLOSURE TRAINING ON PEDIATRIC HIV STATUS DISCLOSURE AND ART ADHERENCE IN HOMABAY COUNTY, KENYA: A COMPARATIVE LONGITUDINAL STUDY.

Purpose: The study objective was to establish the effect of HIV disclosure training on children’s HIV status disclosure and on ART adherence. 
Methodology:This was a comparative longitudinal study in ten health facilities in Homabay County with 860 non-disclosed HIV positive children on ART aged 6-10 years between 2016 to 2018.A randomized sample of 430 caregivers was trained on HIV status disclosure while another 430 caregivers not trained. All caregivers then performed HIV status disclosure to their HIV positive children, and children’s disclosure and adherence to ART status established. We used semi structured questionnaires, FGDs and KIIs for data collection and IBM SPSS version 20, logistic regression, chi-square and Nvivo software for data analysis. 
Results: Mean child age was 8 years for both groups, 35 and 37years for caregivers in control and intervention respectively. 409(95%) interventional caregivers had good overall knowledge on disclosure process compared to control (116(27%). Longitudinal viral suppression increased in both groups; intervention group 345(80.2%) to 384(90.1%), control (279(64.9%) to 296(70.1%). Trained caregivers were 2 times (OR-2.369) likely to disclose children’s HIV status. Disclosure training had significant effect (P<0.05) on child’s adherence. Children of trained caregivers were nine times (OR-9.145) likely to have good adherence. Level of education of caregivers (p=0. 035) and knowledge of care givers on the disclosure process (p=0.05) were significantly associated with ART adherence. Disclosure knowledge and lack of disclosure skills were cited in FGDs and KIIs as the major facilitator and barrier to disclosure and ART adherence respectively. 
Unique contribution to theory, practice and policy: The findings provide evidence – based interventions that will guide caregivers, the Ministry of Education and Ministry of Health on how and when to disclose to a child his own HIV status. Disclosure culminates into behavior change which is anticipated to enhance the reduction in the spread of HIV to the next generation and it is one way of sustaining the fight against HIV and AIDS.The study recommends all children in the age bracket of 6-10 years be disclosed to their own HIV status in order to increase their level of adherence to ART.