FACTORS INFLUENCING HUMAN IMMUNODEFICIENCY SEROPOSITIVE STATUS DISCLOSURE AND ADHERENCE: COMPARISON OF PREGNANT AND NON-PREGNANT WOMEN ATTENDING ANTIRETROVIRAL CLINICS IN OSUN STATE, SOUTHWEST NIGERIA

Abstract

Disclosure of Human immunodeficiency virus (HIV) sero-status is reported low in developing countries particularly among non-pregnant women. For pregnant women, considering the attendant risks for mother to child transmission and special health support (implementation of HIV-risk reduction with partners, improving access to treatment as well as motivate partners for voluntary counselling and testing) required by this vulnerable population, information on disclosure status and factors affecting willingness for disclosure is critical for adopting effective public health management strategies. A comparative cross-sectional, hospital-based study among HIV-positive women (pregnant and non-pregnant n= 235 each), using a two- stage sampling technique was undertaken between July-September 2016 in Osun state, Nigeria. Stage-one involved the proportionate selection of the facilities among the Private, State and Tertiary owned facilities (2:4:1). Stage- two, sampling of respondents that met the inclusion criteria. Pretested semi-structured questionnaire was used. Chi-square and logistic regression were performed. Statistical outputs were considered significant at p<0.05. Descriptive analysis of respondent showed that, of 235 respondent from each study group, 126 (53.6%) pregnant and 128 (54.5%) non-pregnant respondent were within the age range 35-49 years. Two hundred and twenty-six (96.2%) were presently married , 177 (76.6) been in relationship for more than 2 years, and 200 (86.2%) were in monogamous type of marriage among those pregnant. Also among the non-pregnant respondents, 153 (65.1 %) were presently married, 197 (91.2%) in relationship for more than 2 years and 158 (73.5%) in monogamous marriage. Prevalence of HIV disclosure status among this population showed 198 (84.3%) pregnant respondent have disclosed their status to their spouse compared with 141 (60.0%) non-pregnant respondent. Anti retroviral therapy has been commenced among, 223 (94.9%) pregnant and 228 (97.0%) non-pregnant women. One hundred and eighty-five (83.0%) of those pregnant were recorded to have high self reported adherence, compared with 123 (53.9%) among non- pregnant. Bivariate analysis revealed significant association (p<0.05) between disclosure status and type of marriage, length of relationship, level of education, number of children ever had, been accompanied by spouses, pre-test counselling and social support. Predictors of HIV disclosure among pregnant women were; informing spouses before going for HlV test, (AOR 11.58; Cl 2.16- 60.97) and awareness of partner's HIV status, (AOR 18.16; CI 3.82-86.48). However, among the non-pregnant women the predictors of HIV seropositive status disclosure were; been presently married , (AOR 3.65; Cl=1.39 - 9.63), been in monogamous type of marriage (AOR 3.58; CI=1.36 - 9.46). Also pre-test counselling (AOR 9.39; CI=1.13 - 78.10) and awareness of partner's HIV status (AOR 25.95; CI 9.57 - 70.42). Disclosure of HIV seropositive status was higher among pregnant compared to the nonpregnant women which might indicate that Spousal involvement in HIV management is important. Effective awareness strategies, targeted at spouses of HIV-positive women should be adopted and couple counselling strengthened as it could help improve partner participation in prevention of mother to child transmission and subsequently, achieving zero case of HIV.