Increasing HIV serostatus disclosure in low and middle-income countries

Abstract

Objective To review the effectiveness of interventions to increase HIV serostatus disclosure in low- and middle-income countries. Design Systematic review of peer-reviewed articles providing pre-post or multi-arm evaluations of disclosure interventions, defined broadly as any intervention with the goal of increasing rates of voluntary disclosure of HIV serostatus through self-disclosure or partner notification. Methods Articles were included if they reported post-intervention evaluation results and were published between January 1, 1990 and August 1, 2014. Searching was conducted through 5 electronic databases, secondary searching of four journals, and hand searching reference lists of included articles. Systematic methods were used for screening and data abstraction, which was conducted in duplicate. Study quality (rigor) was assessed with eight items. Results Fourteen articles evaluating 13 interventions met the inclusion criteria, all from sub-Saharan Africa. Most interventions focused on people living with HIV and used cognitive-behavioral group sessions or peer/community health worker support to encourage disclosure to sexual partners, family members, or friends. One focused on maternal disclosure to HIV-uninfected children, while two examined voluntary partner notification interventions. Several studies had limitations due to weak designs, small sample sizes, or high attrition. Findings on disclosure were mixed, with most effect sizes being relatively small and some, more rigorous studies showing no effect. Partner notification interventions had the strongest evidence of impact. Conclusion The existing evidence base for interventions to increase disclosure is limited and shows variable results. Further research is needed to determine whether current approaches to increasing disclosure are effective or whether new approaches should be considered.

Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review

“…cognitive-behavioral support groups, community-based/ home-based outreach services, and partner-notification services [42]. The actions and behavioral targets of support group interventions ranged from (i) information transfer and motivational interviewing to improve patient activation, (ii) experience-sharing and communication skills development to facilitate comfort with disclosure, and (iii) development of planning and conflict resolution skills to strengthen coping behaviors.…”

Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa

“…Maternal HIV disclosure has generally been found to be beneficial for children, parents and families (Qiao et al., 2013) and became a World Health Organization recommendation in 2012 (WHO, 2011). However, there is a dearth of interventions to support parents (Kennedy et al., 2015), in particular those with younger children, with this challenging task.…”

HIV disclosure to children in low-and middle-income countries

“…We hope that these studies, conducted in five different countries, will assist in moving the field forward towards more effective interventions for both paediatric and parental HIV status disclosure. As reported by Kennedy et al [32], only few interventions to date have been robustly tested in LMIC that were intended to support either paediatric or parental HIV status disclosure. Of the 13 disclosure intervention studies they identified, only one was concerned with disclosure to children, focusing in particular on maternal HIV status disclosure to HIV-uninfected children [32].…”