CIRA Talk: "Sankofa 1 and 2 - Implementation Research to Optimize Disclosure of HIV Status to Children in Ghana"

Disclosing HIV status to HIV‐positive children is a major challenge facing families and healthcare providers. Despite recommendations for disclosure, rates remain low. We developed and tested a clinic‐based disclosure intervention, Sankofa, delivered as an integral component of routine care in Ghana (NIH/NICHD, R01HD074253). At one year (primary endpoint), 51.4% of children in the Sankofa group had been disclosed to versus 16.2% in the control (p<0.001). While highly promising, the Sankofa intervention was only examined in a single site under optimal conditions. In an ongoing study (NIH/NICHD, R01HD103512), we are building on the successful Sankofa trial by testing the intervention in a larger scale study delivered under “real‐world” clinic conditions. A pragmatic, stepped wedge cluster randomized trial is being conducted in 12 HIV pediatric clinics in Ghana. We are recruiting dyads of 720 children (ages 7‐18) and their caregivers. Our findings will further a scientific understanding of the mechanisms of action, cost, and individual (child and caregiver), and organizational‐level facilitators and barriers to effective and sustainable delivery of the intervention in a variety of clinical settings. This session will elaborate on background and methods.