title: Partner HIV serostatus disclosure and determinants of serodiscordance among prevention of mother to child transmission clients in Nigeria.
abstract: BACKGROUND
  Serodiscordance exists when the known HIV result of one member of a couple pair is positive while that of his/her partner is negative. In sub-Saharan Africa, in stable long-term couple partnerships (married or cohabiting), serodiscordance is a growing source of HIV-transmissions. This study aimed to ascertain across Nigeria, serodiscordance prevalence, partner HIV status disclosure and explore associations between suspected determinants and serodiscordance among PMTCT enrolled HIV positive pregnant women and their partners.
  
  
  METHODS
  A retrospective Quality of Care performance evaluation was conducted in July 2013 among 544 HIV positive pregnant enrolees of PMTCT services in 62 comprehensive facilities across 5 of Nigeria's 6 geo-political zones. Data of client-partner pairs were abstracted from pre-existing medical records and analysed using chi-square statistics and logistic regression.
  
  
  RESULTS
  A total of 544 (22%) of 2499 clients with complete partner details were analysed. Clients' age ranged from 15 to 50 years with a mean of 30 years. Serodiscordant prevalence was 52% and chi-square test suggests no significant difference between serodiscordant and seroconcordant clients and their partners (p = 0.265). Serodiscordant rates were closely associated trend wise with national HIV sero-prevalence rates and the median CD4+ count was 425 ul/mm(3) (IQR: 290-606 ul/mm(3)). Similar proportion of clients (99%) received testing and agreed to disclose status to their partners. Yet, there was no association between clients agreement to disclose HIV status to their partners and these partners getting tested and receiving results (p = 0.919). Significantly, 87% of clients in concordant HIV positive relationships appeared to be symptomatic (WHO clinical stage 3 or 4) compared to 13% clients in HIV-discordant relationships (p < 0.003). Client's age and CD4+ count did not aptly predict serodiscordance (Wald = 0.011 and 0.436 respectively). However, the WHO clinical staging appeared to be a better predictor of serodiscordance and concordance than other variables (Wald = 3.167).
  
  
  CONCLUSIONS
  The results suggest that clinical staging (WHO) could be a better predictor of client- partner pair discordant or concordant HIV serostatus. Early partner testing and notification can avert seroconversion, hence properly designed and mainstreamed interventions that target serodiscordant couples are essential.
authors: Department of Public Health, University of Calabar, Calabar, Cross Rivers, Nigeria. amobi_onovo@yahoo.com.|A39 Lazarus Mouka Crescent, El-salem Estate Lugbe, Abuja, 900286, FCT, Nigeria. amobi_onovo@yahoo.com.
authors: Amobi Andrew
authors: AA
authors: Onovo
authors: Department of Health Systems Strengthening, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria. inta@ihvnigeria.org.
authors: Iboro Ekpo
authors: IE
authors: Nta
authors: Department of Health Systems Strengthening, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria. aonah@ihvnigeria.org.
authors: Aaron Anyebe
authors: AA
authors: Onah
authors: Strategic Information, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria. cokolo@ihvnigeria.org.
authors: Chukwuemeka Arinze
authors: CA
authors: Okolo
authors: Strategic Information, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria. aaliyu@ihvnigeria.org.
authors: Ahmad
authors: A
authors: Aliyu
authors: Office of the CEO, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria. pdakum@ihvnigeria.org.
authors: Patrick
authors: P
authors: Dakum
authors: United States Agency for International Development (USAID), Abuja, FCT, Nigeria. aatobatel@usaid.gov.
authors: Akinyemi Olumuyiwa
authors: AO
authors: Atobatele
authors: United States Agency for International Development (USAID), Abuja, FCT, Nigeria. pgado@usaid.gov.
authors: Pamela
authors: P
authors: Gado
mesh_terms: D017954:Africa South of the Sahara; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000517:prevention & control / Q000635:transmission*; D006679:HIV Seropositivity; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009549:Nigeria; D011247:Pregnancy; D037841:Pregnant People; D015995:Prevalence; D012189:Retrospective Studies; D012747:Sexual Partners; D014342:Truth Disclosure