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. 2021 Apr;68(4):713-718.
doi: 10.1016/j.jadohealth.2020.10.010. Epub 2020 Nov 10.

Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic

Keerti L Dantuluri  1 , James G Carlucci  2 , Leigh M Howard  2 , David P Johnson  3 , Hillary Spencer  2 , Neerav A Desai  4 , Kathryn A Garguilo  2 , Gregory J Wilson  2
Affiliations

Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic

Keerti L Dantuluri et al. J Adolesc Health. 2021 Apr.

Abstract

Purpose: The purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11 years who undergo developmentally appropriate disclosure about their HIV status.

Methods: A quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11 years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data.

Results: Before the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11 years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11 years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%.

Conclusions: Several interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.

Keywords: Adolescent health; Disclosure; HIV; Quality improvement.

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Conflict of interest statement

Conflicts of interest: None of the authors have any conflicts of interest.

Figures

Figure 1.
Figure 1.
The gray box highlights the section of the plan within the HIV clinic note template where providers are prompted to document disclosure status and plan.
Figure 2.
Figure 2.
The blue line represents the percentage of YLWH aged ≥11 years disclosed at the time represented on the horizontal axis, the red line represents the baseline percentage of disclosed YLWH before the initiation of the project (57%), and the green line represents the goal percentage of YLWH to be disclosed (≥80%). Gray arrows indicate the interventions/PDSA cycles.
Figure 3.
Figure 3.
Panel A represents the distribution of ages of undisclosed YLWH before the start of the QI project, in July 2018. Panel B represents the distribution of undisclosed YLWH after the end of the QI project, in March 2020. The x-axes represent the age of YLWH, and the y-axes represent the number of undisclosed YLWH for each age. Undisclosed YLWH aged ≥11 years are represented to the right of the red vertical line.
Figure 4.
Figure 4.
The blue line represents the percentage of undisclosed YLWH of all ages with documentation of their HIV status at the time represented on the horizontal axis, the red line represents the baseline percentage of undisclosed YLWH with documented status before the initiation of the project (0%), and the green line represents the goal percentage of undisclosed YLWH to have a documented status (100%). Gray arrows indicate the interventions/PDSA cycles.
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References

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