Healthcare workers’ perspective about barriers and facilitators to pediatric HIV status disclosure in eastern Uganda using Capability Opportunity and Motivation of Behavior change model

Abstract

Background HIV status disclosure by caregivers to children and adolescents living with HIV (CALH) remains a public health concern in countries with a high burden of HIV despite guidelines for healthcare workers to facilitate the process. Objective This study aimed at exploring barriers and facilitators to HIV status disclosure experienced by healthcare workers (HCWs) at two large regional referral hospitals in eastern Uganda with special focus on utilization of guidelines by World Health Organization and Uganda Ministry of Health. Methods Qualitative in-depth interviews were conducted among all healthcare workers involved in management of CALH at three hospital-based pediatric HIV clinics. Trained research assistants collected data using a pilot tested semi-structured interview guide designed basing on the capability, opportunity and motivation of behavior change model. The audio recorded interviews were transcribed verbatim and analyzed thematically based on the social ecological model using inductive content approach with Atlas ti software. Results A total of 16 in-depth interviews were conducted among healthcare workers including both male and female in equal numbers. The barriers to disclosure were categorized into five levels; 1) individual level: internalized/anticipated stigma of HIV, 2) interpersonal level: anticipated stigma of HIV among caregivers, 3) institutional level: lack of preparatory procedures and training for HIV status disclosure, 4) community level: enacted HIV stigma and unstable home environment for CALH and 5) policy level: limited health funding and access to disclosure guidelines by HCWs. On the other hand, facilitators were mainly at three level; 1) individual level: orphanhood status of the child, emotional reward to HCWs, and HCWs’ awareness of responsibilities, 2) interpersonal level: peer support for CALH, their caregivers and HCWs and teamwork among HCWs and 3) institutional level: disclosure related checklist, monitoring and supervision of HCWs. Conclusion The findings highlighted several potentially modifiable factors which when addressed, or reinforced HIV status disclosure among CALH and utilization of existing guidelines can be improved. There is need to conduct more research regarding the implementation of the existing pediatric HIV status disclosure guidelines in Uganda.