Disclosure of HIV status to children on antiretroviral therapy: Perspectives and experiences of healthcare providers in the Masaka region, Uganda

BACKGROUND: This study explored healthcare providers' perspectives and experiences regarding HIV status disclosure to children receiving antiretroviral therapy (ART) in the Masaka region of Uganda. Despite national and World Health Organization (WHO) recommendations to disclose HIV status by age 12 years, disclosure rates remain low in Uganda. Understanding providers' views is critical, given their central role in supporting caregivers and children throughout the process. METHODS: The study employed a qualitative design, drawing on key informant interviews (KIIs) with 18 purposively selected healthcare providers that included, medical officers, clinical officers, nurses, and counsellors. Data were analysed thematically following Braun and Clarke's approach. RESULTS: Two overarching themes emerged: HIV disclosure enablers and impediments. HIV disclosure enablers included the availability of national disclosure guidelines, integration of disclosure activities into routine ART clinic practice, provision of safe psychosocial spaces for children and caregivers, and the presence of structured peer support networks led by young people with HIV. These elements facilitated developmentally appropriate, emotionally supportive, and systematic disclosure. Conversely, HIV disclosure impediments included unstable or unsupportive home environments, domestic violence, child schooling and extended stays with relatives, prioritisation of disclosure only for children with high viral loads, lack of standardised facility-level disclosure protocols, and role ambiguity between caregivers and providers. Such barriers often delayed or undermined the process, leaving many adolescents unaware of their HIV status despite being on lifelong treatment. DISCUSSION: The findings underscore that paediatric HIV disclosure is a complex, multilevel process shaped by structural, psychosocial, and contextual factors. Strengthening health system structures through standardised guidelines, continuous provider training, and clear role delineation, combined with psychosocial interventions such as providing social and psychological spaces for clients to vent their issues and strong child peer support, can enhance disclosure practices. Tailored approaches for children in schools and extended family settings are also essential for improving adherence, retention, and long-term well-being among children with HIV.