Charles John, Exavery Amon, Barankena Asheri, Kuhlik Erica, Mubyazi Godfrey M, Abdul Ramadhani, Koler Alison, Kikoyo Levina, Jere Elizabeth
Pact, P.O. Box 6348, Dar es Salaam, Tanzania.
Pact, Inc., 1828 L St NW Suite 300, Washington, DC, 20036, USA.
AIDS Res Ther. 2020 Jul 16;17(1):42. doi: 10.1186/s12981-020-00299-8.
HIV status disclosure facilitates receipt of HIV prevention and treatment services. Although disclosure to sexual partners, family members or friends has been extensively studied, disclosure to community-based HIV programs is missing. This study assesses the magnitude of, and factors associated with undisclosed HIV status to a community-based HIV prevention program among caregivers of orphans and vulnerable children (OVC) in Tanzania.
Data are from the USAID-funded Kizazi Kipya project that seeks to increase uptake of HIV, health, and social services by OVC and their caregivers in Tanzania. Data on OVC caregivers who were enrolled in the project during January-March 2017 in 18 regions of Tanzania were analyzed. Caregivers included were those who had complete information on their HIV status disclosure, household socioeconomic status, and sociodemographic characteristics. HIV status was self-reported, with undisclosed status representing all those who knew their HIV status but did not disclose it. Multilevel mixed-effects logistic regression, with caregivers' HIV status disclosure being the outcome variable was conducted.
The analysis was based on 59,683 OVC caregivers (mean age = 50.4 years), 71.2% of whom were female. Of these, 37.2% did not disclose their HIV status to the USAID Kizazi Kipya program at the time of enrollment. Multivariate analysis showed that the likelihood of HIV status non-disclosure was significantly higher among: male caregivers (odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.16-1.28); unmarried (OR = 1.12, 95% CI 1.03-1.23); widowed (OR = 1.12, 95% CI 1.07-1.18); those without health insurance (OR = 1.36, 95% CI 1.28-1.45); age 61 + years (OR = 1.72, 95% CI 1.59-1.88); those with physical or mental disability (OR = 1.14, 95% CI 1.04-1.25); and rural residents (OR = 1.58, 95% CI 1.34-1.86). HIV status non-disclosure was less likely with higher education (p < 0.001); and with better economic status (p < 0.001).
While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status. This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive. Further support is needed to support disclosure in this population.
披露艾滋病病毒（HIV）感染状况有助于获得HIV预防和治疗服务。尽管向性伴侣、家庭成员或朋友披露感染状况已得到广泛研究，但向社区HIV项目披露的情况却鲜有涉及。本研究评估了坦桑尼亚孤儿和弱势儿童（OVC）照料者中未向社区HIV预防项目披露HIV感染状况的比例及相关因素。
数据来自美国国际开发署资助的“Kizazi Kipya”项目，该项目旨在提高坦桑尼亚OVC及其照料者对HIV、健康和社会服务的接受度。对2017年1月至3月在坦桑尼亚18个地区参与该项目的OVC照料者的数据进行了分析。纳入的照料者需具备关于其HIV感染状况披露、家庭社会经济状况和社会人口学特征的完整信息。HIV感染状况由照料者自行报告，未披露状况指所有知晓自身HIV感染状况但未予披露的人。以照料者的HIV感染状况披露情况为结果变量，进行了多水平混合效应逻辑回归分析。
分析基于59683名OVC照料者（平均年龄 = 50.4岁），其中71.2%为女性。在这些照料者中，37.2%在登记时未向美国国际开发署“Kizazi Kipya”项目披露其HIV感染状况。多变量分析显示，以下人群未披露HIV感染状况的可能性显著更高：男性照料者（比值比（OR）= 1.22，95%置信区间（CI）1.16 - 1.28）；未婚者（OR = 1.12，95% CI 1.03 - 1.23）；丧偶者（OR = 1.12，95% CI 1.07 - 1.18）；无健康保险者（OR = 1.36，95% CI 1.28 - 1.45）；61岁及以上者（OR = 1.72，95% CI 1.59 - 1.88）；有身体或精神残疾者（OR = 1.14，95% CI 1.04 - 1.25）；以及农村居民（OR = 1.58，95% CI 1.34 - 1.86）。受教育程度较高者（p < 0.001）和经济状况较好者（p < 0.001）未披露HIV感染状况的可能性较小。
虽然提高教育水平、加强经济支持和扩大健康保险覆盖范围似乎有助于改善HIV感染状况的披露，但对于男性、未婚者、丧偶者、农村居民和老年人群体，因其隐瞒HIV感染状况的可能性较高，可能需要给予更多关注。对于可能感染HIV的人群而言，这显然是错失了及时获得护理和治疗服务的机会。需要进一步提供支持以促进该人群披露感染状况。
