Antiretroviral therapy availability and HIV disclosure to spouse in Rakai, Uganda: a longitudinal population-based study
Published Date:Jun 1 2015
Source:J Acquir Immune Defic Syndr. 69(2):241-247.
Antiretroviral Therapy, Highly Active
Discrete-time Survival Analysis
Disease Transmission, Infectious
Health Services Accessibility
Pubmed Central ID:PMC4445459
Funding:R01 HD 050180/HD/NICHD NIH HHS/United States
R01 HD050180/HD/NICHD NIH HHS/United States
R36 PS001580-01/PS/NCHHSTP CDC HHS/United States
T32 AI050056-09/AI/NIAID NIH HHS/United States
T32 HD 007546-06/HD/NICHD NIH HHS/United States
A decade after the rollout of antiretroviral therapy (ART) in sub-Saharan Africa, the effects of this structural change on social aspects of HIV such as rates of HIV disclosure to partners remain largely unmeasured. We evaluated whether the introduction of ART was associated with disclosure of HIV diagnosis to spouses in Rakai, Uganda, using longitudinal, population-based data.
We identified individuals in marital/cohabitating unions who were newly diagnosed with HIV in Rakai Community Cohort Study (RCCS) surveys between 2000 and 2008, where antiretroviral therapy (ART) was introduced in mid-2004. Using discrete-time survival analysis, we assessed the hazard of self-reported HIV disclosure to spouse after diagnosis pre- and post-ART rollout, adjusting for individual and union characteristics. Disclosure in the ART period was further stratified by ART initiation.
The analysis included 557 married adults, 264 of whom were diagnosed with HIV before ART was available (2000-2004) and 293 diagnosed after ART was introduced (2005-2008). The cumulative incidence of self-reported disclosure was 75.2% in the post-ART period, compared to 58.3% before ART availability (p<0.001, adjusted hazard 1.46 [95% CI 1.16, 1.83]). In the post-ART period, observed disclosure rates were 39% (72/184) among those not in HIV care, 65% (82/126) among those in pre-ART care, and 85% (64/75) among persons on ART (p<0.001).
Treatment availability and use, especially ART initiation, was associated with increased self-disclosure of HIV diagnosis to partners. ART access may facilitate the prevention of transmission to uninfected partners and linkage to treatment for infected couples.
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