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Impact of inter-partner HIV disclosure patterns in Malawi's PMTCT program: A mixed-method study
Monique van Lettow1,2, Fabian Cataldo1,2, Megan Landes1,3
1Medical and Research Department, Dignitas International, Zomba, Malawi.
Plos One
|July 27, 2019
Summary
Partner disclosure of HIV status is crucial for preventing mother-to-child transmission. Non-disclosure by partners was linked to lower antiretroviral therapy (ART) uptake, adherence, and increased HIV transmission.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Partner disclosure of HIV status may impact prevention of mother-to-child transmission of HIV (PMTCT) outcomes.
- Understanding this dynamic is key for effective HIV interventions in postpartum women.
Purpose of the Study:
- To examine the association between partner disclosure of HIV status and maternal antiretroviral therapy (ART) uptake and adherence.
- To investigate the relationship between partner disclosure and mother-to-child transmission (MTCT) of HIV in Malawian women.
Main Methods:
- A cross-sectional mixed-method study within a nationally representative longitudinal cohort.
- Included 3,153 known HIV-infected mothers and qualitative data from interviews with mothers, partners, and healthcare workers.
- Utilized multivariable models to assess associations between disclosure, ART, and MTCT.
Main Results:
- Among 2,882 couples, neither partner disclosed HIV status in 5.9% of cases.
- Non-disclosure was significantly associated with no maternal ART uptake (aOR 4.7), suboptimal adherence (aOR 1.8), and MTCT (aOR 2.1).
- Women's fear of blame and difficulty disclosing were key barriers.
Conclusions:
- Partner disclosure plays a critical role in ART initiation and adherence for HIV-infected women.
- Inter-partner non-disclosure is linked to poorer ART outcomes and increased MTCT.
- Addressing fears and facilitating disclosure are vital for PMTCT programs.
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