Disclosure of HIV status outcome of regular counseling in a cohort of patients attending HIV clinics (original) (raw)
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International Journal of Gynecology & Obstetrics, 2012
Objective: To evaluate factors independently associated with disclosure of HIV serostatus in the era of widespread access to antiretroviral agents (ARVs) among individuals receiving HIV care in Uganda. Methods: Between January 1 and August 31, 2009, 403 HIV-positive individuals attending Kabale Hospital in southwestern Uganda were interviewed about their sociodemographic characteristics; sexuality; contraceptive use and sexual behavior; and disclosure of HIV serostatus to sexual partners. Data regarding disclosure versus nondisclosure were analyzed to identify factors independently associated with disclosure of serostatus. Results: The study participants were predominantly female (74.0%). In all, 82.5% of the patients were receiving ARVs. Disclosure of HIV serostatus to regular sexual partners was reported by 50.9% of the participants, while 49.1% had chosen not to disclose their serostatus. Factors independently associated with nondisclosure were marital status; current use of ARVs; having children who had died (from any cause); being sexually active in the previous 6 months; and the number of sexual partners during the previous 6 months (P b 0.05 for all associations). Fear of stigma was the main reason for nondisclosure of HIV serostatus. Conclusion: Despite receiving treatment with ARVs, many of the study participants neither disclosed their own HIV serostatus nor knew the HIV serostatus of their sexual partners.
BMC Health Services Research, 2013
Background: Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the providerclient experiences, perceptions and client satisfaction with the information provided differs in the two approaches. Methods: In 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient.
Quality of HIV Counselling Services Offered in Public Health Facilities in Kampala, Uganda
Acta Scientific Medical Sciences, 2022
Background: HIV counselling is increasingly available in public health facilities in Uganda. Counselling is an entry point into care, treatment and support services of many HIV/AIDS prevention programs. Quality of HCT services have significant role on prognosis of HIV patients. This study assessed the quality of HIV counselling services offered in public health facilities in Kampala by reviewing adherence to the HIV Counselling and Testing (HCT) policy guidelines, content of counselling information offered to clients and health facility amenities. Methods: This was a cross-sectional study conducted in 2016 utilizing quantitative methods of data collection. Quality of HIV counseling was defined in accordance with adherence to the HCT guidelines, offering 'good' content of counselling information and health facilities having adequate amenities. We used principal component analysis to obtain and reveal current composite scores of the variables. Data were summarized into frequencies and proportions using STATA, version 13.0. Scores below 70% were considered as 'poor' quality. Results: In this study, 74 health workers offering HIV counselling services at five public health facilities were interviewed. The study revealed that quality of HIV counselling at the five public health facilities was 'poor' as 74% of the health workers offered 'poor' quality HIV counselling and only one out of five health facilities was found to have adequate amenities. Majority (74.3%) of the health workers were found not to adhere to HCT guidelines. In addition, 67.6% of the health workers offered 'poor' content of counseling information. Conclusion: Overall quality of HIV counselling was found to be poor. Improvements should be focused on mentorship programs for all health workers involved in HIV counselling. Provision of modest space for counselling is also required so as to ensure privacy during counselling sessions.
BMC Health Services Research, 2014
Background: Disclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda. Methods: Qualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data. Results: Of the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men. Conclusions: There is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender appears to influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies.
AIDS Patient Care and STDs, 2010
Provider-initiated routine HIV testing is being scaled up throughout the world, however, little is known about the outcomes of routine HIV testing on subsequent behavior. This study examined the initial outcomes of provider-initiated routine HIV testing at a rural Ugandan hospital regarding partner HIV testing, sexual risk behavior, disclosure, and HIV care seeking. In a prospective cohort study, 245 outpatients receiving routine HIV testing completed baseline and 3-month follow-up interviews. After receiving routine HIV testing the percentage of participants engaging in risky sex decreased from 70.1% to 50.3% among HIV-negative and from 75.0% to 53.5% among HIV-positive participants, the percentage knowing their partner(s)' HIV status increased from 18.7% to 34.3% of HIV-negative and from 14.3% to 35.7% of HIV-positive participants. Among those reporting risky sex at baseline, HIV-positive participants were more likely to eliminate risky sex in general and specifically to become abstinent at follow-up than were HIV-negative participants. Similarly, unmarried participants who were risky at baseline were more likely to become safe in general, become abstinent, and start 100% condom use than were married=cohabitating participants. Rates of disclosure were high. Over 85% of those who tested HIV positive enrolled in care. Routine HIV testing in this setting may promote earlier HIV diagnosis and access to care but leads to only modest reductions in risky sexual behavior. To fully realize the potential HIV prevention benefits of routine HIV testing an emphasis on tailored risk-reduction counseling may be necessary.
BMC Women's Health
Introduction: HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between receipt of FP counselling and current use of modern contraception to inform programming. Methods: Data were drawn from a quantitative national cross-sectional survey of 5198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counselling was defined as provision of FP information (i.e. available FP methods and choices) to an HIV-positive woman by a health provider during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counselling were done on 2760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counselling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1. Results: Overall, 2104 (76.2%) HIV-positive women reported that they received FP counselling at any of the three critical time-points. Of the 24% (n = 656) who did not, 37.9% missed FP counselling at ANC; 41% missed FP counselling during delivery; while 54% missed FP counselling at the post-natal care visit. HIV-positive women who received any FP counselling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33). Conclusion: Nearly one-quarter of HIV-positive women did not receive any form of FP counselling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counselling into HIV care at all critical time-points.