Magnitude of Prompt HIV-Seropositive Status Disclosure to Partner and Associated Factors among Adult Clients on ART at Holeta Health Center, Central Ethiopia, 2020

Kebede, Guta; Dufera, Adugna; Kolola, Tufa; Girma, Teka; Belema, Daniel

doi:https://doi.org/10.1155/2022/6167597

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Abstract Background Methods Results Discussion Conclusion Abbreviations Data Availability Ethical Approval Consent Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Research Article | Open Access

Volume 2022 | Article ID 6167597 | https://doi.org/10.1155/2022/6167597

Magnitude of Prompt HIV-Seropositive Status Disclosure to Partner and Associated Factors among Adult Clients on ART at Holeta Health Center, Central Ethiopia, 2020

Guta Kebede,¹Adugna Dufera,²Tufa Kolola,³Teka Girma,⁴and Daniel Belema⁴

Academic Editor: Daniel Diaz

Received14 Oct 2021

Revised03 Mar 2022

Accepted28 Apr 2022

Published13 May 2022

Abstract

Background. Disclosure of HIV-seropositive status is important for HIV prevention and maintenance of health for people living with HIV and the community at large. Most of the disclosure in our country and elsewhere were after putting the partner at risk of contracting HIV/AIDS. This study aimed to assess prompt HIV-seropositive status disclosure to partner and its associated factors among people living with HIV and attending care and treatment at a health center, in central Ethiopia. Methods. A cross-sectional study was carried out from September 15, 2019, to March 15, 2020, among 438 people living with HIV who were more than 18 years old and had sexual partner attending ART clinic at Holeta Health Center, central Ethiopia. The data were collected through face-to-face interviews using a structured questionnaire. The data were entered into Epi data version 3.1 and exported to SPSS version 21 for analysis. Descriptive analysis was conducted to determine the magnitude of prompt HIV seropositive status disclosure to partner and multivariable logistic regression analysis was computed to identify factors associated with prompt HIV seropositive status disclosure. Results. A total of 434 study participants took part in this study giving a response rate of 99%. Three hundred thirteen (72.1%) respondents disclosed their seropositive status to their partners promptly. Being married (AOR = 2.99, 95% CI = 1.09–8.21), less than 24-months duration on treatment (AOR = 0.185, 95% CI = 0.076–0.454), discouraging response of partner about the test (AOR = 0.34, 95% CI = 0.0149–0.780), knowing serostatus of one’s own partner (AOR = 10.42, 95% CI = 4.19–25.19), and using condom always with a partner (AOR = 11.44, 95% CI = 3.37–38.79) were factors significantly associated with prompt HIV seropositive status disclosure to partner. Conclusion. The proportion of prompt disclosure of HIV seropositive status to partner was low when compared to the overall partner disclosure rate. Being in marriage, less than 24 months duration on treatment, discouraging response of partner about the test, knowing serostatus of one’s partner, and using condom always with a partner were identified as predictors of prompt HIV seropositive status disclosure to partner.

1. Background

Globally, 38 million people were living with HIV and 1.7 million of them were new infections in 2019. An estimated 32.2 million adults aged 15–49 years worldwide are living with HIV [1, 2]. These increments in the number of patients resulted because of continuing new infections, living longer with HIV. and population growth [2]. In 2019, sub-Saharan Africa, the hardest-hit region, is home to nearly 54% of people living with HIV, 1.1 million children living with HIV, 300,000 AIDS-related deaths, and 730,000 new infections [3]. Ethiopia also has a large and very vulnerable population that there were more than half-million (671,941) HIV-positive population, 14,405 new HIV infections, and 24, 813 deaths in 2016 [4]. A common concern within HIV prevention is that HIV-positive individuals do not disclose their HIV status to their partners who are thus at increased risk for HIV infection [5]. HIV disclosure to sexual partners is an important HIV prevention strategy and is associated with a reduced risk of HIV transmission by 18% to 41% [6]. HIV discordance among couples considerably contributes to the HIV epidemic and represents an unmet HIV prevention need in sub-Saharan Africa. In East Africa, less than 10% of HIV-seropositive individuals know their partners’ status and only about 20% of the couples know that they are living in a discordant relationship [7–9]. On-time disclosure makes the partner either look to be diagnosed and adhere to ART or to be prevented from infection or reinfection with new strains [6]. It also helps the couples to discuss their reproductive health and their future of having a child which would have great success in reducing vertical transmission of HIV/AIDS [10, 11]. Furthermore, intervention programs will be in accordance with the scenarios as a seroconcordant should be put for the same interventions (ART or prevention packages) while in the case of serodiscordant, the negative partner should be engaged in effective HIV prevention (condom and PrEP) and test while the other should initiate ART [12].

