Are the Things Told to Care Providers Kept Confidential?: Perceived Breaches of Confidentiality and Associated Factors Among HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Figures & data

Table 1 Socio-Demographic Characteristics of HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Variables	Category	Frequency	Percentage (%)
Age in years	18–25	113	26.71
	26–32	116	27.42
	33–40	113	26.71
	≥41	81	19.15
Sex	Male	192	45.39
	Female	231	54.61
Religion	Protestant	228	53.9
	Orthodox	151	35.7
	Muslim	39	9.22
	Other	5	1.29
Residence	Rural	128	30.26
	Urban	295	69.74
Marital status	Single	96	22.7
	Married	210	49.65
	Divorced	80	18.91
	Widowed	37	8.75
Educational level	Write and read only	97	22.93
	Primary school	142	33.57
	Secondary school	73	17.26
	College and above	111	26.24
Occupation	Unemployed	13	3.07
	Student	28	6.62
	Employed	77	18.20
	Daily laborer	40	9.46
	Farmer	47	11.11
	Merchant	47	11.11
	Housewife	136	32.15
	Other*	35	8.27

Note: *Drivers, house servants, cleaners.

Table 2 Clinical Characteristics of HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Variables	Category	Frequency	Percentage (%)
Baseline CD4 cell count	≤200 cells/mm^3	79	18.68
	201–350 cells/mm^3	78	18.44
	351–500 cells/mm^3	79	18.68
	>500 cells/mm^3	187	44.21
Baseline WHO clinical stage	WHO stage I	158	37.35
	WHO stage II	111	26.24
	WHO stage III	125	29.55
	WHO stage IV	29	6.86
Functional status	Working	351	82.98
	Ambulatory	35	8.27
	Bedridden	37	8.75
TB/HIV co-infection	Yes	43	10.17
	No	380	89.83
Baseline OIs other than TB	Yes	4	0.95
	No	419	99.05
BMI	Normal	262	61.94
	Mild underweight	97	22.93
	Moderate/severe underweight	64	15.13
HIV test approach	PITC	245	57.92
	VCT	178	42.08
Delayed ART start	Yes	144	34.04
	No ART	279	65.96

Abbreviations: CD4, cluster of differentiation 4; WHO, World Health Organization; TB, tuberculosis; HIV, human immunodeficiency virus; OI, opportunistic infection; BMI, body mass index; PITC, provider-initiated testing and counseling; VCT, voluntary counseling and testing; ART, anti-retroviral therapy.

Table 3 Behavioral and Social Characteristics of HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Variables	Category	Frequency	Percentage (%)
Have regular sexual partner	Yes	278	65.72
	No	145	34.28
How often tested for HIV	Once	298	70.45
	Twice and above	125	20.55
Disclosed HIV status	Yes	312	73.76
	No	111	26.24
Ever used substance	Yes	249	58.87
	No	174	41.13
Practice traditional healing	Yes	255	60.28
	No	158	39.72
Know other ART user(s)	Yes	177	41.84
	No	246	58.16
Location of ART clinic	Within catchment	345	81.56
	Out of catchment	78	18.44
Communication barrier during HIV test	Yes	30	7.09
	No	393	92.91
Level of social support	Poor	203	47.99
	Medium	190	44.92
	Strong	30	7.09

Abbreviations: ART, anti-retroviral therapy; HIV, human immunodeficiency virus.

Figure 1 Perceived breaches of confidentiality among HIV/AIDS clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021.

Table 4 Concepts Raised by HIV/AIDS Clients at Different Working Units of the Hospital, With Explanation and Application to Perceived Breaches of Confidentiality

Areas Where PBC Experienced	Explanation	Application to Perceived Breaches of Confidentiality
ART clinic open location	The ART unit is positioned and located where everyone can see who enters or exits	The HIV/AIDS clients fear that their relatives, friends, and co-workers may see them entering or coming out of the clinic and suspect them of having the disease.
Client transfer/linkage	Telling the runners on the corridor to take clients to the ART clinic	Open discussion between the provider who conducted the HIV test and the runners heard and seen by other clients in the waiting section.
Providers’ approaches	Some providers talk too much	Speaking providers can easily disclose the clients’ status, forgetting that this may lead to stigmatization of the clients.
Ward admission	Putting the HIV clients at the side of the ward	Most of the time, nurses in the ward gave less nursing care to HIV clients than to other patients. Besides, some nurses isolated HIV clients to a corner of the ward in order to have less contact with them, so that clients were often exposed or known to other patients.
Follow-up/refill	Contact with new providers at different follow-up appointment	Clients having contact with new care providers at different follow-up appointments may fear for their privacy if they suspect that other non-medical staff may know their medical information.
Investigation	Investigation request form contains the client’s address and status	The ART clinic unit and laboratory unit are located at different places in the hospital, and HIV/AIDS clients receive the investigation request form that includes their full address and health status, and cross a number of corridors in between the locations where they may meet other individuals. The laboratory technicians are also aware of their status based on the address on the request and treat them differently, to the extent that they are known by other patients sitting around waiting for their turn.

Abbreviations: HIV, human immunodeficiency virus; AIDS, acquired immune deficiency virus; PBC, perceived breach of confidentiality; ART, anti-retroviral therapy.

Figure 2 Areas where breaches of confidentiality were perceived among HIV/AIDS clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021.

