Disclosure Of HIV-positive Status Research Articles

Prevalence of and Risk Factors for Intimate Partner Violence in the First 6Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda.

Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positivestatus. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.

HIV positive status disclosure and associated factor among HIV infected children in pediatric ART clinics in Gondar town public health facilities, North West Ethiopia, 2018

BackgroundDue to the increasing availability of antiretroviral treatment, HIV infected children are living longer which points out the necessity of disclosure. And which is important to support the uptake and adherence to treatment. Disclosure is an important measure to prevent secondary transmission when children are sexually active. ObjectiveThe aim of this study was to determine the prevalence of HIV positive status disclosure and associated factors among human immune virus-infected children in pediatric antiretroviral treatment clinics in Gondar town public health facilities. MethodAn institution based cross-sectional study was conducted among 449 primary caregivers of children aged 6–15years in regular follow-up at pediatric ART clinics in Gondar town public health facilities between March 3, 2018, to April 25, 2018. All subjects in the study area were included in the study. Data was collected in 5 pediatric ART clinics in Gondar town by structured questionnaires through face to face interview and supplemented by chart review to obtain some clinical factors. The variables which have an association with disclosure were identified on the basis of AOR, with 95%CI and p-value <0. 05. Model fitness was checked using Hosmer and Lemeshow goodness of fit test. ResultOut of 449 participants, 418 were interviewed with response rate of 93%. The prevalence of HIV positive status disclosure found to be 44%. Age of child >10years [AOR=5.88, (95% CI: 3.52, 9.81)], duration on ART [AOR=2.67 (95% CI: 1.59, 4.51)], place of follow-up [AOR=2.23 (95% CI: 1.27, 5.01)] and educational status of caregiver [AOR=3.00 (95% CI: 1.62, 5.56)] were identified variables. ConclusionThe prevalence of disclosure found to be low. Therefore appropriate measure should be taken to promote disclosure.

Disclosure of Human Immunodeficiency Virus Serostatus to the Patient; Issues for Laboratory Staff

Background: The disclosure of positive HIV status to a patient is not an easy task. In the developed world with established protocols for doing this, it becomes relatively simpler to present the results to the patient. In underdeveloped countries like Pakistan, it is not easy for the laboratory personnel in particular to convey such results to the patient. Case Presentation: The problem has been discussed in the light of two cases presenting to Shalamar Teaching Hospital. The first case is an example of “Provider referral” and the second one the “Self-referral”. At the end, recommendations are made to effectively handle the situation in an underdeveloped setup like Pakistan. Discussion: Complete knowledge of the disease is an essential requirement for anybody from the pathology department contemplating this responsibility. In addition, all communications should be in the local language and the counselor must be able to address all the questions/concerns raised by the patients and/or their families. The counselor learns the skill more through supervised training rather than a taught course. Conclusion: This responsibility should be accepted only if the laboratory staff has no other option.

Disclosure of HIV Positive Status: A Challenge Facing HIV Control, Alexandria, Egypt

Disclosure of HIV Positive Status: A Challenge Facing HIV Control, Alexandria, Egypt

Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life

ABSTRACTHIV-related stigma and the effect on quality of life is an on-going public health concern despite decades of education, prevention, and intervention efforts. The main purposes of this study were to examine the mediating role of four coping styles and the moderating role of gender on the relationship between HIV-positive status disclosure concerns and eight health-related quality of life outcomes. Data were collected from 346 women and men living with HIV. Results indicated that two coping styles – acquiring social support and positive reframing – mediated the negative relationship between disclosure concerns and health-related quality of life outcomes. There was no support for a moderated mediation. Interventions aimed at helping people living with HIV should focus on identifying and acquiring coping styles that transform perceptions of HIV-related stigma to support disclosure and improve health-related quality of life.

HIV Disclosure: HIV-positive status disclosure to sexual partners among individuals receiving HIV care in Addis Ababa, Ethiopia.

IntroductionDisclosure of HIV status to sexual partners can help HIV prevention efforts and enable HIV positive people to receive social support, as well as increasing access and adherence to treatment. This study was conducted to determine the rate, processes, outcomes, and correlates of HIV status disclosure to sexual partners among HIV positive individuals.MethodA cross-sectional study was conducted between September and November 2015 at two HIV outpatient clinics in Addis Ababa, Ethiopia. Data were collected using an interviewer- administered semi-structured questionnaire. Logistic analysis was used to determine the independent correlates of serostatus disclosure.ResultsOf 742 participants, (371 men and 371 women), 727 (98%) were on antiretroviral therapy and 676 (91.1%) had at least one sexual partner since their HIV diagnosis, of whom 558 (82.5%) had disclosed their HIV status to their most recent sexual partner. Of those who reported having disclosed their status to their most recent sexual partner, 82 (14.7%) had at least one unprotected sexual encounter with the partner, after HIV diagnosis but prior to disclosure. The most commonly reported initial outcome of disclosure was gaining emotional and/or financial support. Some (11.3%) also reported that their disclosure immediately initiated their partner for HIV testing. Negative outcomes to disclosure, such as stigma and discrimination, were more common among females (26.2%) compared to males (12.7%). In the multiple regression analysis, disclosure was associated with greater condom use, greater social support, knowing the partner’s HIV status, having a good relationship with the partner, and cohabiting with the partner.ConclusionHIV disclosure was common amongst participants, although sometimes delayed, with possible consequences for onward transmission. Fear of negative outcomes, such as verbal abuse and physical violence, were major barriers to disclosure. Efforts to support disclosure have the potential to contribute to HIV control and prevention by encouraging safer sexual practice, initiating partners for HIV testing, and enhancing support for people living with HIV.

Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women.

Background:Kenya has the fourth-largest HIV epidemic across the globe. Disclosure of HIV-positive status plays a critical role in the prevention of HIV transmission. Disclosure, specifically to sexual partners, has been shown to foster safer sexual behaviors in addition to emotional, social, or monetary support from partners.Objective:This study was conducted to identify factors associated with HIV-positive status disclosure to sexual partners compared to disclosure to other than sexual partners.Methods:A cross-sectional study was conducted from May to August 2012 among 497 HIV-positive women 19–49 years of age who had sex in the past six months. Participants were recruited from the Kenyatta National Hospital and Mbagathi Direct Hospital in Nairobi, Kenya. A questionnaire was administered to obtain data on HIV disclosure. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with disclosure of HIV-positive status to sexual partners.Results:Of the 497 women, 349 reported to whom they had disclosed their HIV status. Approximately 34% had disclosed their HIV-positive status to a sexual partner. Women who disclosed to their sexual partners were 11 times more likely to be married or in a common-law relationship and 4 times more likely for their sexual partner or spouse to be the heads of the households. Frequency of condom use, belief that HIV disclosure is important for HIV prevention and control, knowledge of partner’s HIV status, and number of sex partners were also significantly associated with disclosing to a sexual partner.Conclusion:This study found a low rate of disclosure of HIV-positive status by women to sexual partners and identified a number of factors associated with disclosure to sexual partners. These findings can be used in designing interventions that focus on individuals who have not disclosed their HIV-positive status to their sexual partners by demonstrating the importance of disclosure and safe sex practices.

The Metamorphosis of People Living with Human Immunodeficiency Virus (HIV)

The present study aimed to investigate the lived experiences of beingHIV positive; to describe common themes of experiences of being HIVpositive; and to analyze the meaning of experiences of being HIV positive.The participants of this study were five HIV-positive men under the careof the Department of Health (DOH) Region VI in Iloilo City. Specifically,they belonged to the United Western Visayas Incorporated (UWVI), acommunity-based group of people living with HIV (PLHIV) based in Iloiloand operating in Panay and Guimaras areas. Narrative writing encouragedthe participants to rummage through emotions tied to being HIV positive.This gave them the chance to revisit strong feelings without divulging theiridentities, thus protecting their anonymity. Eight main textural themesemerged from the lived experiences of these men, namely: disclosureof HIV-positive status; stigma and discrimination attached to HIV; socialsupport from family, friends, and others; depression accompanying thediagnosis; the physical symptoms experienced during seroconversion;antiretroviral therapy after the diagnosis; and HIV advocacy with UWVI.These HIV positive men have metamorphosed, from the acceptanceof their HIV positive status to reinventing their new reality and findingpurpose through their HIV advocacy. The findings suggest implications forsupportive counseling to provide empathy, support and encouragement,and developing specific coping strategies with PLHIV.