Apart from the overall HIV-seropositive disclosure status [13–17], the study finding specifically on prompt HIV-seropositive disclosure status to the sexual partner is limited in Ethiopia including our study area. Therefore, this study aimed to assess the proportion of prompt HIV-seropositive status disclosure to their partner and associated factors among adult clients on ART at a health centre, in central Ethiopia.

2. Methods

2.1. Study Area and Period

The study was carried out in Holeta Health Centre, central Ethiopia from September 2019 to March 2020. Holeta Health Centre is found in Holeta town which is located 29 km to the west of Addis Ababa. There are 2 public health centres, 8 health posts, one primary hospital under construction, and 14 private clinics in the town. Holeta Health Center was the only antiretroviral therapy site in the town.

The health centre (HC) ART clinic started the provision of antiretroviral drugs in 2007 and currently gives follow-up and treatment services for about 1079 HIV/AIDS patients out of which 996 were adults.

2.2. Study Design and Study Population

A cross-sectional study design was carried out. All people living with HIV/AIDS (PLWHA) attending the ART clinic in Holeta Health Center were our source population. All PLWH on ART at Holeta HC ART clinic who were above 18 years old and had a sexual partner were the study population (n = 438) for this study.

2.3. Data Collection Tool, Quality Control, and Measurements

A structured, interview-administered questionnaire was prepared in English and translated into Afan Oromo. The tool was adapted from the previous literature in different parts of the world and modified according to the local context [14, 18–20]. Two nurses were recruited as data collectors. The data collectors were then trained for one day on how to collect data before the actual data collection started. Moreover, a pretest was performed on 5% of the study participants and the necessary adjustment was made on some items of the questionnaire based on pretest results.

2.4. Operational Definition

Prompt disclosure: disclosing HIV-positive status to partner on the day of diagnosis before having sexual intercourse with a partner.

Seroconcordant is a couple with both partners having the same result (HIV-positive or HIV-negative).

Serodiscordant is a couple with one partner HIV-positive and the other HIV-negative.

2.5. Data Processing and Analysis

Before data entry, the questionnaire was checked for its completeness. The data were entered into Epi data version 3.1 and then exported to SPSS version 21 for further analysis. The descriptive analysis such as the frequency with its percentage and mean were calculated. The bivariate binary logistic regression analysis was used to identify associations between variables. Effects of confounders were controlled through multivariable logistic regression analysis entering variables in similar categories such as sociodemographic, magnitude, and reasons of nondisclosure characteristics together in their order. The variables that had a value ≤ of 0.05 in the bivariate analysis were transferred to multivariable logistic regression models. The adjusted odds ratio with its 95% confidence interval was computed for variables entered into the multivariable model. Variables that had a value <0.05 were considered statistically significant in a multivariable model.

3. Results

A total of 438 study subjects were recruited for this study, of which 434 responded making a response rate of 99%. The mean age of the respondents was 39 years with SD ± 10.03 years. Slightly more than half of the respondents (229, 52.8%) were females. Concerning occupational status, 120 (27.6%) of the respondents were daily laborers while 46 (10.6%) were government employees. Out of four hundred thirty-four respondents, 95 (21.9%) had completed secondary education while 172 (39.6%) were not educated (Table 1).

The overall seropositive status disclosure rate to sexual partner was 378 (87.1%). Prompt HIV-seropositive status disclosure to sexual partner was 313 (72.1%). However, 65 (17.2%) of the study participants disclosed their seropositive status after committing sexual intercourse (Table 2).

3.1. Reasons for Prompt Disclosure

The main reasons for prompt disclosure of HIV-seropositive status to sexual partner were feeling of obligation to tell the partner (56.8%), not wanting to put the partner at more risk (22.6%), and letting others learn from (7.7%) (Table 3).

3.2. Factor Associated with Prompt HIV-Seropositive Status Disclosure

In bivariate analysis, educational status, relationship duration, marital status, duration of treatment, telling partner when went to get test service, response of partner about the test, knowing serostatus of own partner, and frequency of condom use with the partner were found significant at value <0.05. After adjusting variables in the multivariate logistic regression analysis, marital status, duration of treatment, response of partner about the test, knowing serostatus of own partner, and frequency of condom use with the partner were significantly associated with prompt HIV-seropositive status disclosure at a value <0.05.

Respondents in marriage were about 3 times more likely to disclose their HIV-positive status to their partner promptly as compared to respondents out of marriage (AOR = 2.99, 95% CI: 1.09, 8.21). Respondents whose duration of treatment was <24 months were 81% less likely to disclose their HIV-positive status to their partner promptly as compared to respondents >24-months duration of treatment (AOR = 0.185, 95% CI: 0.076, 0.454). Respondents who were discouraged about the test by their partner were 66% less likely to disclose their HIV-positive status to their partners promptly as compared to respondents who were encouraged about the test by their partners (AOR = 0.341, 95% CI 0.0149, 0.780). Respondents who had known serostatus of their partner were 10 times more likely to disclose their HIV-positive status to their partner promptly as compared to those who had not known serostatus of their partners (AOR = 10.42, 95% CI 4.19, 25.19). Respondents who had used condoms always with their partners were 11 times more likely to disclose their HIV-positive status to their partner promptly as compared to those who had never used condoms (AOR = 11.44, 95% CI 3.37, 38.79) (Table 4).

