Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
AIDS Research and Therapy
Published in: AIDS Research and Therapy 1/2020

01-12-2020 | Human Immunodeficiency Virus | Research

Determinants of undisclosed HIV status to a community-based HIV program: findings from caregivers of orphans and vulnerable children in Tanzania

Authors: John Charles, Amon Exavery, Asheri Barankena, Erica Kuhlik, Godfrey M. Mubyazi, Ramadhani Abdul, Alison Koler, Levina Kikoyo, Elizabeth Jere

Published in: AIDS Research and Therapy | Issue 1/2020

Login to get access

Abstract

Background

HIV status disclosure facilitates receipt of HIV prevention and treatment services. Although disclosure to sexual partners, family members or friends has been extensively studied, disclosure to community-based HIV programs is missing. This study assesses the magnitude of, and factors associated with undisclosed HIV status to a community-based HIV prevention program among caregivers of orphans and vulnerable children (OVC) in Tanzania.

Methods

Data are from the USAID-funded Kizazi Kipya project that seeks to increase uptake of HIV, health, and social services by OVC and their caregivers in Tanzania. Data on OVC caregivers who were enrolled in the project during January–March 2017 in 18 regions of Tanzania were analyzed. Caregivers included were those who had complete information on their HIV status disclosure, household socioeconomic status, and sociodemographic characteristics. HIV status was self-reported, with undisclosed status representing all those who knew their HIV status but did not disclose it. Multilevel mixed-effects logistic regression, with caregivers’ HIV status disclosure being the outcome variable was conducted.

Results

The analysis was based on 59,683 OVC caregivers (mean age = 50.4 years), 71.2% of whom were female. Of these, 37.2% did not disclose their HIV status to the USAID Kizazi Kipya program at the time of enrollment. Multivariate analysis showed that the likelihood of HIV status non-disclosure was significantly higher among: male caregivers (odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.16–1.28); unmarried (OR = 1.12, 95% CI 1.03–1.23); widowed (OR = 1.12, 95% CI 1.07–1.18); those without health insurance (OR = 1.36, 95% CI 1.28–1.45); age 61 + years (OR = 1.72, 95% CI 1.59–1.88); those with physical or mental disability (OR = 1.14, 95% CI 1.04–1.25); and rural residents (OR = 1.58, 95% CI 1.34–1.86). HIV status non-disclosure was less likely with higher education (p < 0.001); and with better economic status (p < 0.001).