2196. Effect of Depression, Anxiety, Stigma, and Disclosure on Quality of Life Among People Living with Hepatitis B Infection in Dalian, China

BackgroundIn China, chronic hepatitis B virus (HBV) infection is a major public health problem with ~6% of the population chronically infected. We investigated the effect of depression, anxiety, stigma, and disclosure on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in Dalian city, Liaoning, China.MethodsUsing a cross-sectional study design, 401 subjects with CHB were studied from January 2017 to September 2017. Study measures included Beck depression and anxiety inventory, WHOQOL-BREF, Toronto Chinese HBV Stigma Scale, and a questionnaire, which collected sociodemographic characteristic and disclosure of positive HIV status to sexual partners. The primary outcome was HRQoL score. A linear regression model examined the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and socio-demographic factors. Stigma, disclosure, depression, and anxiety are the covariates of interest. Age, sex, education, medical insurance, cirrhosis, other chronic diseases, and years of diagnose were adjusted in the model.ResultsMajority of participants were males (251, 62.59%). married (37.41%), and completed high and middle school (67%). Four factors of Depression, anxiety, stigma and disclosure had negative associated with QOL physical, psychological, social and environmental domains (P < 0.05) among CHB patients. Depression was the independent factor significant negative associated with HRQoL (P < 0.0001). Patients’ age had a significantly negative association with HRQOL in the psychological domain (P = 0.0083). Patients”education level had a significantly positive association with HRQOL for all four domains.ConclusionOur study is the first time to evaluate psychosocial factors affecting the HRQOL among people living with CHB in Dalian. Depression significantly affects the HRQOL among people living with CHB in Dalian, China warranting the urgent need for screening, early diagnosis, and implementation and integration of psychological interventions as part of routine care.Disclosures All authors: No reported disclosures.

Human immunodeficiency virus infection disclosure status to infected school aged children and associated factors in bale zone, Southeast Ethiopia: cross sectional study

BackgroundHuman immunodeficiency virus (HIV) positive status disclosure is an essential component of Pediatric care and long term disease management. Children have a right to know their HIV diagnosis result. However, Pediatric HIV disclosure is complex and varies in different communities. This study aimed to assess the prevalence of HIV-positive status disclosure to infected children and associated factors among caregivers of infected children.MethodologyA facility based mixed methods research design study was conducted in Bale Zone of South East Ethiopia. Randomly selected caregivers of HIV-positive children were interviewed using structured questionnaires for quantitative study and 17 in-depth interviews of health care workers and caregivers were conducted for qualitative data. Content analysis was done for qualitative data and logistic regression analysis was used to see the association between different variables and HIV-positive disclosure status. Odds ratio with 95% CI was computed to determine the presence and strength of the associated factors.ResultsA total of 200 caregivers of school aged (6–14 years) children participated in the study. Only 57 (28.5%) of the care givers disclosed HIV-positive status to the child for whom they were caring. The main reason for disclosure delay was due to fear of negative consequences, perception on maturity of the child, and fear of social rejection and stigma. Having social support [AOR = 2.7, 95% CI: (1.1–6.4)], caring for a child between 10 and 14 years with HIV [AOR = 6.5, 95% CI: (2.1–20.2)], a child diagnosed with HIV at age > 5 years [AOR = 2.8, 95% CI: (1.1–7.1)], and children on antiretroviral therapy (ART) with follow-up for > 5 years [AOR = 4.7, 95% CI: (1.8–11.2)] had significant association with HIV- positive status disclosure to infected children.ConclusionThe frequency of HIV infection disclosure to infected children was very low in our cohort. Having social support, having an older child with HIV, a long period of ART follow-up and HIV diagnosis after age of five years were positively associated with HIV-positive status disclosure to infected children. Giving age appropriate counselling to children, social support to the caregivers and working on related factors are very important to improve the observed low disclosure status.

Factors Affecting Intention to Disclose HIV Status among Adult Population in Sarawak, Malaysia.

Background Disclosure of HIV-positive status is an essential prerequisite for the prevention and care of person living with HIV/AIDS as well as to tackle hidden epidemic in the society. Objective To determine the intention to disclose the HIV/AIDS status among adult population in Sarawak, Malaysia, and factors affecting thereof. Methods This cross-sectional community-based study was conducted among adult population aged 18 years and above in Sarawak, Malaysia. A gender-stratified multistage cluster sampling technique was adopted to select the participants. A total of 900 respondents were successfully interviewed by face-to-face interview using interview schedule. Stepwise binary logistic regression models were fitted in SPSS version 22.0 to identify the factors associated with the disclosure of HIV/AIDS status. A p value less than 0.05 was considered as statistically significant. Results The mean (SD) age of male and female respondents was 41.57 (13.45) and 38.99 (13.09) years, respectively. A statistically significant difference of intention to disclosure of HIV status was found between males and females (p < 0.05). A stepwise binary logistic regression analysis revealed that age, occupation, knowledge on HIV transmission, and content of discussion about HIV/AIDS appeared to be potential predictors for male respondents to disclose HIV status, while ethnicity and content of discussion on HIV/AIDS were found to be important predictors among the female respondents (p < 0.05). Conclusion and Recommendation Though the study did not depict the national prevalence of disclosure of HIV/AIDS status, the findings of the study would provide an important basic information for programme intervention, policy, and future research agenda.

Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study

ObjectivesThe aim of this study was to assess the level and factors associated with caregivers’ disclosure of perinatally HIV-infected (PHIV+) children’s seropositive status.DesignWe conducted a cross-sectional study in five public...

Patterns and predictors of disclosure of HIV positive status among youth living with HIV in Ibadan, Nigeria.

Background Information on disclosure of HIV status among youth is sparse in spite of the fact that they bear a significant burden of the HIV epidemic. Our objective was to determine the predictors of HIV disclosure among youth aged 18-35 years in Ibadan, Nigeria. Methods A cross-sectional study was conducted among youth with HIV attending two HIV support groups and one ARV clinic in Ibadan, Nigeria. Information was obtained with the aid of an interviewer-administered questionnaire. Descriptive and analytic statistics were conducted. Results There were 170 clients with a mean age of 29.6 ± 3.9 years; 140 (82.4%) were female and 139 (81.8%) had disclosed their status. Common people first informed included respondents' mother 49 (35.3%), spouse 39 (28.1%) or father, 38 (27.3%). Disclosure to an unmarried sexual partner was low as only six (12.0%) of the 50 single youth who had a current sexual partner had disclosed their status to him/her. Youth who were aware that their spouse/partner was HIV positive (OR = 9.87; CI = 1.09-88.83) or negative (OR = 9.98; CI = 1.18-84.70) were more likely to have disclosed their status than those unaware of their spouse/partners' status. Disclosure was also higher among members of an HIV support group (OR = 3.32; CI = 1.03-10.72). Conclusions Many respondents had disclosed their status although disclosure to an unmarried sexual partner was low. Interventions to improve HIV disclosure especially among unmarried sexually active youth could improve disclosure and overall management of HIV in our study area.

Outcomes and Factors Affecting HIV Status Disclosure to Regular Sexual Partner among Women Attending Antiretroviral Treatment Clinic

Introduction: HIV infected individuals face a number of challenges when they disclose their sero-status. Although discloser improves access to HIV prevention, increased opportunities for risk reduction and increased opportunities to plan for the future, HIV positive status discloser is lower in developing countries. Objective: To assess outcomes and factors affecting HIV status discloser to regular sexual partner among women attending anti-retroviral treatment clinic at Hawassa university comprehensive specialized hospital. Method and materials: An institution based cross sectional study was conducted among 191 randomly selected HIV positive women attending Hawassa university referral hospital ART Clinic from Mar 1 –Mar 30 in 2017. The data was collected after having ethical clearance letter from institutional review board and consent from client. Data were collected through interview using pre-tested questioners. The collected data was analyzed by using SPSS version 20. Bivariate and multivariate logistic regressions were done and final significantly associated factors were identified on the basis of OR with 95% CI. Results: over all 72.9 of the women has disclosed their HIV status to sexual partners. Among those disclosed their HIV positive status, 54.1% get their freedom to have follow up. While 30% get their freedom to use condom. Negative outcomes associated with status disclosure were stigma 11.6%, discrimination 10.1% and psychological violence 5%.Women who had rough relation with her 89% less likely to disclose their status as compared to women with smooth relationship (AOR=0.11 955CI 0.01, 0.119). Women who had children were 9.89 times more likely to disclose their status to sexual partners than their counter parts (AOR 9.89, 95% CI 2.68, 36.36 ).women who received counseling were almost 7 times more likely disclose their HIV status to their sexual partner (AOR=5.63 95%CI 2.24, 14.13) . Conclusion: HIV positive status discloses to sexual partners was found to be low.HIV status disclosure was accompanied by both negative and positive consequences. Presence of offspring, counseling, relationship status before status disclosure was factors associated with HIV positive status disclosure.

Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa

ABSTRACTDisclosure of HIV status remains one of the major challenges to the effectiveness of the prevention of mother to child transmission of HIV in rural areas in South Africa. This study aimed at assessing the determinants of HIV status disclosure among HIV infected pregnant women who have disclosed their HIV status to someone, as well as among those who have disclosed to their partners. Cross-sectional data was collected from 673 HIV sero-positive pregnant women receiving antenatal care services at 12 Community Health Centers in Mpumalanga province. Results indicated that over two-thirds (72.1%) disclosed their status to someone, while just over half (58.4%) disclosed to their partners. Multivariate analysis showed that both disclosure of ones HIV status to someone and to their male partners was significantly associated with increase in antiretroviral therapy (ART) adherence, the known HIV positive status of their partner, and male involvement during pregnancy. Participants who were diagnosed HIV positive during this current pregnancy were less likely to disclose their HIV status to someone. Non-disclosure during current pregnancy highlights a need for interventions that will encourage disclosure among HIV positive women, with a particular focus on those who are newly diagnosed. The findings also need to integrate male partner involvement and partner disclosure during pregnancy.

Exploring the Experiences of Adolescents on Highly Active Antiretroviral Therapy in Tembisa: A Pilot Study

This study was aimed at exploring the experiences of adolescents who are on long-term Highly Active Antiretroviral Therapy (HAART) treatment in Tembisa, Gauteng province. The study is based on a qualitative research method using in-depth semi-structured open-ended interviews and a focus group for data collection. The sample consisted of three adolescents as this was a pilot study. Thematic data analysis method was used to analyse data. The study findings cover the negative and positive experiences and the perceived role of HAART treatment over a longer period of time. The predominant themes identified from participants were disclosure of HIV-positive status and the stigma surrounding a positive status, early childhood experience of parental death, challenges of taking HAART treatment, factors influencing adherence and non-adherence to HAART treatment, and lastly, the impact of religion on HAART treatment adherence. The findings suggest that adolescents who are on HAART treatment over an extended period of time experience drug fatigue. Drug fatigue has far-reaching implications for the health of adolescents, as it has a higher likelihood that poor adherence or even complete refusal to take HAART treatment will occur. Poor adherence or refusal to take HAART treatment will most likely lead to cross infection and further spread of HIV and AIDS. A recommendation was made to include the establishment of a youth and adolescent-friendly centre by the hospital – one that is designated for the provision of tailored adolescent services and sensitive to adolescent developmental stages so as to minimise the likelihood of infected adolescents falling through the healthcare cracks. The introduction of a hospital-based school, an education unit run by dedicated and qualified facilitators focusing on aiding hospitalised learners with catch-up scholarly programmes, was a further recommendation

HIV Status Disclosure Among Postpartum Women in Zambia with Varied Intimate Partner Violence Experiences.

