Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho

ABSTRACT

Disclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p < .1). In adjusted models, all point estimates were similar and greater TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39–0.90) and CIP (aOR 0.20, 95% CI 0.05–0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p < .1) in unadjusted analyses included being female, married/cohabitating, electricity at home, not knowing if partner was HIV-positive, and TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01–0.12), having electricity at home (aOR 0.38, 95% CI 0.17–0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59–0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners’ status.

KEYWORDS:

• HIV
• tuberculosis
• TB-HIV co-infection
• disclosure
• sexual partnerships

Acknowledgements

We are grateful to the study participants for partaking in the study. We thank Mashale Shale, Limakatso Lebelo, Moeketsi Ntoane, staff at the study sites, village health workers in the surrounding communities, the Berea District Health Management Team, and the Lesotho Ministry of Health for their invaluable assistance in conducting this study. We also thank Susie Hoffman for her feedback on early drafts.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through United States Agency for International Development (USAID) under the terms of Award Number USAID-OAA-A-12-00022. EHL and YHM were supported by National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award numbers T32AI114398 and 1K01A104351, respectively. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Government.