The Influence of HIV-Status Disclosure on Adherence, Immunological and Virological Outcomes among HIV-Infected Patients Started on Antiretroviral Therapy in Dar-es- Salaam, Tanzania

Abstract

Background: Disclosure of HIV status pose a great challenge in many societies due to associated stigma. We prospectively investigated whether or not HIV-status disclosure before commencement of antiretroviral therapy (ART) has influence on adherence, immunological response and viral load suppression (VLS) in HIV-infected patients. Methods: Using systematic sampling, 520 HIV-infected patients were selected prior to initiation of ART from 4 HIV care and treatment clinics (CTC) in Dar-es-Salaam. Data on HIV status disclosure and adherence were collected using a structured questionnaire, while viral load and CD4+ T-cell counts were determined through laboratory investigations. Patients were followed up for one year. We performed logistic regression to determine the association between HIV status disclosure and the outcomes. Results: Four hundred and sixty two patients were analyzed, of whom 136 (29.4%) were males. Sixty (13%) and 310 (67.1%) of the study patients disclosed their HIV-status early and late respectively, while 92 (19.9%) did not disclose their HIV-status. Between males and females in each category, male had low number of HIV-status disclosure, p<0.05. The proportion adhering to therapy of 96.7% was higher in patients who disclosed their HIV-status before ART initiation compared to that of 85.4% among those who disclosed later on, p=0.0109. There was a statistically significant difference in terms of CD4+ T-cell counts recovery between patients who disclosed earlier and those who disclosed later on, p=0.0341. A statistically significant difference in terms of viral load suppression was also noted between early and later HIV status disclosure, p=0.0036. Conclusion: Disclosure of HIV-status before initiation of ART improves patients’ adherence, and has a positive influence on CD4+ T-cell counts recovery as well as viral load suppression.