HIV-positive pregnant and postpartum women's status disclosure to male sexual partners is associated with improved HIV and maternal and child health outcomes. Yet, status disclosure remains a challenge for many women living with HIV in sub-Saharan Africa, particularly those who are fearful of violence. The objective of the present study is to advance the current understanding of the relationship between intimate partner violence against women and their HIV status disclosure behaviors. We specifically evaluate how the severity, frequency, and type of violence against postpartum HIV-positive women affect status disclosure within married/cohabiting couples. A cross-sectional survey was administered by trained local research assistants to 320 HIV-positive postpartum women attending a large public health center for pediatric immunizations in Lusaka, Zambia. Survey data captured women's self-reports of various forms of intimate partner violence and whether they disclosed their HIV status to the current male partner. Multiple logistic regression models determined the odds of status disclosure by the severity, frequency, and type of violence women experienced. Our findings indicate a negative dose-response relationship between the severity and frequency of intimate partner violence and status disclosure to male partners. Physical violence has a more pronounced affect on status disclosure than sexual or emotional violence. Safe options for women living with HIV who experience intimate partner violence, particularly severe and frequent physical violence, are urgently needed. This includes HIV counselors' ability to evaluate the pros and cons of status disclosure among women and support some women's decisions not to disclose.

Determinant factors of HIV positive status disclosure among adults in Axum Health Facilities, Northern Ethiopia: Implication on treatment adherence

Disclosure of HIV positive status to sexual partners, friends or relatives is crucial for HIV prevention and care implementation strategies. Hence, it is important to explore factors determining individuals to disclose their HIV positive status in order to achieve a goal of zero new HIV infection. Facility based mixed cross-sectional study was conducted from July to August, 2013 among 361 HIV positive adults attending Axum Health Facilities. They were selected through systematic random sampling. Data were collected by trained counselors and ART nurses and then entered into SPSS version 20 databases. Bivariate and multivariable logistic regression models were used to identify predictors of HIV positive status disclosure at 95% confidence intervals and p-value of less than 0.05. Among 361 respondents, 289 disclosed their HIV status to someone and 151(41.8%) to intimate partners. In the multivariate logistic regression analysis, variables significantly associated at p-value <0.05 were married; knowing partner’s HIV status and membership in an HIV-Support Group were positive predictors of disclosure. These findings were supported by qualitative study in which fear of discrimination, fear of breaking confidentiality and fear of families make them to conceal their status. The rate of HIV positive status disclosure among HIV positive adults has remained low. Marital status of respondents, knowledge of partners’ HIV status and being member in Anti- HIV/AIDS Association were identified as predictors of HIV positive status disclosure. Addressing the issues of disclosure was recommended to encourage free disclosure and coping with negative reactions, which is a crucial way for adherence to treatment. Key words: Adult, Axum health facilities, Ethiopia, HIV positive disclosure.

Role of male partner involvement in ART retention and adherence in Malawi’s Option B+ program

ABSTRACTMalawi’s Option B+ program provides all HIV-infected pregnant women free lifelong antiretroviral therapy (ART), but challenges remain regarding retention and ART adherence, potentially due to male partner barriers. We explored relationships between male partner involvement and Option B+ retention and adherence. In 2014, a randomized controlled trial in Malawi compared male recruitment strategies for couple HIV testing and counseling (cHTC) at an antenatal clinic. This secondary analysis was conducted among the entire cohort (N = 200) of women, irrespective of randomization status. We assessed whether cHTC attendance, early disclosure of HIV-positive status, and partner ART reminders were associated with retention and adherence at one month after starting treatment. Retention was defined as attending HIV clinic follow-up within one day of running out of pills. Adherence was defined as taking ≥95% of ARTs by pill count. We used binomial regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Median female age was 26 years. Most women (79%) were retained; of these, 68% were adherent. Receiving cHTC was associated with improved retention (aRR 1.33, 95% CI 1.12, 1.59). Receiving male partner ART reminders was weakly associated with retention (aRR 1.16, 95% CI 0.96, 1.39). Disclosure within one day was not associated with retention (aRR 1.08, 95% CI: 0.91, 1.28). Among those who were retained, these three behaviors were not associated with improved 95% adherence. CHTC could play an important role in improving Option B+ retention. Increasing cHTC participation and enhancing adherence-related messages within cHTC are important.

Motivators of couple HIV counseling and testing (CHCT) uptake in a rural setting in Uganda

BackgroundCouple HIV Counseling and Testing (CHCT) is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda.MethodsThe study was conducted in two sub-counties in a rural district (Mukono district) about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT) members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology.ResultsThe study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53) and 49% (26/53) of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC) attendance and preparation for marriage.ConclusionThe motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater attention to enhancers of CHCT programming is needed in trying to strengthen its uptake.