Background HIV status disclosure among sexual partners is vital in HIV management. Community health workers (CHW) support HIV disclosure among adults living with HIV (ALHIV) in sexual relationships with disclosure difficulties. However, experiences and challenges of using CHW-led disclosure support mechanism were not documented. This study explored experiences and challenges involved in using CHW-led disclosure support mechanism among ALHIV in heterosexual relationships in the rural Uganda. Methods This was a phenomenological qualitative study involving in-depth interviews among CHWs and ALHIV with HIV disclosure difficulties to sexual partners in greater Luwero region, Uganda. We conducted 27 interviews among purposively selected CHWs and participants who had participated in the CHW-led disclosure support mechanism. Interviews were conducted until saturation was reached; and analysis was done using inductive and deductive content analysis in Atlas. Results All respondents viewed HIV disclosure as an important strategy in HIV management. Provision of adequate counseling and support to those intending to disclose was instrumental for successful disclosure. However, fear of the negative disclosure outcomes was viewed as a barrier to disclosure. The CHWs were viewed as having an added advantage in supporting disclosure as opposed to the routine disclosure counseling. However, HIV disclosure using CHW-led support mechanism would be limited by possible bleach of client’s confidentiality. Therefore, respondents thought that appropriate selection of CHWs would improve their trust in the community. Additionally, providing CHWs with adequate training and facilitation during the disclosure support mechanism was viewed to improve their work. Conclusion Community health workers were viewed as being more supportive in HIV disclosure among ALHIV with disclosure difficulties to sexual partners compared to routine facility based disclosure counseling. Therefore, near location CHW-led disclosure mechanism was acceptable and useful in supporting HIV disclosure among HIV-affected sexual partners in rural settings.

Background HIV disclosure is vital in HIV management. Community Health Workers (CHW) were reported to support partner disclosure among HIV affected heterosexual partners with disclosure difficulties. However, time to disclosure attributed to use of CHW led disclosure support mechanism was not documented. This study compared the incidence of sexual partner disclosure among adults living with HIV (ALHIV) with CHW support and those without in the greater Luwero region, Uganda. Methods We conducted a quasi-experimental study with two arms allocated by geographically determined clusters and adjusted for between-group differences; among ALHIV in the greater Luwero region of Uganda who had never disclosed to their current primary sexual partners. We allocated study clusters to either a CHW-led intervention or control arm. In both arms, we consecutively recruited participants; those in the intervention arm received CHW disclosure support in addition to routine care. The overall follow-up was six months, and the primary outcome was disclosure to the partner. We used survival analysis with proportional hazard ratios to determine the time to partner disclosure in both arms. Results A total of 245 participants were enrolled, and 230 (93.9%) completed the study; of these, 112 (48.7%) were in the intervention and 118 (51.3%) in the control arm. The mean age was 31 ± 8 years with a range of 18 to 55 years; the majority 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-days versus 5.15 [95%CI: 4.85–6.48] per 1,000 person-days in the control arm, log-rank test, X2 = 12.93, P < 0.001. Male gender, aHR = 1.82, tertiary education, aHR = 1.51, and relationship duration of > six months, aHR = 1.19 predicted disclosure. Prior disclosure to a relative, aHR = 0.55, and having more than one sexual partner in the past three months, aHR = 0.74, predicted non-disclosure. Conclusion CHW-led support mechanism increased the rate of sexual partner disclosure among ALHIV with disclosure difficulties. Therefore, to achieve the global targets of ending HIV, near location CHW-led disclosure support mechanism may be used to hasten HIV disclosure in rural settings.

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.