Conclusion

While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status. This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive. Further support is needed to support disclosure in this population.
Appendix
Available only for authorised users
Literature
1.
Maeri I, El Ayadi A, Getahun M, Charlebois E, Akatukwasa C, Tumwebaze D, et al. ‘How can I tell?’ Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV ‘test-and-treat’ trial. AIDS Care. 2016;28(3):59–66.PubMedPubMedCentral
2.
Deribe K, Woldemichael K, Wondafrash M, Haile A, Amberbir A. Disclosure experience and associated factors among HIV positive men and women clinical service users in southwest Ethiopia. BMC Public Health. 2008;29(8):81.
3.
Neville Miller A, Rubin DL. Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi, Kenya: people living with HIV/AIDS in the sub-Sahara. Qual Health Res. 2007;17(5):586–98.PubMed
4.
Greeff M, Phetlhu R, Makoae LN, Dlamini PS, Holzemer WL, Naidoo JR, et al. Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in Africa. Qual Health Res. 2008;18(3):311–24.PubMed
5.
Damian DJ, Ngahatilwa D, Fadhili H, Mkiza JG, Mahande MJ, Ngocho JS, et al. Factors associated with HIV status disclosure to partners and its outcomes among HIV-positive women attending Care and Treatment Clinics at Kilimanjaro region, Tanzania. PLoS ONE. 2019;14(3):e0211921.PubMedPubMedCentral
6.
Alema HB, Yalew WA, Beyene MB, Woldu MG. HIV positive status disclosure and associated factors among HIV positive adults in Axum health facilities, Tigray, Northern Ethiopia. Sci J Public Health. 2015;3(1):61.
7.
8.
9.
10.
11.
12.
Walcott MM, Hatcher AM, Kwena Z, Turan JM. Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study. BMC Public Health. 2013;2(13):1115.
13.
Maeri I, El Ayadi A, Getahun M, Charlebois E, Akatukwasa C, Tumwebaze D, et al. “How can I tell?” Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV “test-and-treat” trial. AIDS Care. 2016;28(Suppl 3):59–66.PubMedPubMedCentral
14.
Parsons JT, VanOra J, Missildine W, Purcell DW, Gómez CA. Positive and negative consequences of HIV disclosure among seropositive injection drug users. AIDS Educ Prev Off Publ Int Soc AIDS Educ. 2004;16(5):459–75.
15.
Przybyla SM, Golin CE, Widman L, Grodensky CA, Earp JA, Suchindran C. Serostatus disclosure to sexual partners among people living with HIV: examining the roles of partner characteristics and stigma. AIDS Care. 2013;25(5):566–72.PubMed
16.
Hosseinzadeh H, Hossain SZ, Bazargan-Hejazi S. Perceived stigma and social risk of HIV testing and disclosure among Iranian-Australians living in the Sydney metropolitan area. Sex Health. 2012;9(2):171–7.PubMed
17.
Dageid W, Govender K, Gordon SF. Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention. Cult Health Sex. 2012;14(8):925–40.PubMed
18.
Stirratt MJ, Remien RH, Smith A, Copeland OQ, Dolezal C, Krieger D, et al. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10(5):483–93.PubMed
19.
Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect. 2007;83(1):29–34.PubMed
20.
Pinkerton SD, Galletly CL. Reducing HIV transmission risk by increasing serostatus disclosure: a mathematical modeling analysis. AIDS Behav. 2007;11(5):698–705.PubMed
21.
Shacham E, Small E, Onen N, Stamm K, Overton ET. Serostatus disclosure among adults with HIV in the era of HIV therapy. AIDS Patient Care STDs. 2012;26(1):29–35.PubMedPubMedCentral
22.
Cissé M, Diop S, Abadie A, Henry E, Bernier A, Fugon L, et al. Factors associated with HIV voluntary disclosure to one’s steady sexual partner in mali: results from a community-based study. J Biosoc Sci. 2016;48(1):51–65.PubMed
23.
Conserve DF, King G, Dévieux JG, Jean-Gilles M, Malow R. Determinants of HIV serostatus disclosure to sexual partner among HIV-positive alcohol users in Haiti. AIDS Behav. 2014;18(6):1037–45.PubMedPubMedCentral
24.
Obermeyer CM, Baijal P, Pegurri E. Facilitating HIV disclosure across diverse settings: a review. Am J Public Health. 2011;101(6):1011–23.PubMedPubMedCentral
25.
Hallberg D, Kimario TD, Mtuya C, Msuya M, Björling G. Factors affecting HIV disclosure among partners in Morongo, Tanzania. Int J Afr Nurs Sci. 2019;1(10):49–54.
26.
Gultie T, Genet M, Sebsibie G. Disclosure of HIV-positive status to sexual partner and associated factors among ART users in Mekelle Hospital. HIV/AIDS Res Palliative Care. 2015;9(7):209–14.
27.
Dessalegn NG, Hailemichael RG, Shewa-amare A, Sawleshwarkar S, Lodebo B, Amberbir A, et al. HIV Disclosure: HIV-positive status disclosure to sexual partners among individuals receiving HIV care in Addis Ababa, Ethiopia. PLoS ONE. 2019;14(2):e0211967.PubMedPubMedCentral
