Predictors of HIV status disclosure to sexual partners among HIV seropositve clinic attendants in five hospitals in Ghana Martha Ali Abdulai, Frank Baiden, Samuel Afari-Asiedu, Lawrence Gyabaa-Febir, Kwame Kesse Adjei, Emmanuel Mahama, Charlotte Tawiah, Samuel Newton, Kwaku Poku Asante, Seth Owusu-Agyei. Institution: Kintampo Health Research Centre, Kintampo-Brong Ahafo Region, Ghana

Outline of presentation About Kintampo Health Research Centre Study background Study Objective Method Results and Discussion Conclusion and Recommendation Acknowledgement

Background of KHRC Established in 1994 A Ghana Health Service/Ministry of Health institution under the Research and Development Directorate Long track record of policy-relevant public health research

Mission Our mission is to conduct public health research and develop health research capacity which will contribute to a reduction in ill-health and the achievement of the Millennium Development Goals for Africa’s most disadvantaged communities. To deliver high quality research that is relevant to healthcare priorities in Ghana in particular and across Africa.

About KHRC: Research areas Currently: Maternal and child health Clinical Intervention Trials Malaria, meningitis Relevant studies in other age groups Elderly Adolescents Non communicable diseases Communicable diseases particularly HIV/AIDS, TB, Hepatitis Environmental Health Sciences

Background I The Joint United Nations Programme (JUNP) on HIV/AIDS has placed universal access to HIV prevention, treatment, care and support as a key global priority (WHO, 2013) Despite the progress made, about 36.7million people are living with HIV worldwide (UNAIDS, 2015) An estimated 2.5 million people were newly infected with HIV in 2015 (UNAIDS, 2015). HIV disclosure has become important in HIV prevention, treatment and care

Background II HIV disclosure is defined as the act of sharing or informing someone else about one’s HIV status (Johnson et al., 2013). HIV disclosure derives its importance partly from the role it plays in reducing the incidence of HIV, especially in sero-discordance of HIV (Dunkle et al., 2008) Disclosure of HIV status to sex partners is central to the prevention and care for PLWH. It expands the knowledge of HIV risk to both partners allows the partners to make collective decisions on how to protect their health including consistent condom use (Timberlake & Heywood, 2000).

Background II Some PLWH have experience dismal consequences following disclosure Broken marriages, stigmatization and violence in all it forms Such experiences have led to the reluctance of PLWH to disclose to their sexual partners 20-45% PLWH who are receiving clinical care in sub-Saharan Africa do not know the HIV status of their partners Regardless of efforts to increase disclosure, it remains a challenge among PLWH Given the importance of disclosure in HIV prevention treatment and care, factors that predicts disclosure needs to be critically appraised.

Objective Identify the predictors of disclosure to sexual partners among HIV seropositive patients in five hospitals in Ghana. It is expected that this study will contribute to and guide the development and implementation of programmes targeted at increasing disclosure.

Methods I Study Design A cross-sectional study among HIV seropositive patients attending HIV clinics in five Hospitals in the Brong Ahafo and Ashanti Regions of Ghana The study was carried out in July 2010 Study setting Five health facilities : (3 Brong Ahafo Region (BAR), 2 Ashanti Region(AR) BAR: Kintampo Municipal Hospital, Kintampo; Holy Family Hospital, Techiman; Brong Ahafo Regional Hospital, Sunyani AR: St Patrick’s Hospital, Offinso , Agogo Presbyterian Hospital, Agogo.

Methods II Sample size A total of 933 patient folders were selected for the study Data collection methods Folder review For each selected folder, data were collected for one-year period after the patient’s registration in each facility. Data analysis Simple proportion, odds ratios, Bivariate and multivariate logistic regression analysis

Methods III Ethical approval Ghana Health Service Ethics Review Committee London School of Tropical Medicine Institutional Ethics Committee (IEC) Kintampo Health Research centre IEC Written permission was sought from the Ghana AIDS Commission and National AIDS/STI Control Programme Administrative approvals were sought from the authorities of the five hospitals

Results and Discussion I Mean age :37.4 years (standard deviation=10.7years). Sex: 29.1% males;70.9% females. 59.7% of respondents had disclosed to sexual partners within one year after registering in an HIV Clinic. About 92.6% of the patients adhered to antiretroviral therapy and cotrimoxazole. Over 60% of the participants were sexually active. Only 42.6 % regularly used condoms. Majority (95.3%) of the participants referred to their family members for support

Results and Discussion II Unadjusted Odds Ratio(O.R.) Married women from the folders reviewed were less likely to disclose their HIV status to their sexual partners (OR= 0.3, CI: 0.2-0.45, p=<0.01) Those who were up to 19 years (inclusive) of age were more likely to disclose their HIV status to their sexual partners (OR =3.4, CI 1.8-6.4 p=<0.001) Participants who regularly used condoms were less likely to disclose their HIV status to their sexual partners (OR= 0.1, CI 0.1-0.3, p=<0.001) Those who were sexually active were less likely to disclose their HIV status to their sexual partners (OR= 0.2, CI: 0.1-0.3, p=<0.01). 

Results and Discussion III Adjusted O.R Males were less likely to disclose to their sexual partners (OR=0.7, CI: 0.1-0.8, p=0.017) Those who were married were less likely to disclose their sexual partners (OR= 0.3, CI: 0.1-0.95, p=0.002) Participants who regularly used condoms were less likely to disclose (OR= 0.1 CI: 0.04-0.4, p=<0.01)

Strengths and limitations (Ansah et al., 2009; Souteyrand, Collard, Moatti, Grubb, & Guerma, 2008) and made the data representative. Strengths and limitations Records of HIV positives who have reported to the facility were included Missing data due to poor record keeping Social desirability bias may be a potential limitation in this study Despite these setbacks, our study presents relevant information that adds to the HIV prevention, treatment and care discourse.

Conclusion and recommendation HIV disclosure to sexual partners is influenced by gender of respondents, marital status and regular condom use. Male involvement in HIV care remains critical Tailored HIV related messages to PLWH will enhance their self-efficacy to disclose their serostatus to their sexual partners

Acknowledgement Ghana Health Service The director, management and staff of Kintampo Health Research Centre Management and staff of Hospitals of study Study participants

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