Background: HIV status disclosure by pregnant women to their sexual partner enables partner testing and linkage to care, and can facilitate maternal ART adherence and prevention of mother-to-child HIV transmission. Understanding factors associated with disclosure to partners is critical for developing interventions to expand HIV testing and linkage to care.
Methods: This analysis utilized enrollment data from an ongoing trial evaluating mHealth strategies to improve ART adherence among women living with HIV in Nyanza Region and Nairobi, Kenya (Mobile WAChX, NCT02400671). Women were eligible to participate if they were pregnant, HIV-infected, and had daily access to a mobile phone. A structured questionnaire evaluated disclosure to partner, sociodemographic characteristics, self-reported ART adherence information-motivation-behavior skills (modified Lifewindows IMB, 75 point score), depression (PHQ9) and social support (MOS, 72 point score). Plasma samples were collected for viral load (VL) measurement. Univariate logistic regression was used to evaluate associations with partner disclosure.
Results: :Among 825 participants enrolled, 768 (93%) reported current sexual partners and 570 (74%) of these had disclosed their HIV status to their partner. Participants had a median age 27 years (IQR 23-31) and 84% (695) were cohabiting/married. Median social support score was 63 (IQR 50-72). Median ART adherence IMB score was 58 (IQR 55-62). HIV status disclosure was associated with older participant age (OR 1.06 per year, 95% CI: 1.03-1.09), facility delivery (OR 1.52, 95% CI: 1.01-2.27), duration of current relationship (OR 1.15 per year increase, 95% CI: 1.10-1.20) and cohabitation with partner (OR 4.43, 95% CI: 2.89-6.80). Disclosure was also positively associated with social support score (OR 1.01 per point, 95% CI: 1.00-1.02), IMB score (OR 1.05 per point, 95% CI: 1.00-1.08), and negatively associated with stigma (OR 0.90, 95% CI: 0.83-0.99).
Conclusions: Disclosure among pregnant women on lifelong ART was associated with a number of positive outcomes such as information, motivation and behavioral skills for ART adherence, social support and lower stigma. Relationships between these factors are complex. Women who do not or cannot disclose likely require enhanced support for ART adherence.