28.
Burmen B, Obunga J, Mutai K. Disclosure status and disclosure intentions among HIV positive persons in rural western Kenya, 2011–2012. Cogent Med. 2017;4(1):1291096.
29.
Ngonzi J, Mugyenyi G, Kivunike M, Mugisha J, Salongo W, Masembe S, et al. Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda. Pan Afr Med J. 2019;32:200.PubMedPubMedCentral
30.
Ebuenyi ID, Ogoina D, Ikuabe PO, Harry TC, Inatimi O, Chukwueke OU. Prevalence pattern and determinants of disclosure of hiv status in an anti retroviral therapy clinic in the Niger Delta Region of Nigeria. Afr J Infect Dis. 2014;8(2):27–30.PubMedPubMedCentral
31.
Ebuenyi ID, Ogoina D, Ikuabe P, Harry T, Inatimi O, Chukwueke U. HIV status disclosure in an anti retroviral therapy clinic in the Niger Delta region of Nigeria. Int J Infect Dis. 2014;1(21):122–3.
32.
Taylor K, Lamb M, Lahuerta M, Ahoua L, Abacassamo F, Elul B. Patterns and Predictors of HIV Status Disclosure in the 12 Months Following Diagnosis in Mozambique. J Acquir Immune Defic Syndr 1999. 2020 Feb 20;.
33.
Yonah G, Fredrick F, Leyna G. HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania. AIDS Res Ther. 2014;22(11):5.
34.
Mwanga JA. HIV sero status disclosure and associated factors among people living with HIV/AIDS attending a care and treatment centre in Kisarawe district hospital. Tanzania: Muhimbili University of Health and Allied Sciences; 2012.
35.
Longinetti E, Santacatterina M, El-Khatib Z. Gender perspective of risk factors associated with disclosure of HIV status, a cross-sectional study in Soweto, South Africa. PLoS ONE. 2014;17(9):e95440.
36.
Antelman G, Smith Fawzi MC, Kaaya S, Mbwambo J, Msamanga GI, Hunter DJ, et al. Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam, Tanzania. AIDS Lond Engl. 2001;15(14):1865–74.
37.
Taraphdar P, Dasgupta A, Saha B. Disclosure among people living with HIV/AIDS. Indian J Community Med. 2007;32(4):280.
38.
Trinh TT, Yatich N, Ngomoa R, McGrath CJ, Richardson BA, Sakr SR, et al. Partner disclosure and early CD4 response among HIV-infected adults initiating antiretroviral treatment in Nairobi Kenya. PLoS ONE. 2016;11(10):e0163594.PubMedPubMedCentral
39.
Amoran OE. Predictors of disclosure of sero-status to sexual partners among people living with HIV/AIDS in Ogun State, Nigeria. Niger J Clin Pract. 2012;15(4):385–90.PubMed
40.
Agbor IE, Etokidem AJ, Ugwa EA. Factors responsible for disclosure of hiv seropositivity among residents of Cross River State, Nigeria. Ind J Commun Med. 2017.
41.
Whembolua G-L, Conserve DF, Thomas K, Tshiswaka DI, Handler L. HIV serostatus disclosure in the Democratic Republic of the Congo: a systematic review. AIDS Care. 2019;31(4):489–93.PubMed
42.
Ramlagan S, Matseke G, Rodriguez VJ, Jones DL, Peltzer K, Ruiter RAC, et al. Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa. SAHARA J Soc Asp HIV AIDS. 2018;15(1):155–63.
43.
Hayes-Larson E, Hirsch-Moverman Y, Saito S, Frederix K, Pitt B, Maama BL, et al. Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho. AIDS Care. 2017;29(8):978–84.PubMedPubMedCentral
44.
Atuyambe LM, Ssegujja E, Ssali S, Tumwine C, Nekesa N, Nannungi A, et al. HIV/AIDS status disclosure increases support, behavioural change and HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda. BMC Health Serv Res. 2014;14(1):276.PubMedPubMedCentral
45.
Kadowa I, Nuwaha F. Factors influencing disclosure of HIV positive status in Mityana district of Uganda. Afr Health Sci. 2009;9(1):26–33.PubMedPubMedCentral
46.
Kiarie JN, Kreiss JK, Richardson BA, John-Stewart GC. Compliance with antiretroviral regimens to prevent perinatal HIV-1 transmission in Kenya. AIDS Lond Engl. 2003;17(1):65–71.
47.
Kiula ES, Damian DJ, Msuya SE. Predictors of HIV serostatus disclosure to partners among HIV-positive pregnant women in Morogoro, Tanzania. BMC Public Health. 2013;3(13):433.
48.
Maman S, Mbwambo JK, Hogan NM, Weiss E, Kilonzo GP, Sweat MD. High rates and positive outcomes of HIV-serostatus disclosure to sexual partners: reasons for cautious optimism from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. AIDS Behav. 2003;7(4):373–82.PubMed
49.
Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82:299–307.PubMedPubMedCentral
50.
Sariah A, Rugemalila J, Somba M, Minja A, Makuchilo M, Tarimo E, et al. “Experiences with disclosure of HIV-positive status to the infected child”: perspectives of healthcare providers in Dar es Salaam, Tanzania. BMC Public Health. 2016;16(1):1083.PubMedPubMedCentral
51.
Vaz LME, Maman S, Eng E, Barbarin OA, Tshikandu T, Behets F. Patterns of disclosure of HIV-status to infected children in a sub-Saharan African Setting. J Dev Behav Pediatr JDBP. 2011;32(4):307–15.PubMed
