title: Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho.
abstract: Disclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p < .1). In adjusted models, all point estimates were similar and greater TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39-0.90) and CIP (aOR 0.20, 95% CI 0.05-0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p < .1) in unadjusted analyses included being female, married/cohabitating, electricity at home, not knowing if partner was HIV-positive, and TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01-0.12), having electricity at home (aOR 0.38, 95% CI 0.17-0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59-0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners' status.
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.|b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Hayes-Larson
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.|b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hirsch-Moverman
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.|b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Suzue
authors.initials: S
authors.lastname: Saito
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Koen
authors.initials: K
authors.lastname: Frederix
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Blanche
authors.initials: B
authors.lastname: Pitt
authors.affiliation: c National Tuberculosis Control Programme, Lesotho Ministry of Health , Maseru , Lesotho.
authors.forename: Bridget Llang
authors.initials: BL
authors.lastname: Maama
authors.affiliation: a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.|b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003376:Counseling / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007927:Lesotho / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012650:Self Disclosure; D012747:Sexual Partners / Q000523:psychology; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult
keywords: HIV; TB-HIV co-infection; disclosure; sexual partnerships; tuberculosis