AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #250 - The impact of HIV care on serostatus disclosure to relatives among HIV-infected patients initiating antiretroviral therapy in rural district hospitals in Cameroon (STRATALL, ANRS 12-110/ESTHER).
Authors: Presenting Author: Dr Marie Suzan-Monti - INSERM
Additional Authors: Dr. Charles Kouanfack, Dr. Sylvie Boyer, Mr. Jérôme Blanche, Dr. Eric Delaporte, Dr. Patrizia M. Carrieri, Prof. Jean-Paul Moatti, Dr. Christian Laurent, Dr. Bruno Spire,
Aim: Encouraging HIV-positive people to disclose their serostatus to their relatives is considered a key component in psychosocial support and improving antiretroviral (ART) adherence and quality of life. Longitudinal data from STRATALL were used to identify factors associated with HIV disclosure among relatives.
Method / Issue: STRATALL is a 24-month, randomized, open-label trial which enrolled 459 HIV-infected ART-naive adults in 9 district hospitals in Cameroon in 2006-2010. The trial was designed to compare the effectiveness of ART between a laboratory plus clinical monitoring approach (i.e. viral load + CD4) and a clinical monitoring alone. Partial task-shifting to nurses was recommended in the clinical group. Face-to-face interviews at inclusion (M0), and at M3, M6, M12 and M24 after ART initiation were used to collect socio-demographic data and information about disclosure to relatives and experience with HIV testing and care. Data about reasons for participation in the trial were also collected (free access to treatment and care, barriers to asking for financial support from relatives associated with disclosure). Patients with complete data both at enrolment (M0) and at least at one follow-up visit were included in the present analysis (n=386). A disclosure score was computed at each visit as the sum of the number of relatives to whom patients had disclosed their serological status. A mixed Poisson regression was used to estimate predictors of the evolution of the score of disclosure.
Results / Comments: Among the 386 eligible patients (accounting for 1734 follow-up visits from M0 to M24), 29% were males. At enrolment, median [IQR] age was 36[30-44], and51% had a CD4 cell count lower than 200/mm3. The median [IQR] number of relatives to whom patients had disclosed was 2[1-3] and 3[2-5] at M0 and M24 (p-trend<0.001), respectively. Among the study group, 18% reported disclosure-associated barriers to asking for financial support from relatives at enrolment while 16% reported to have been HIV diagnosed following hospitalization. Over the whole follow-up, 483 (28%) visits were task-shifted to nurses. After multiple adjustments, patients whose visits were task-shifted to nurses were more likely to report that they had disclosed their status to a higher number of relatives (IRR[95%CI]:1.1[1.0-1.2]). In addition, antiretroviral treatment duration (1.5[1.4-1.6]) per month) and HIV diagnosis during hospitalization (1.2[1.0-1.4]) were independently associated with the disclosure score. Patients were less likely to disclose (0.8 [0.7-0.9]) if they reported disclosure-associated barriers to asking for financial support from relatives.
Discussion: Comprehensive care including free access to HIV treatment and care as well as psychosocial support provided by paramedical staff can significantly contribute to improving HIV serological status disclosure through reinforcement of individual empowerment.
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