Factors associated with HIV status disclosure to partners and its outcomes among HIV-positive women attending Care and Treatment Clinics at Kilimanjaro region, Tanzania

Background
Sub Saharan Africa continues to be the epicenter of HIV with 70% of people living with HIV globally. Women form nearly 60% of those living with HIV. Studies have shown disclosure of one’s HIV status is important in HIV prevention, in increasing partners who are tested and getting into care early as well as in improving retention in PMTCT and ART programs. This study aimed to determine the prevalence, factors and outcomes of HIV status disclosure to partners among HIV-positive women attending HIV care-and-treatment clinics (CTCs) at Kilimanjaro region, northern Tanzania.
Methods
A cross-sectional study was conducted from January to June 2014 in 3 out of the 7 districts of Kilimanjaro region. The study population was HIV-positive women aged 15–49, who were attending for routine HIV care at 19 selected clinics. Face-to-face interviews were conducted with consenting women to collect necessary information. Multivariate logistic regression analyses were used to determine the independent predictors of HIV status disclosure to partner.
Results
A total of 672 HIV-positive women in Moshi municipal, Hai and Mwanga districts were enrolled. Of them, 609 HIV-positive women reported to have a regular partner. Prevalence of serostatus disclosure to partners was 66%. Of the 400 who had disclosed; 56% did so within the first month of knowing their HIV status. In a multiple logistic regression model, HIV serostatus disclosure was higher among women who: were married/cohabiting (AOR = 4.16, 95% CI: 2.39–7.25; p<0.001), currently on ART (AOR = 2.06, 95% CI: 1.11–3.82; p = 0.020), and who reported had ever communicated with partners on number of children (AOR = 1.85, 95% CI: 1.15–2.98; p = 0.010) and contraceptives use (AOR = 2.01, 95% CI: 1.27–3.20; p = 0.208). Most of the women (81%) who disclosed their HIV status to did not reported negative outcomes.
Conclusion
In this setting still a third of the HIV-positive women (34%) fail to disclose their HIV- serostatus to partners. Interventions to impart skills in communication and negotiation between partners may help in improving disclosure of HIV. Efforts to involve men in general sexual and reproductive health including couple counseling and testing will contribute in improving disclosure and communication on HIV among partners.

研究背景
撒哈拉以南非洲仍是艾滋病（HIV）疫情中心，全球70%的艾滋病病毒感染者聚居于此，其中女性感染者占比近60%。已有研究证实，告知伴侣自身艾滋病感染状况，对于艾滋病预防、提升伴侣检测率与早期诊疗衔接率，以及改善参与者在预防母婴传播（Prevention of Mother-to-Child Transmission，PMTCT）和抗反转录病毒治疗（Antiretroviral Therapy，ART）项目中的留存率均具有重要意义。本研究旨在针对坦桑尼亚北部乞力马扎罗地区艾滋病护理与治疗诊所（Care-and-Treatment Clinics，CTCs）就诊的艾滋病病毒阳性女性群体，探究其向伴侣告知感染状况的流行率、影响因素与结局。

研究方法
本研究于2014年1月至6月期间，在乞力马扎罗地区7个行政区中的3个开展横断面研究。研究对象为年龄在15至49岁之间、在19家入选诊所接受常规艾滋病护理的艾滋病病毒阳性女性。本研究通过对获得知情同意的女性受访者进行面对面访谈，收集所需研究数据。本研究采用多变量logistic回归分析，确定向伴侣告知艾滋病感染状况的独立影响因素。

研究结果
本研究共纳入莫西市、海伊区与姆万加区的672名艾滋病病毒阳性女性。其中609名女性报告拥有固定伴侣。向伴侣告知艾滋病感染状况的流行率为66%。在400名已完成告知的女性中，56%在得知自身感染状况后的1个月内即告知了伴侣。多因素logistic回归分析结果显示，以下几类女性的感染状况告知率更高：已婚/同居者（调整后比值比（Adjusted Odds Ratio，AOR）=4.16，95%置信区间（Confidence Interval，CI）：2.39~7.25；p<0.001）、目前正在接受抗反转录病毒治疗（ART）者（AOR=2.06，95%CI：1.11~3.82；p=0.020）、曾与伴侣就子女数量与避孕措施使用情况进行沟通者（AOR=1.85，95%CI：1.15~2.98；p=0.010；AOR=2.01，95%CI：1.27~3.20；p=0.208）。在完成告知的女性中，绝大多数（81%）未报告负面结局。

研究结论
在本研究涉及的地区，仍有34%的艾滋病病毒阳性女性未向伴侣告知自身感染状况。可通过开展旨在提升伴侣间沟通与协商技能的干预措施，改善艾滋病感染状况告知行为。此外，推动男性参与一般性生殖健康服务，包括伴侣双方的咨询与检测，将有助于提升伴侣间艾滋病感染状况的告知率与沟通水平。