52.
Vreeman RC, Gramelspacher AM, Gisore PO, Scanlon ML, Nyandiko WM. Disclosure of HIV status to children in resource-limited settings: a systematic review. J Int AIDS Soc. 2013;16:1.
53.
Pinzón-Iregui MC, Beck-Sagué CM, Malow RM. Disclosure of Their HIV status to infected children: a review of the literature. J Trop Pediatr. 2013;59(2):84–9.PubMed
54.
Exavery A, Charles J, Kuhlik E, Barankena A, Koler A, Kikoyo L, et al. Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project. BMC Health Serv Res. 2020;20(1):275.PubMedPubMedCentral
55.
USAID Kizazi Kipya Project Case Management and Child Protection Advisor. Standard Operating Procedure: Case Management within the USAID Kizazi Kipya Project (version 1). Dar es Salaam: Pact; 2017.
56.
Rodrıguez G, Elo I. Intra-class correlation in random-effects models for binary data. Stata J. 2003;3(1):32–46.
57.
58.
Kamuzora P, Gilson L. Factors influencing implementation of the Community Health Fund in Tanzania. Health Policy Plan. 2007;22(2):95–102.PubMed
59.
Kapologwe NA, Kagaruki GB, Kalolo A, Ally M, Shao A, Meshack M, et al. Barriers and facilitators to enrollment and re-enrollment into the community health funds/Tiba Kwa Kadi (CHF/TIKA) in Tanzania: a cross-sectional inquiry on the effects of socio-demographic factors and social marketing strategies. BMC Health Serv Res. 2017;17(1):308.PubMedPubMedCentral
60.
Macha J, Kuwawenaruwa A, Makawia S, Mtei G, Borghi J. Determinants of community health fund membership in Tanzania: a mixed methods analysis. BMC Health Serv Res. 2014;20:14.
61.
Macha J, Harris B, Garshong B, Ataguba JE, Akazili J, Kuwawenaruwa A, et al. Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa. Health Policy Plan. 2012;27(Suppl 1):i46–54.PubMed
62.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.PubMed
63.
Marks G, Crepaz N. HIV-positive men’s sexual practices in the context of self-disclosure of HIV status. J Acquir Immune Defic Syndr. 2001;27(1):79–85.PubMed
64.
Dominic B. ‘Women’s Education a tool of social transformation’—a historical study based on Kerala Society. 2011;2(10):7.
65.
Tesfaye T, Darega J, Belachew T, Abera A. HIV positive sero-status disclosure and its determinants among people living with HIV/AIDS following ART clinic in Jimma University Specialized Hospital, Southwest Ethiopia: a facility- based cross-sectional study. Arch Public Health. 2018;15:76.
66.
Akani CI, Erhabor O. Rate, pattern and barriers of HIV serostatus disclosure in a resource-limited setting in the Niger delta of Nigeria. Trop Doct. 2016;36:2.
67.
Latham CE, Morris A. Effects of formal training in communication skills on the ability of veterinary students to communicate with clients. Vet Rec. 2007;160(6):181–6.PubMed
68.
Gholami HR, Sarhangi F, Nouri JM, Javadi M. Nurses’ communication skills in military hospitals. J Nurs Midwifery Sci. 2015;2(1):40.
69.
Abaerei AA, Ncayiyana J, Levin J. Health-care utilization and associated factors in Gauteng province, South Africa. Glob Health Action. 2017;10:1.
70.
71.
Ahn JV, Bailey H, Malyuta R, Volokha A, Thorne C, Ukraine Cohort of HIV-infected Childbearing Women in EuroCoord. Factors associated with non-disclosure of hiv status in a cohort of childbearing HIV-positive women in Ukraine. AIDS Behav. 2016;20(1):174–83.PubMed
72.
73.
Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16–20.PubMedPubMedCentral
74.
Metadata
Title
Determinants of undisclosed HIV status to a community-based HIV program: findings from caregivers of orphans and vulnerable children in Tanzania
Authors
John Charles
Amon Exavery
Asheri Barankena
Erica Kuhlik
Godfrey M. Mubyazi
Ramadhani Abdul
Alison Koler
Levina Kikoyo
Elizabeth Jere
Publication date
01-12-2020
Publisher
BioMed Central
Published in
AIDS Research and Therapy / Issue 1/2020
Electronic ISSN: 1742-6405
DOI
https://doi.org/10.1186/s12981-020-00299-8

Other articles of this Issue 1/2020

AIDS Research and Therapy 1/2020 Go to the issue

Research

Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort

Review

HIV-1 subtype C predicted co-receptor tropism in Africa: an individual sequence level meta-analysis

Research

Comparing self-reported medication adherence measures with hair antiretroviral concentration among people living with HIV in Guangxi, China

Review

HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options

Short Report

Acceptability, motivation and the prospect of cure for people living with HIV and their healthcare providers in HIV cure-focused treatment interruption studies

Research

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits