Introduction
HIV illness, infected with HIV globally, HIV disclosure
In 2021, there were approximately 1.7 million children living with HIV and 160,000 children newly infected with HIV globally (Despite the clear importance of disclosure for children living with HIV, most adolescents in resource-limited settings remain undisclosed. Up to 50% of adolescents across studies in low and middle-income countries were told non-HIV related reasons for HIV illness and healthcare visits (Interventions focused on HIV disclosure have been developed across the world—including in Kenya (Based on this literature, it is well-understood that HIV disclosure interventions are successful in improving disclosure rates and play an important role in supporting the overall health and wellbeing of adolescents living with HIV. Yet, an important assumption remains unquestioned from existing research: is the action of disclosure itself, or participation in a disclosure intervention, more predictive of improved health outcomes? In other words, does disclosure matter after a dedicated HIV disclosure intervention, or could these same outcomes be found from participation in the intervention even without disclosure? Relatedly, are there common characteristics among caregivers who decide to disclose post-intervention, and are these relevant to their child's post-disclosure outcomes?This study attempts to answer these questions by employing instrumental variable analysis to isolate disclosure as an independent variable separate from intervention participation using data from a cluster-randomized controlled trial of an HIV disclosure intervention conducted in Kenya from 2013–2015 (