Background Greater access to ART has resulted in more HIV-infected children surviving into adolescence and adulthood. Adolescence is associated with a sense of independence and sexual debut, therefore knowledge of HIV status may improve ART adherence and help in preventing HIV transmission. This study aimed to determine the incidence rate of and factors associated with disclosure in HIV-infected children at the Coptic Hope Center, Nairobi, Kenya.

Methods This was a retrospective cohort of HIV-infected children aged8–14 years unaware of their HIV status at enrollment. Disclosure was defined as knowledge of HIV status as reported by caregiver and confirmed by child, as assessed at every clinic visit. Cox proportional hazards regression models were used to determine incidence rate and factors associated with paediatric disclosure of HIV status during 1-year follow-up.

Results At enrollment, 112 of 136(82%) HIV-infected children were unaware of their HIV-status. Among these, 77 (69%) were 8–10 years of age[median 10.2 years, Interquartile range (IQR), 8.9–11.6]. Disclosure occurred in 46 (41%) of the children. One-year incidence of disclosure per 100 person-years was 67.7 [95% Confidence Interval (CI): 50.7–90.4].Disclosure was more likely to happen to children aged 11–14 years as compared to those aged 8–10 years. Disclosure in children aged 11–14 years was higher in the first 6months, but in children aged 8–10 years, disclosure was higher in the last 6months of follow-up. In multivariate analysis, older age [adjusted hazard ratio (aHR), 1.53, P < 0.001] and WHO stage 3/4 (aHR, 0.48, P = 0.04) were associated with disclosure. Attendance of disclosure sessions was suggestive of increase in disclosure probability (aHR, 3.15, P = 0.11).

Conclusions While paediatric disclosure was low, disclosure sessions may play a role in facilitating disclosure. These results reinforce the continued need for development and evaluation of paediatric disclosure interventions to increase disclosure incidence.