Table 5 Results of Bivariable Analysis and Factors Associated with Breaches of Confidentiality Among HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Variables	Category	PBC			P-Value	95% CI
		Yes	No	COR
Delayed ART start	Yes	48	96	2.18	0.001	1.37–3.45
	No	52	227	1
Sex	Male	28	164	1
	Female	72	159	2.65	0.000	1.62–4.32
Marital status	Single	22	74	1.18	0.561	0.66–2.13
	Married	42	168	1	–	–
	Divorced	21	59	1.42	0.25	0.77–2.59
	Widowed	15	22	2.72	0.008	1.30–5.70
Educational level	Write and read only	10	87	1	–	–
	Primary school	31	111	2.42	0.023	1.12–5.22
	Secondary school	25	48	4.53	0.000	2.00–10.22
	College and above	34	77	3.84	0.001	1.78–8.28
Residence	Rural	18	110	1
	Urban	82	213	2.35	0.003	1.34–4.11
Baseline OIs	Yes	97	322	9.95	0.048	1.02–96.83
	No	3	1	1
Nutritional status	Normal	74	188	2.75	0.012	1.25–6.05
	Mild underweight	18	79	1.59	0.310	0.64–3.92
	Moderate/severe underweight	8	56	1	–	–
HIV test approach	PITC	68	177	1.75	0.02	1.09–2.81
	VCT	32	146	1	–	–
Have regular sex partner	Yes	53	225	1
	No	47	98	2.03	0.002	1.28–3.22
How often tested for HIV	Once	64	234	1
	Twice and above	36	89	1.47	0.107	0.91–2.37
Disclosed HIV status	Yes	67	245	1
	No	33	78	1.54	0.08	0.94–2.52
Ever used substance	Yes	70	179	1.87	0.01	1.16–3.03
	No	30	144	1
Ever used traditional healing	Yes	72	183	1.96	0.007	1.20–3.20
	No	28	140	1
Know other user(s)	Yes	31	146	1
	No	69	177	1.83	0.13	1.13–2.95
Location of ART clinic	Within catchment area	87	258	1.68	0.111	0.88–3.20
	Out of catchment area	13	65	1
Baseline CD4 cell count	≤200 cells/mm^3	28	51	2.65	0.001	1.46–4.83
	201–350 cells/mm^3	19	59	1.55	0.175	0.82–2.96
	351−500 cells/mm^3	21	58	1.75	0.079	0.93–3.28
	>500 cells/mm^3	32	155	1	1
Level of social support	Poor	64	139	2.99	0.049	1.00–8.93
	Medium	32	158	1.31	0.63	0.42–4.03
	Strong	4	26	1

Abbreviations: PBC, perceived breach of confidentiality; ART, anti-retroviral therapy; OI, opportunistic infection; HIV, human immunodeficiency virus; PITC, provider-initiated testing and counseling; VCT, voluntary counseling and testing; CD4, cluster of differentiation 4; COR, crude odds ratio; CI, confidence interval.

Table 6 Results of Multivariable Analysis and Factors Associated with Breaches of Confidentiality Among HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Variables	Category	PBC		AOR	P-Value	95% CI
		Yes	No
Delayed ART start	Yes	48	96	1.97	0.034	1.05–3.71
	No	52	227	1
Sex	Male	28	164	1
	Female	72	159	4.03	0.000	2.14–7.59
Marital status	Single	22	74	1.13	0.73	0.54–2.37
	Married	42	168	1
	Divorced	21	59	1.17	0.68	0.54–2.55
	Widowed	15	22	4.11	0.006	1.50–11.20
Educational level	Write and read only	10	87	1
	Primary school	31	111	7.89	0.000	2.92–21.33
	Secondary school	25	48	16.37	0.000	5.57–48.08
	College and above	34	77	10.89	0.000	3.93–30.14
Residence	Rural	18	110	1
	Urban	82	213	1.89	0.058	0.97–3.65
Baseline OIs	Yes	97	322	9.11	0.091	0.70–118.33
	No	3	1	1
Nutritional status	Normal	74	188	2.72	0.037	1.06–6.99
	Mild underweight	18	79	1.78	0.290	0.60–5.23
	Moderate/severe underweight	8	56	1
HIV test approach	PITC	68	177	1.51	0.170	0.83–2.74
	VCT	32	146	1
Have regular sex partner	Yes	53	225	1
	No	47	98	1.78	0.06	0.97–3.74
How often tested for HIV	Once	64	234	1
	Twice and above	36	89	1.12	0.709	0.60–2.10
Disclosed HIV status	Yes	67	245	1
	No	33	78	1.91	0.056	0.98–3.72
Ever used substance	Yes	70	179	1.93	0.036	1.04–3.58
	No	30	144	1
Used traditional healing	Yes	72	183	1.60	0.176	0.80–3.19
	No	28	140	1
Know other user(s)	Yes	31	146	1
	No	69	177	2.89	0.001	1.53–5.47
Location of ART clinic	Within catchment	87	258	1.24	0.581	0.57–2.71
	Out of catchment	13	65	1
Baseline CD4 cell count	≤200 cells/mm^3	28	51	2.63	0.013	1.22–5.68
	201–350 cells/mm^3	19	59	1.27	0.563	0.55–2.93
	351−500 cells/mm^3	21	58	1.87	0.127	0.83–4.21
	>500 cells/mm^3	32	155	1
Level of social support	Poor	64	139	2.24	0.252	0.56–8.99
	Medium	32	158	1.04	0.950	0.26–4.16
	Strong	4	26	1

Abbreviations: PBC, perceived breach of confidentiality; ART, anti-retroviral therapy; OI, opportunistic infection; HIV, human immunodeficiency virus; PITC, provider-initiated testing and counseling; VCT, voluntary counseling and testing; CD4, cluster of differentiation 4; AOR, adjusted odds ratio; CI, confidence interval.