Factors Influencing HIV Status Disclosure to Partners Among Antiretroviral Therapy Clients in the Upper East Region, Ghana

Atugba, Thomas Abugbilla; Aninagyei, Enoch; Binka, Fred; Duedu, Kwabena Obeng

doi:10.1007/s10461-022-03612-w

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Our cohort comprised slightly more females than males, consistent with the over-representation of females among PLWH globally (UNAIDS estimates that 54% of all PLWH in 2021 were women and girls [ 2 ]), and in sub-Saharan Africa [ 62 , 63 , 64 ], including Ghana [ 16 , 27 , 65 ], in particular. Consistent with previous reports from Ghana [ 19 , 27 , 66 ], the dominant mode of transmission in our cohort was heterosexual, and the cohort age distribution was comparable to recent studies in the region [ 25 ].…”

Section: Discussionsupporting

confidence: 92%

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

Appah

Beelen

Kirkby

et al. 2022

Viruses

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The greatest HIV-1 genetic diversity is found in West/Central Africa due to the pandemic’s origins in this region, but this diversity remains understudied. We characterized HIV-1 subtype diversity (from both sub-genomic and full-genome viral sequences), drug resistance and coreceptor usage in 103 predominantly (90%) antiretroviral-naive individuals living with HIV-1 in Ghana. Full-genome HIV-1 subtyping confirmed the circulating recombinant form CRF02_AG as the dominant (53.9%) subtype in the region, with the complex recombinant 06_cpx (4%) present as well. Unique recombinants, most of which were mosaics containing CRF02_AG and/or 06_cpx, made up 37% of sequences, while “pure” subtypes were rare (<6%). Pretreatment resistance to at least one drug class was observed in 17% of the cohort, with NNRTI resistance being the most common (12%) and INSTI resistance being relatively rare (2%). CXCR4-using HIV-1 sequences were identified in 23% of participants. Overall, our findings advance our understanding of HIV-1 molecular epidemiology in Ghana. Extensive HIV-1 genetic diversity in the region appears to be fueling the ongoing creation of novel recombinants, the majority CRF02_AG-containing, in the region. The relatively high prevalence of pretreatment NNRTI resistance but low prevalence of INSTI resistance supports the use of INSTI-based first-line regimens in Ghana.

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Section: Discussionsupporting

confidence: 92%

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

Appah

Beelen

Kirkby

et al. 2022

Viruses

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“…Mistrust in HCWs and fears about lack of confidentiality have been found to be barriers to APS in other settings as well, including the importance noted in a qualitative study in Kenya of establishing trust between the client and HCW in order to increase uptake of APS [ 21 ], and the importance of trust in the HCW to maintain confidentiality in Barbados [ 36 ]. The fear of stigma created by broken confidentiality is consistent with those found in other settings including Ethiopia [ 37 ], Malawi [ 38 ], Tanzania [ 39 ], Ghana, [ 40 ], and Barbados [ 36 ]. Participant trust in the different facets of APS is critical to acceptability and comfort with the intervention, and HCWs play an important role in building and maintaining that trust.…”

Section: Discussionsupporting

confidence: 82%

“I feel good because I have saved their lives”: Acceptability of assisted partner services among female index clients and male sexual partners in Kenya

