“It’s a very, very thorny issue … ”: healthcare providers’ experiences, challenges, and insights on HIV status disclosure to children and adolescents living with HIV from across 12 African countries

<b>ABSTRACT</b>Knowing one's HIV status is associated with better outcomes for children and adolescents living with HIV (CALHIV). The World Health Organization (2021) recommends that adolescents be counselled about the potential benefits and risks of disclosing their HIV status. CALHIV who are fully disclosed to by an appropriate age have better retention in care and better psychosocial outcomes. Most disclosures occur in health system settings, with healthcare providers playing a key role in the disclosure process. This study draws on insights from participants in the Paediatric-Adolescent Treatment Africa (PATA) Summit - a convening of healthcare providers caring for CALHIV. The study explores disclosure-related experiences under three primary themes: (1) perspectives on managing patients and families; (2) healthcare provider skills in facilitating disclosure; and (3) foundations for healthy disclosure. Cross-cutting issues included the importance of developmentally appropriate communication, balancing risks and benefits, addressing stigma, and strengthening pre- and post-disclosure support. Findings were mapped onto a socioecological model that identified barriers and facilitators at the child/adolescent, caregiver/family, healthcare provider, and community levels. Stigma and the temporal nature of disclosure were cross-cutting across all levels. Findings highlight the multifaceted nature of disclosure and the necessity for a coordinated, multisectoral approach that extends beyond health facilities.