Disclosure of HIV/AIDS status to infected children in Ghana – A north-south comparison of barriers and enablers

Disclosure of HIV status to infected children plays critical role in child health and wellbeing. This study identifies and compares child HIV disclosure barriers and facilitators in Upper East, Northern and Ashanti regions of Ghana. Prospective data was collected through a questionnaire on 180 caregivers of HIV-infected children 5–18 years from 12 antiretroviral treatment (ART) centres from May 2017 to November 2018 enrolling 89 (49.5%) males and 91 (50.5%) female children. A bivariate and binary multiple logistic regression analysis was performed to test child and caregiver related variable with disclosure. A total of 42 (23.3%) children with a median age of 12 years had been disclosed to. The median age of 138 undisclosed children was 7 (IQR = 5–11) years. The median age at disclosure was 9.5 (IQR = 6–11) years in contrast to 16.3 years, which was proposed as the intended age of disclosure by caregivers. Approval for child status disclosure to be facilitated by only child’s family member differed significantly between caregivers from northern Ghana and southern Ghana (17% vs 83%, p < 0.03). In the multivariate binary logistic regression, a child questioning caregiver frequently about continuous medication intake (AOR = 19.0, p < 0.01) increased the odds of disclosure. Enablers to disclosure were child age, ART start age and resident region of the care giver. The barriers to disclosure involved limited caregiver knowledge and caregiver notion of non-disclosure as a best interest and child protection decision. Difference in region of residence of the child contributes to enhance or impede child HIV disclosure. This calls for developing appropriate age specific child disclosure-promoting guideline to facilitate disclosure.