4. Discussion

The proportion of prompt HIV-seropositive status disclosure to partner is 72.1% (95% CI: 67.7–76.7) which is higher than the studies conducted in Mekele Hospital (58%) [13] and Sagamu of Nigeria (49.3%) [21]. These differences may be due to differences in study periods and study areas. In the study conducted in Ambo, 84% of the participants disclosed their HIV-seropositive status immediately after diagnosis which is higher than the finding from the current study [22]. This could be because the study conducted in Ambo reported the disclosure to partner or other family members.

Study participants who were in marriage were about 3 times more likely to disclose promptly to their sexual partners compared with their counterparts which is consistent with studies conducted in Ambo Hospital [22] and Axum [23], Ethiopia. Respondents who were on treatment for less than 24 months were 81% less likely to disclose their HIV-positive status to partner promptly as compared to respondents who stayed ≥24 months duration of treatment which is agreed with studies conducted in Mekele [17] and Ambo Hospital [22]. This may be since the client stayed longer on HAART treatment and was counselled repeatedly to become stable, assured more, and become more comfortable which can increase their social relationship and disclosure. This study showed that respondents who were discouraged by their partner when they asked about their need for a test were 66% less likely to disclose their HIV-positive status to their partner promptly. This finding is in line with a study conducted in Kemissie, northern Ethiopia [15]. This might be due to the fact that discussing HIV/AIDS openly and test results with a partner might help the individual to be strong to disclose their result.

Furthermore, knowing the serostatus of their partner is significantly associated with prompt HIV-seropositive status disclosure to their partner. Respondents who knew the serostatus of their partner were more likely to disclose promptly when compared with respondents who did not know the serostatus of their partners. A consistent finding was reported by other studies conducted in Jimma [18], Hawassa [14], Mekele [13], Ambo [22], Axum [23], Kemissie [15], and Bale [16].

Similarly, respondents who had always used a condom with their partner were 11 times more likely to disclose their HIV-seropositive status to their partner promptly as compared to those who had never used a condom. This may be due to the fact that using condoms regularly is safe for partners and as far as the partner was not put at risk of getting HIV-positive, disclosing may not be frustrating so that the one who disclose may not feel guilt. The finding was in line with studies conducted in Addis Ababa [24].

4.1. Limitation and Strength of the Study

As far as a cross-sectional study is a snapshot, respondents were expected to remember information retrospectively at that moment. Recall and interviewer bias were the potential limitations of this study. However, several scientific procedures have been employed to minimize the possible effects. To reduce the recall bias, for instance, only about the recent partner was asked for the respondents frequently changed their partner. The study was also cost-effective and versatile.

5. Conclusion and Recommendation

The proportion of prompt disclosure of HIV seropositive status to partners was low as compared to the overall partner disclosure rate of the national target of the country. Being in marriage, having less than 24-months duration on treatment, discouraging response of partner about the test, knowing serostatus of one’s partner, and using a condom always with a partner were identified as predictors of prompt HIV-seropositive status disclosure to partner. Thus, counsellors and respective health care providers in collaboration with concerned stakeholders should focus on treatment adherence, partner testing, regular condom use, and partners’ open discussion so that they in turn affect the prompt serostatus disclosure among partners.

Abbreviations

HIV:	Human immunodeficiency virus
PrEP:	Pre-exposure prophylaxis
HAART:	Highly active antiretroviral therapy.

Data Availability

Full data for this research are available through the corresponding author upon request.

Ethical Approval

The proposal of this study was approved by the Ethics Review Committee of the College of Medicine and Health Sciences, Ambo University (ref: CMHS-ERC: 035/12). Then, the ethical clearance letter was obtained from the college and submitted to the Holeta Town Administration Health Office for permission to undertake the study. Moreover, the study participants were not identified for confidentiality reasons.

Verbal informed consent was obtained from all study participants before the interview since the study presents no more than minimal risk of harm to subjects and involves no procedures as well as significant number of our study participants cannot read and write to provide written informed consent.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

GK and AD conceptualized the study, searched the literature, trained field researchers for data collection, and wrote the results and discussion sections. TK and TG contributed to the design of the study, data interpretation, and took part in the analysis. DB has critically reviewed the result and prepared the manuscript for publication. Finally, all authors have proofread the final manuscript.

Acknowledgments

The authors thank all the study participants for their cooperation in providing the necessary information. The authors also thank the research assistants who participated in data collection and supervision during this study.

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Copyright © 2022 Guta Kebede et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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