Healthcare workers' perspectives and practices regarding the disclosure of HIV status to children in Malawi: A cross-sectional study

Background: In 2011 the World Health Organisation recommended that children with a diagnosis of HIV be gradually informed about their HIV status between the ages of 6 and 12 years. However, to date, literature has focused mainly on primary caregiver and child experiences with HIV disclosure, little is known about healthcare workers' perspectives and practices of HIV status disclosure to children. The aim of this study was to assess healthcare workers' perspectives and practices regarding the disclosure of HIV status to children aged between 6 and 12 years in Malawi. Methods: A cross-sectional survey was used to collect data from 168 healthcare providers working in antiretroviral clinics in all government District and Tertiary Hospitals in Malawi. Participants were asked questions regarding their knowledge, practice, and barriers to HIV disclosure. Data were analysed using binary logistic regression. Results: Almost all healthcare workers (98%) reported that it was important to disclose HIV status to children. A significant proportion (37%) reported that they had never disclosed HIV status to a child and about half estimated that the rate of HIV disclosure at their facility was 25% or less. The main barriers to disclosure were lack of training on disclosure (85%) and lack of a standard tool for disclosure (84%). Female healthcare workers (aOR) 2.4; 95% CI: 1.1-5.5) and lack of training on disclosure (aOR 7.7; 95% CI: 3.4-10.7) were independently associated with never having disclosed HIV status to a child. Conclusions: This study highlights the need for providing appropriate training in HIV disclosure for healthcare workers and the provision of standardised disclosure materials

Endemic mycoses in americas

American continent concentrates important endemic mycoses, both systemic and subcutaneous, such as coccidioidomycosis, blastomycosis, histoplasmosis, paracoccidioidomycosis and sporotrichosis. The common factor among these mycoses is the dimorphic nature of their etiologic agents, like Coccidioides spp., Blastomyces spp., Histoplasma spp., Paracoccidioides spp. and Sporothrix spp., respectively. Human and animal coccidioidomycoses are found in the USA (states of California, Texas, Arizona and New Mexico), Brazil (states of Piauí and Ceará) and Argentina (states of Catamarca, Santiago del Estero, San Luis and Córdoba). Blastomycosis is restricted to North America, mainly in the valleys of the Mississippi and Ohio Rivers of the USA, and is predominantly observed in dogs. Cases of classical histoplasmosis in humans and animals occur mainly in the USA (Mississippi, Missouri, Ohio River valley), Canada (Ontario and Montreal) and in some regions of Latin America (Colombia and Brazil). Paracoccidioidomycosis is the most important systemic mycosis in Latin American countries, highlighting Brazil, Colombia, Venezuela and Argentina. It predominantly affects humans, despite some cases of animal disease being recently reported. In Brazil, there was a special situation concerning sporotrichosis, where thousands of cases of human disease were transmitted due to cat scratches, characterizing a great epidemic of zoonotic transmission. The most prevalent species reported was Sporothrix brasiliensis which is considered to be one of the most virulent species of Sporothrix species complex.Laboratory of Medical Mycology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Fungal Biology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Medical Mycology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Fungal Biology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/Botucat