Community Health Workers Increase the Rate of HIV Disclosure Among HIV Affected Heterosexual Partners in Rural Uganda; A Cluster Non-Randomized Controlled Trial

Background: HIV disclosure is a critical component of HIV prevention and treatment programs. Community Health Workers (CHW) play an important role in HIV disclosure counseling among HIV-affected heterosexual partners. However, time to disclosure attributed to the use of CHW in the disclosure process remains undocumented. This study assessed the effect of CHW-facilitated counseling on time to partner disclosure among Adults living with HIV (ALHIV) in the greater Luwero region, Uganda Methods: We conducted a two-arm cluster, non-randomized controlled trial. HIV care facilities in the greater Luwero region were allocated to either the intervention or control arm. Eligible participants were ALHIV in heterosexual partnerships who had never disclosed to their current partners. In the control arm, participants received routine regular facility-based counseling. In the intervention arm, alongside usual care, participants received CHW-facilitated disclosure counseling. Data were collected at baseline, 3 and 6 months with the primary outcome of disclosure. Survival analysis with proportional hazard ratios was used to determine the time to disclosure in both arms. Results: A total of 245 participants were enrolled, of whom complete data were available for 230 (93.9%). Of these, 112 (48.7%) were in the intervention arm and 118 (51.3%) were in the control arm. Mean ± SD age was 31±8 years with a range of 18 to 55 years. More participants were females 176 (76.5%). The cumulative incidence of disclosure was higher in the intervention arm 8.76 [95% CI: 7.20-10.67] per 1,000 person-time versus 5.15 [95%CI: 4.85-6.48] per 1,000 person-time in the control arm, log-rank test, X 2 = 12.93, P<0.001. Male gender, aHR =1.82 [95% CI: 1.26-2.65], tertiary education, aHR = 1.51 [95% CI: 1.43-1.60] and relationship duration of >6 months, aHR = 1.19 [95% CI: 1.16-1.22] predicted disclosure. Prior disclosure to a relative, aHR = 0.55 [95% CI: 0.39-0.78] and having >1 sexual partner in the past 3 months, aHR = 0.74 [95% CI: 0.60-0.92] predicted non-disclosure Conclusion: CHW-led counseling increased the rate of partner HIV disclosure among ALHIV in heterosexual partnerships. Therefore, CHW-facilitated counseling may be used to quicken disclosure, reduce stigma and improve HIV treatment outcomes among ALHIV with disclosure difficulties.