Naughton

Owuor²,

Wamuti

et al. 2023

PLOS Glob Public Health

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Introduction Assisted partner services (APS), or notification for sexual partners of people diagnosed with HIV, is an efficient, effective, and high yield strategy to identify people living with HIV and is recommended by the World Health Organization (WHO). However, there remains a need to further understand the acceptability of APS qualitatively from a client lens, particularly when APS is integrated into the national health system. We investigated acceptability of APS when integrated into HIV services in Kenya. Methods Starting in May 2018, APS was implemented in 31 health facilities in Kisumu and Homa Bay counties in western Kenya. From January to December 2019, we conducted in-depth interviews (IDIs) with female index clients (n = 16) and male sexual partners (n = 17) in 10 facilities participating in an APS scale up study. Interviews assessed APS satisfaction, perceived benefits of the intervention, and challenges that may affect delivery or uptake. We applied the Theoretical Framework of Acceptability by Sekhon et al. (2017) as a guide to organize our findings. Results We find that views of APS are often guided by an individual’s trust in the intervention’s design and implementation, and an interest to preserve one’s health and that of one’s family and children. There were strong and consistent acceptable views of APS as “doing good” and “saving a life” and as a means of showing love towards one’s partner(s). The initial acceptability framing of individuals engaging with APS was predicated either on a feeling of comfort with the intervention, or a wariness of divulging sex partner personal information. Health care workers (HCWs) were seen to play an important role in mitigating participant fears linked with the intervention, particularly around the sensitive nature of HIV disclosure and sexual partners. Clients noted considerable challenges that affected acceptability, including the risk to the relationship of disclosing one’s HIV status, and the risk of intimate partner violence. Discussion We found that APS is acceptable as a strategy to reach male sexual partners of females diagnosed with HIV, and these findings provide opportunities to inform recommendations for further scale-up. Opportunities such as focusing on intervention confidentiality and appropriate counseling, excluding female clients at risk of IPV from this intervention, and highlighting the altruistic benefits of APS to potential clients. Understanding the perspectives of clients receiving APS in a real-world setting may be valuable to policy-makers and stakeholders interested in scaling up or enhancing APS within health systems.

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Predictors of HIV status disclosure among PLHIV in the Volta region of Ghana: the disclosure conundrum and its policy implications.

Alhassan¹

2023

Preprint

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Background Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are currently living with HIV with 66% of them being females; out of this number, 71% know their status and 99% of the people diagnosed with HIV in Ghana received sustained antiretroviral therapy (ART), and 79% on ART have achieved viral suppression. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known on the determinants of HIV status disclosure among the adult population of people living with HIV (PLHIV) in Ghana. Objective Determine the predictors of HIV status disclosure among the adult population of PLHIV and stimulate national policy discourse on support systems for self-disclosure in Ghana. Methods The study is a descriptive cross-sectional design among PLHIV (n = 181) in a tertiary hospital in the Volta region of Ghana. Bivariate analysis with Pearson Chi-square and Fisher’s Exact tests were run alongside stepwise forward logistic regression to determine factors associated with HIV status disclosure among PLHIV at 95% confidence level. Results HIV status disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members. HIV status disclosure was significantly associated with marital status (p = 0.000), level of education (p = 0.035), divorce due to HIV (p = 0.000), monthly income (p = 0.019), occupation (p = 0.010) and partner being HIV positive. The odds of disclosing HIV status was higher among single/never married persons (OR = 0.012; p-value = 0.017, 95% [CI = 0.000 0.447), persons of Catholic denomination (OR = 0.060; p-value = 0.057, 95% [CI = 0.003 1.089), persons with monthly income of approximately (USD 44–88) (OR = 0.068; p-value = 0.011, 95% [CI = 0.009 0.543]) and persons adherent to ART (OR = 6.161; p-value = 0.058, 95% [CI = 0.937 40.490]). Conclusions HIV status disclosure is low in Ghana due to socio-economic and religious factors. There is the need for a national debate on policy guidelines for HIV status disclosure for PLHIV; targeted support systems for vulnerable groups within PLHIV would also help ameliorate their predicaments.

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Factors Influencing HIV Status Disclosure to Partners Among Antiretroviral Therapy Clients in the Upper East Region, Ghana

Cited by 3 publications

References 32 publications

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

“I feel good because I have saved their lives”: Acceptability of assisted partner services among female index clients and male sexual partners in Kenya

Predictors of HIV status disclosure among PLHIV in the Volta region of Ghana: the disclosure conundrum and its policy implications.

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