HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania

HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania

HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatment cascade, particularly in Sub-Saharan Afric...

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Main Authors: Ostermann, Jan, Pence, Brian, Whetten, Kathryn, Yao, Jia, Itemba, Dafrosa, Maro, Venance, Reddy, Elizabeth, Thielman, Nathan
Format: Online
Language:English
Published: Taylor & Francis 2015
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685596/
id pubmed-4685596
recordtype oai_dc
spelling pubmed-46855962016-01-04 HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania Ostermann, Jan Pence, Brian Whetten, Kathryn Yao, Jia Itemba, Dafrosa Maro, Venance Reddy, Elizabeth Thielman, Nathan Original Articles HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatment cascade, particularly in Sub-Saharan Africa. We used data from a cohort of HIV-infected adults in Northern Tanzania to describe associations between disclosure and engagement and retention in the HIV treatment cascade. Between 2008 and 2009, the Coping with HIV/AIDS in Tanzania (CHAT) study enrolled 260 clients newly diagnosed with HIV and 492 HIV-infected patients in established HIV care in two large HIV care and treatment centers in Northern Tanzania. Participants aged 18 and older completed annual clinical assessments and twice-annual in-person interviews for 3.5 years. Using logistic regression models, we assessed sociodemographic correlates of HIV serostatus disclosure to at least one household member, and associations between this disclosure measure and linkage to care, evaluation for antiretroviral therapy (ART) eligibility, ART coverage, and rates of undetectable HIV RNA levels during the follow-up period. Married individuals and those diagnosed earlier were more likely to have disclosed their HIV infection to at least one household member. During follow-up, HIV serostatus disclosure was associated with higher rates of linkage to care, evaluation for ART eligibility, and ART coverage. No significant association was observed with rates of undetectable viral loads. Marginal effects estimates suggest that a 10 percentage-point lower probability of linkage to care for those who did not disclose their HIV serostatus (86% vs. 96%; p = 0.035) was compounded by an 18 percentage-point lower probability of ever receiving a CD4 count (62% vs. 80%; p = .039), and a 20 percentage-point lower probability of ever receiving ART (55% vs. 75%; p = .029). If causal, these findings suggest an important role for disclosure assistance efforts across the HIV treatment cascade. Taylor & Francis 2015-11-02 2015-11-29 /pmc/articles/PMC4685596/ /pubmed/26616126 http://dx.doi.org/10.1080/09540121.2015.1090534 Text en © 2015 The Author(s). Published by Taylor & Francis. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Ostermann, Jan
Pence, Brian
Whetten, Kathryn
Yao, Jia
Itemba, Dafrosa
Maro, Venance
Reddy, Elizabeth
Thielman, Nathan
spellingShingle Ostermann, Jan
Pence, Brian
Whetten, Kathryn
Yao, Jia
Itemba, Dafrosa
Maro, Venance
Reddy, Elizabeth
Thielman, Nathan
HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
author_facet Ostermann, Jan
Pence, Brian
Whetten, Kathryn
Yao, Jia
Itemba, Dafrosa
Maro, Venance
Reddy, Elizabeth
Thielman, Nathan
author_sort Ostermann, Jan
title HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
title_short HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
title_full HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
title_fullStr HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
title_full_unstemmed HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania
title_sort hiv serostatus disclosure in the treatment cascade: evidence from northern tanzania
description HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatment cascade, particularly in Sub-Saharan Africa. We used data from a cohort of HIV-infected adults in Northern Tanzania to describe associations between disclosure and engagement and retention in the HIV treatment cascade. Between 2008 and 2009, the Coping with HIV/AIDS in Tanzania (CHAT) study enrolled 260 clients newly diagnosed with HIV and 492 HIV-infected patients in established HIV care in two large HIV care and treatment centers in Northern Tanzania. Participants aged 18 and older completed annual clinical assessments and twice-annual in-person interviews for 3.5 years. Using logistic regression models, we assessed sociodemographic correlates of HIV serostatus disclosure to at least one household member, and associations between this disclosure measure and linkage to care, evaluation for antiretroviral therapy (ART) eligibility, ART coverage, and rates of undetectable HIV RNA levels during the follow-up period. Married individuals and those diagnosed earlier were more likely to have disclosed their HIV infection to at least one household member. During follow-up, HIV serostatus disclosure was associated with higher rates of linkage to care, evaluation for ART eligibility, and ART coverage. No significant association was observed with rates of undetectable viral loads. Marginal effects estimates suggest that a 10 percentage-point lower probability of linkage to care for those who did not disclose their HIV serostatus (86% vs. 96%; p = 0.035) was compounded by an 18 percentage-point lower probability of ever receiving a CD4 count (62% vs. 80%; p = .039), and a 20 percentage-point lower probability of ever receiving ART (55% vs. 75%; p = .029). If causal, these findings suggest an important role for disclosure assistance efforts across the HIV treatment cascade.
publisher Taylor & Francis
publishDate 2015
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685596/
_version_ 1613514912011649024

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