Interventions Supporting Disclosure Among Children and Adolescents Living with HIV: A Scoping Review and Realist Synthesis

HIV status disclosure remains a persistent challenge for children and adolescents aged 6-19 years. Disclosure is critical to improving treatment adherence, viral suppression, and psychosocial wellbeing, and promoting informed decision-making. This scoping review aimed to identify evidence on interventions focused on disclosing children's and adolescents' HIV statuses to them, and those supporting them with onward disclosure. We conducted a global scoping review to identify and analyze interventions supporting HIV status disclosure to, and by, children and adolescents living with HIV, identifying 25 interventions. Interventions were categorized into (1) disclosure-specific (directly focused on disclosure) and (2) disclosure-inclusive interventions (involving disclosure within broader support). Realist methods were used to evaluate disclosure-specific interventions; narrative synthesis was used for disclosure-inclusive interventions due to their heterogeneity. Disclosure-specific interventions shared common building blocks, including recognition of autonomy and dignity, tools to enhance engagement, and integration with broader health and social support systems. These contributed to improved confidence, communication, and decision-making among children and adolescents. Disclosure-inclusive interventions frequently employed intergenerational and peer support models, alongside health system strengthening strategies. Findings revealed differences in available evidence for disclosure interventions, with limited adolescent-tailored disclosure-specific interventions and few rights-based paradigms. While interventions to promote disclosure and retention in care aimed to work within participants' support systems, fewer made efforts to bolster these systems or enhance linkages; these approaches require further evidence. Priority actions emerging from the review include enhancing training and education, adopting youth-driven and rights-based approaches, strengthening metrics, and adapting to the evolving HIV landscape.