Community Health Workers Improve HIV Disclosure Among HIV-Affected Sexual Partners in Rural Uganda: A Quasi-Experimental Study

Zubair Lukyamuzi; Ruth Mirembe Nabisere; Rita Nakalega; Patience Atuhaire; Hajira Kataike; Bashir Ssuna; Mazen Baroudi; Flavia Matovu Kiweewa; Philippa Musoke; Lisa M. Butler

doi:10.9745/GHSP-D-21-00631

Key Findings

Community health workers used community-based counseling, home visits, phone calls, and disclosure skills building to support adults living with HIV in the disclosure process, which led to increased disclosure.
Having community health workers able to support the disclosure process among adults living with HIV can help expand community-based HIV care and management for those experiencing difficulties with sexual partner disclosure or barriers to accessing health facilities or trained health care workers.

Key Implications

In addressing challenges of HIV treatment and management adherence in low-resource settings, policy makers should leverage community health worker programs to integrate HIV disclosure mechanisms for adults living with HIV in heterosexual relationships.
In addressing HIV disclosure challenges among sexual partners, HIV care programs in low- and middle-income countries should advocate for community-based disclosure mechanisms located near populations with low attendance at health facilities.

ABSTRACT

Background:

We evaluated the efficacy of a community health worker (CHW)–led intervention in supporting disclosure among adults living with HIV in heterosexual relationships.

Methods:

We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure.

Results:

Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25–37) years, the majority were women (76.5%), and most (80%) did not know their partners’ HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39).

Conclusion:

CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.

Received: September 10, 2021.
Accepted: August 23, 2022.
Published: October 31, 2022.

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