Determinants of HIV Status Disclosure to Adolescents in Western Kenya: Developing an Evidence-based Disclosure Guide

HIV status disclosure to adolescents living with Human Immunodeficiency Virus (ALHIV) is essential for adherence to ART treatment and psychosocial well‑being yet it remains delayed in high‑burden settings. This study examined the rate and timing of HIV status disclosure and identified individual, familial, and socio-cultural determinants influencing HIV status disclosure to adolescents in Western Kenya. A convergent parallel mixed?methods design was used. Quantitative data were collected from 310 caregivers of ALHIV aged 10–19 years attending three health facilities in Bondo Sub?County using structured questionnaires. Qualitative data were obtained through eight focus group discussions (64 caregivers) and 10 key informant interviews with healthcare providers. Quantitative data were analysed using multivariate logistic regression with quadratic age terms, while qualitative data were analysed thematically. Integration was achieved through joint displays and a weaving approach. The HIV status disclosure rate was 74.5%, yet disclosure was delayed in early adolescence: only 1.8% of adolescents aged 10–12 years had been disclosed to, compared with 60.5% of those aged 13–14 years and 96.3% of those aged 15–19 years (mean disclosure age: 11.8 years). Age demonstrated a strong non?linear association with disclosure (quadratic aOR = 0.70, 95% CI: 0.59–0.83; p < 0.001). Independent predictors of disclosure included caregiver training the strongest modifiable determinant (aOR = 15.61)—caregiver confidence in discussing HIV (aOR = 2.42), access to adolescent peer support groups (aOR = 3.33), facility of care (aOR = 2.96), and perceived adolescent emotional maturity (aOR = 1.52), while fear of psychological distress emerged as the dominant barrier (aOR = 0.27). Although 34.6% of adolescents experienced initial distress following disclosure, 93.9% demonstrated improved ART adherence and 92.6% improved emotional well-being. Findings showed HIV disclosure decisions depended on caregiver capacity and health system support. In Western Kenya, adolescent disclosure remains delayed beyond guideline recommendations, with age serving as a threshold. Effective disclosure requires alignment between adolescent emotional readiness, caregiver preparedness, and supportive health system structures. An evidence-based disclosure guide was developed comprising three-core components: readiness-based assessment integrated with caregiver capacity building, family-engaged disclosure planning, and health-system enabling with structured post-disclosure support. This framework reconceptualises HIV disclosure from an age-driven expectation to a system-dependent process. There is need to implement structured HIV disclosure approaches that integrate readiness-based assessment, systematic caregiver capacity building, and strengthened adolescent peer support systems. Disclosure should be initiated earlier through individualised, and informed planning. Lastly, trauma-informed post-disclosure follow-up should be embedded within routine care to address initial distress and sustain improvements in adherence and emotional well-being.