Breaking Down Barriers to Tell: A Mixed Methods Study of Health Worker Involvement in Disclosing to Children That They Are Living with HIV in Rural South Africa

Disclosing to a child that s/he is living with HIV is necessary to promote adherence to treatment and improve health outcomes. Facilitating disclosure between caregivers and children remains a challenge for health workers. Understanding how health workers are involved in and perceive the disclosure process is integral to engaging with such challenges. We held group discussions with and surveyed 73 physicians, nurses, and counselors across 16 randomly selected facilities in two rural South African health districts, exploring their experiences of supporting disclosure between caregivers and children. Ninety percent of those surveyed agreed that children should be informed of their HIV status. Differences between categories of health workers regarding training, involvement in the disclosure process, and perceived responsibility for disclosure support led to inconsistent disclosure practices within facilities. Disclosure-strengthening interventions must consider the composition of the health worker team and the role that each category of health worker performs in their local settings. Hanlie Myburgh, MA, was a Quality Improvement Officer, Anova Health Institute, Paarl, South Africa, and is now a Social Science Researcher, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. (*Correspondence to: hmyburgh@sun.ac,za). Esme Calitz, MBChB, is a Senior Medical Officer, Anova Health Institute, Paarl, South Africa. Jean P. Railton, MBChB, DMH, FCFP, MMed, Dip HIV Man (SA), is a Program Manager; Anova Health Institute, Tzaneen, South Africa. Christina Maluleke, MBChB (SMU), Dip HIV Man SA, MPH (UL), is a Senior Medical Officer; Anova Health Institute, Tzaneen, South Africa. Elizabeth Mashao is a Community Outreach Officer; Anova Health Institute, Tzaneen, South Africa. Patiswa Ketelo is a Data Quality Assistant and HIV Counsellor, Anova Health Institute, Paarl, South Africa. Geoff Jobson, MDev, is a Senior Researcher; Anova Health Institute, Johannesburg, South Africa. Cornelius J. Grobbelaar, MBChB, is a Project Manager; Anova Health Institute, Paarl, South Africa. Helen E. Struthers, MSc, MBA, PhD, is the Chief Operating Officer; Anova Health Institute, Johannesburg, South Africa and an Honorary Research Associate, Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa. Remco P H. Peters, MD, PhD, DLSHTM, Dip HIV Man (SA), is a Clinical Program Specialist, Anova Health Institute, Johannesburg, South Africa. Copyright (C) 2018 Association of Nurses in AIDS Care