Impact of inter-partner HIV disclosure patterns in Malawi’s PMTCT program: A mixed-method study

Yotebieng, Marcel; van Lettow, Monique; Cataldo, Fabian; Landes, Megan; Kasende, Florence; Nkhoma, Pearson; van Oosterhout, Joep J.; Kim, Evelyn; Schouten, Erik; Nkhoma, Ernest; Nyirenda, Rose and Tippett Barr, Beth A.. 2019. Impact of inter-partner HIV disclosure patterns in Malawi’s PMTCT program: A mixed-method study. PLoS ONE, 14(7), e0219967. ISSN 1932-6203 [Article]

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Abstract or Description

Background: Evidence suggests that disclosure of HIV status between partners may influence prevention of maternal-to-child transmission of HIV (PMTCT) outcomes. We report partner disclosure in relation to maternal antiretroviral therapy (ART) uptake and adherence, and MTCT among postpartum HIV-infected Malawian women.

Methods: A cross-sectional mixed-method study was conducted as part of a nationally representative longitudinal cohort study. Between 2014–2016, all (34,637) mothers attending 54 under-5 clinics with their 4–26 week-old infants were approached, of which 98% (33,980) were screened for HIV; infants received HIV-1 DNA testing. HIV-exposure was confirmed in 3,566/33,980 (10.5%). Baseline data from mothers who were known to be HIV-infected at time of screening were included in the current analysis. Guardians (n = 17), newly diagnosed HIV-infected mothers (n = 256) and mothers or infants with undetermined HIV status (n = 30) were excluded. Data collected included socio-demographics, partner disclosure, maternal ART uptake, and adherence. Between 2016–2017, in-depth interviews and focus group discussions were conducted with adult mothers (n = 53) and their spouse/cohabiting partners (n = 19), adolescent mothers (n = 13), lost-to-follow up (LTFU) mothers (n = 22), community leaders (n = 23) and healthcare workers (n = 154).

Results: Of 3153 known HIV-infected mothers, 2882 (91.4%) reported having a spouse/cohabiting partner. Among 2882 couples, both partners, one partner, and neither partner disclosed to each other in 2090 (72.5%), 622 (21.6%), and 169 (5.9%), respectively. In multivariable models, neither partner disclosing was associated with no maternal ART (aOR 4.7; 95%CI 2.5–8.8), suboptimal treatment adherence (aOR 1.8; 95%CI 1.1–2.8) and MTCT (aOR 2.1; 95%CI 1.1–4.1). Women’s fear of blame by partners was central to decisions not to disclose within couples and when starting new relationships. LTFU mothers struggled to accept and disclose their status, hindering treatment initiation; some were unable to hide ART and feared involuntary disclosure.

Conclusion: Partner disclosure seems to play an important role in women’s decisions regarding ART initiation and adherence. Inter-partner non-disclosure was associated with no ART uptake, suboptimal treatment adherence and MTCT.

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Funding: This work was supported by the U.S. President’s Emergency Plan for AIDS Relief grant U2GGH000721-02 to the US Centers for Disease Control and Prevention. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Access Statement:

All relevant data are within the manuscript and its Supporting Information files.

Departments, Centres and Research Units:

Social, Therapeutic & Community Engagement (STaCS)
Social, Therapeutic & Community Engagement (STaCS) > Centre for Community Engagement Research


26 July 2019Published
6 July 2019Accepted
26 January 2019Submitted

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Date Deposited:

04 Dec 2023 09:40

Last Modified:

04 Dec 2023 09:40

Peer Reviewed:

Yes, this version has been peer-reviewed.


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