The Factors Influencing the HIV status Disclosure among Children Aged 2 - 14 Years in Songwe region in

2023: A Cross Sectional Study

Filberth F. Ilaza1*, Vicent Josephat J1, Gabriel J. Hatari1, Hendri A. Thobias1, James C. Dotto1, Isamulah M. Kilalo1,
Zablon Zakayo2, Bernard Mbwele2*

Affiliations
1. Medical students
University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), P.O Box 608
Mbeya, Tanzania

2. Department of Epidemiology, Biostatistics and Clinical Research

University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), P.O Box 608
Mbeya, Tanzania

Abstract
Background
HIV status disclosure among children on antiretroviral treatment has been highly associated with the outcome of pediatric
HIV care. There are factors attributing delays or complicated approaches of HIV status disclosure among children due
to stigma. We aimed to determine the HIV status Disclosure among children in Songwe region of Tanzania.

Methods
The cross-sectional hospital-based was conducted in 6 hospitals in April 2023 to identify the magnitude and factors
affecting HIV status disclosure among children aged 2-14 years. Convenient and Systematic random sampling was used
to identify patient files with data extraction by a validated case report form. Analysis was conducted using STATA v-16
for univariate, bivariate Chi-square, logistic, and finally multivariate logistic regression was executed at 95% Confidence
Interval (95% CI).

Results
A total of 291 children files were studied with age 8.6 ± 4.3 ranging from 0.89 to 14.7 years. A total of 103 children
(35.4%) received disclosure of their HIV/AIDS status while 188 (64.6%) were not disclose their HIV/AIDS status. Among
the disclosed 73 were females (70.9) and 30 males (29.1%) Pearson X2(1) = 49.3, p value <0.001. Age of 5 – 10 years
40 (38.8%) and 10 -14 years 63(61.2%) X2(1) = 92.3, p-value <0.001. WHO stage X2(3) = 55.4, p value <0.001, Viral
Load X2(2) = 115.06, CD4 Count X2 (4) = 1.539, p=0.820. Age of 10-15 years AOR =11.1, 95%CI (1.6 - 73.6), p=0.013,
female AOR = 4.0, 95%CI(1.2 - 13.3) p= 0.024, WHO stage 3 AOR=6.0 95%CI(1.3 - 27.5) p= 0.021, WHO stage 4
AOR=10.3 95%CI (1.7 - 60.0) p= 0.01, Viral Load 0-50 cell/ml AOR = 0.4 95%CI (0.05 - 2.7), p=0.3 Viral Load >1000
copies/ml AOR =28.6 95%CI (7.2 - 112.5) p<0.001.

Conclusion
The disclosure rate is less than half mostly affected by age above 10 years, female sex, higher WHO stage, Viral load
higher than 1000 copies/ml.

Publications
1. A Situational Analysis of Home Delivery among Maasai Communities of Orkesumet, Northern Tanzania: The
qualitative Evidences. Bernard Mbwele, Uswege K. Mwaitebele, Alem Kahsay, Othniel P. Kihako, Samuel J.
Luhunga,
2. Mohamed A. Zuberi, Juhudi R. Athumani, Pauline L. Sylvester, Elinda G. Kuhoga, Zebadia M. Ramadhani,
George R. Jonas, Lillian Kavishe. 2019, 2(1): 1-13. doi: 10.31014/aior.1994.02.01.13

3. Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical
patients in Africa (ASOS-2): a cluster-randomized controlled trial. ASOS-2 Investigators. Lancet Glob Health.
2021 Oct; 9(10):e1391-e1401. doi: 10.1016/S2214-109X(21)00291-6. Epub 2021 Aug 19.PMID: 34418380

4. Quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania: learning from mothers' experiences.
Mbwele B, Ide NL, Reddy E, Ward SA, Melnick JA, Masokoto FA, Manongi R. BMC Pediatr. 2013 May 3;
13:68. doi: 10.1186/1471-2431-13-68.PMID: 23642257

5. Maternal and neonatal outcomes after cesarean delivery in the African Surgical Outcomes Study: a 7-day
prospective observational cohort study. Bishop D, Dyer RA, Maswime S, Rodseth RN, van Dyk D, Kluyts HL,
 Tumukunde JT,Madzimbamuto FD, Elkhogia AM, Mbwele B, Ndonga AKN, Ngumi ZWW, Omigbodun AO,
Amanor-Boadu SD, Zoumenou E, Basenero A, Munlemvo DM, Youssouf C, Ndayisaba G, Antwi-Kusi A, obin
V, Forget P, Mbwele B, Ndasi H, Rakotoarison SR, Samateh AL, Mehyaoui R, Patel-Mujajati U, Sani CM,
Esterhuizen TM, Madiba TE, Pearse RM, Biccard BM; ASOS investigators.Lancet Glob Health. 2019
Apr;7(4):e513-e522. doi: 10.1016/S2214-109X(19)30036-1.PMID: 30879511

6. Bernard Asumwisye Mbwele. Neonatal Health Care: A Rapid Appraisal of Quality of Neonatal Health Care in
Kilimanjaro Region, Tanzania. OMICS Group International, 2015.
http://esciencecentral.org/ebooks/Neonotology/#

HIV Disclosure Odds Ratio Std. Err. z P>z [95% Conf. Interval]
Age
5-9 4.719002 4.892417 1.5 0.134 0.618541 36.00243
10 -14 11.12088 10.72685 2.5 0.013 1.679178 73.65147

Sex
Female 4.000487 2.452096 2.26 0.024 1.203288 13.30014

WHO stage
Stage 2 1.74823 1.978805 0.49 0.622 0.190166 16.07183
Stage 3 6.017807 4.669161 2.31 0.021 1.315221 27.53454
Stage 4 10.29809 9.261057 2.59 0.01 1.767148 60.01238

VLCat2
VL <50 copies 0.378138 0.379443 -0.97 0.332 0.052907 2.702648
/ml
VL >1000 28.58415 19.98745 4.79 0 7.259774 112.5453
copies / ml

Dr. Bernard Mbwele is an Epidemiologist and Clinical Researcher at the University of Dar es Salaam (UDSM-MCHA).
He has been trained in Medicine at UDSM and Clinical Research at Tumaini University, KCMUCo then quality of care
at Radboud University, the Netherlands, and Multidisciplinary Health sciences at Stellenbosch University in Cape Town,
South Africa. He is a research fellow for Patient-Centered Outcome Research (PCOR) at MUHAS and Northwestern
University focusing on PMTCT. He is a research collaborator at University College London (UCL) for Obstetric
Hemorrhage management as a Co-PI for the London - Mbeya Obstetric Project. He is a senior program manager for the
C-Safe Program and a national Lead in Tanzania in collaboration with an Indian team through the WHO Collaborating
Center for Women’s Health at Birmingham University. A national lead for the African Surgical Outcome studies in
Tanzania in collaboration with the University of Cape Town.

He works for the University of Dar es Salaam - Mbeya College of Health and Allied Sciences based in Mbeya. He has
published more than 20 articles on Reproductive Maternal Newborn and Child Health as well as Surgical Outcome
studies in Africa. He has recently led Chapter 4 and Chapter 25 of the Tanzanian Standard Treatment Guideline and
National Essential Medicine List (STG & NEMT) using AMR reports in Tanzania. He has also been collaborating with
Antwerp University and the Northumbria University Newcastle for Global PPS use in AMS - Mbeya, Tanzania.