Background
Adolescents and young adults living with HIV (ALHIV) face multifaceted challenges to long-term treatment success. We characterized HIV status disclosure among ALHIV and assessed relationships between status disclosure, antiretroviral therapy (ART) adherence and viral suppression.
Methods
The prospective African Cohort Study enrolls people with and without HIV, ≥15 years, at 12 PEPFAR-supported facilities in Kenya, Nigeria, Tanzania, and Uganda. Socio-behavioral questionnaires are administered at enrollment and six-monthly visits; responses to questions around voluntary status disclosure are self-reported. Participants living with HIV on ART and <25 years old were included. Patterns of status disclosure were described. Robust Poisson regression was used to assess relationships between disclosure to an immediate family member (spouse/partner, parent, sibling, or child) and 1) ART adherence (none vs 1+ missed doses of ART in past 30 days); 2) viral suppression (<1000 vs >1000 copies/mL) using data from participants’ most recent visit. Models were stratified by sex.
Results
Between January 2013 and December 2023, 3381 (81.7%) participants living with HIV were enrolled. At most recent visit, 698 were <25 years, living with HIV and on ART including 625 complete cases. Of these, 244 (35.0%) had ever disclosed their HIV status (Figure). A greater proportion of females vs males had disclosed to a spouse/partner (12.4% vs 6.9%; p=0.09). A greater proportion with vertical vs nonvertical transmission had disclosed to a parent (28.6% vs 17.0%; p=0.02), while a smaller proportion with vertical transmission had disclosed to a spouse/partner (4.5% vs 11.5%; p=0.08). After adjusting for age and program site, females who disclosed to an immediate family member were less likely to have missed ART doses compared to those who had not disclosed (aRR: 0.54; 95% CI: 0.32-0.93); for males, the association was not statistically significant (aRR: 1.32; 95% CI: 0.76-2.31). Although not significant, females who disclosed to an immediate family member were less likely to be virally unsuppressed (aRR: 0.74; 95% CI: 0.37-1.50) after adjusting for age, program site and ART adherence, while males were more likely to be unsuppressed (aRR: 1.73; 95% CI: 0.79-3.81).
Conclusions
HIV status disclosure among ALHIV was low. Sex differences suggest targeted interventions for young men may improve treatment outcomes. Social support, violence and stigma should also be investigated.
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