HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania

Figures & data

Table 1. Participant characteristics at enrollment and HIV serostatus disclosure over time.

		Newly diagnosed		In established care			Correlates of disclosure^a,c
		Mean (sd) or N (%)		Mean (sd) or N (%)			OR [95% CI]
Number of participants	At baseline	260		492			733
	After 3.5 years	175		435
Gender	Female (vs. male)	179	(68.8%)	335	(68.1%)		0.81 [0.52–1.27]
Age	In years	37.4	(8.9)	41.8	(8.8)	***	1.01 [0.99–1.03]
Education	Any secondary (vs. primary or less)	33	(12.7%)	100	(20.3%)		0.80 [0.48–1.33]
Marital status	Married (vs. all others)	98	(37.7%)	181	(36.8%)		3.04 [1.98–4.65]	***
Residence	Urban (vs. rural)	122	(46.9%)	239	(48.6%)		0.89 [0.62–1.28]
Time since diagnosis (years)		0.4	(1.5)	2.6	(2.0)	***	1.16 [1.02–1.33]	*
SF-8 composite scores	Physical health	44.1	(11.5)	49.4	(8.7)	***	1.01 [0.98–1.03]
	Mental health	47.7	(10.5)	52.6	(7.5)	***	1.00 [0.97–1.02]
Stigma score (higher is worse)		0.5	(0.4)	0.5	(0.3)		0.96 [0.56–1.64]
Lifetime partners	1–2	89	(34.4%)	224	(46.0%)	**	Ref
	3–4	92	(35.5%)	128	(26.3%)		1.39 [0.88–2.20]
	5 or more	78	(30.1%)	135	(27.7%)		1.42 [0.88–2.30]
Commercial sex	Ever (vs. never)	92	(35.4%)	84	(17.1%)		1.04 [0.66–1.63]
Enrollment location	Hospital (vs. community VCT site)	149	(57.3%)				Ref
Treatment location	Regional public hospital			224	(45.5%)		1.84 [1.08–3.15]	*
	Private zonal referral hospital			149	(57.3%)		1.39 [0.71–2.70]
Disclosed HIV status to at least one household member
	… at baseline^a	107	(45.3%)	338	(73.5%)	***
	… after 3.5 years^a,b	115	(74.7%)	343	(83.7%)	*

^aExcludes participants in single-person households.

^bExcludes loss to follow-up; see Table 2.

^cDisclosure as of the last round observed; association evaluated using logistic regression with robust standard errors.

*Statistical significance at the 0.05 level.

**Statistical significance at the 0.01 level.

***Statistical significance at the 0.001 level.

Figure 1. HIV serostatus disclosure and engagement in HIV care during a 3.5-year follow-up period. Note: Statistical significance assessed using Fisher's exact test. ¹Consistently undetectable viral load, threshold of 150 cells/mm³, in up to 4 assessments at baseline, 12, 24 and 36 months, fewer in the case of loss to follow-up; among participants who were on ART at least 180 days prior to enrollment.

Table 2. HIV serostatus disclosure and retention in the HIV treatment cascade during a 3.5-year follow-up period.

	Ever linked to care		Ever had a CD4 count		Ever on ART		Undetectable viral load ^a
(A) Number of participants (%)
Study cohort	Enrolled after a new HIV diagnosis						In established care
Number of study participants enrolled	N = 260						N = 492
Number of participants lost to follow-up	85 (32.6%)						57 (11.6%)
Exclusion criterion	–		Never linked to care		Never linked to care		Not on ART
Met exclusion criterion	–		9 (3.5%)		9 (3.5%)		126 (25.6%)
No other persons in the household	21 (8.1%)		21 (8.1%)		21 (8.1%)		19 (3.9%)
Missing data on key variables ^a	-		-		12 (4.6%)		5 (1.0%)
Number of observations included in analyses	N = 154		N = 145		N = 145		N = 285
(B) Retention in the HIV treatment cascade
Ever linked to care	145 (94.2%)
Ever had a CD4 count			110 (75.9%)
Ever on ART					102 (70.3%)
Consistently undetectable viral load							221 (77.5%)
(C) Multivariate associations^b
With characteristics at enrollment
Age	1.17 [1.03–1.32]*		1.05 [1.00–1.10]		1.04 [0.99–1.09]		1.01 [0.98–1.05]
Female	3.78 [0.85–16.75]		1.15 [0.45–2.89]		0.50 [0.18–1.39]		0.93 [0.47–1.83]
Secondary education	0.61 [0.09–4.08]		0.83 [0.24–2.86]		0.88 [0.28–2.81]		1.39 [0.65–2.97]
Married	0.48 [0.09–2.60]		0.95 [0.41–2.20]		1.20 [0.53–2.73]		0.73 [0.40–1.34]
Urban residence	1.18 [0.26–5.31]		1.13 [0.50–2.57]		1.27 [0.59–2.76]		1.30 [0.74–2.29]
With HIV serostatus disclosure at follow-up
Disclosed to at least one household member	4.75 [1.11–20.26]*		2.6 [1.12–6.04]*		2.56 [1.13–5.79]*		1.10 [0.50–2.42]

Note: Fewer in the case of loss to follow-up; among participants who were on ART at least 180 days prior to enrollment. 230 participants (81%) had 4 assessments; 42 (15%) had 3 assessments; 7 (2%) had 2 assessments and 6 (2%) had 1 assessment.

^aMissing data on ART coverage or date of initiation of ART, respectively.

^bOdds ratios with 95% confidence intervals from multivariate logistic regression models

^cConsistently undetectable viral load, threshold of 150 cells/mm³, in up to 4 assessments at baseline, 12, 24 and 36 months.

*Statistical significance at the 0.05 level.