Uptake of assisted partner notification and associated factors among HIV positive persons with severe mental illness at Butabika National Mental Referral Hospital Uganda – a cross sectional study
Nante Wangi, Rachel
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Introduction: People with severe mental illnesses (SMI) have a greater HIV prevalence than the general population. In order to identify more than 95 percent of people living with HIV (PLHIV) in the community, World Health Organization (WHO) introduced assisted partner notification (APN) services to its 2015 consolidated guidelines. APN is effective in helping people who were previously unaware of their HIV status know their stand, and facilitating their referral to care. The uptake of APN in the general population is also high (81%). At every stage of the HIV treatment process, however, mental health impairment leads to negative health consequences, including actively participating in APN. The extent to which APN service is used among individuals with HIV and have a diagnosis of SMI, and the factors associated with its uptake are unknown. Objective: To determine the uptake of assisted partner notification and associated factors, among HIV positive persons with severe mental illness at Butabika hospital. Methods: A cross-sectional design with descriptive and analytic components employing both quantitative and qualitative data collection methods. A total of 139 medical files of PLHIV with a diagnosis of SMI at Butabika hospital antiretroviral therapy (ART) clinic were reviewed between November 2021 and January 2022, and 125 participants’ files included in the analysis. A data abstraction tool was used to collect quantitative data on age, sex, marital status, education level, relationship with next of kin(NOK), drug abuse, ART adherence level, duration on psychiatric drugs, art regimen, CD4 count and routine counselling. Ten in-depth interviews and six key informant interviews were conducted among patients and health care workers (HCW) respectively for qualitative data to explore all the socio-cultural barriers to uptake of APN. Quantitative data was entered into Epi data 4.0 version and exported to STATA 14.0 for analysis, while qualitative data was analysed using inductive analysis. Triangulation of data was used to corroborate the findings. Bivariate and multivariate analyses were performed using logistic regression, to check the association between uptake of APN and independent variables. Socio-cultural barriers were themes generated from key informant interviews and in-depth interviews. Results: Majority of the participants were females 66.4% (83/125) and 42.4% (53/125) were between 24-34 years. Approximately 34.2% (40/104) and 33.3% (39/104) were single or had never been married and married or cohabiting respectively. Less than half of the participants had attained up to primary education 36.6% (15/41). Majority of the participants had been on anti-psychotic treatment for more than 6 months 80.8% (101/25), were in WHO stage 3 at enrolment 85.6% (107/125) and were on first line ART regimen 94.4% (118/125). Only 52% (64/123) of them had a record of good adherence to ART on their last visits and 72% (85/118) had a record of at least three routine counselling sessions in their files. The overall uptake of APN among individuals with HIV who had a diagnosis of SMI at Butabika hospital was 32.8% (95%CI: 25.1% – 41.6%). Uptake of APN was low among individuals who belonged to Pentecostal religion (PR=0.44, P=0.031, 95%CI: 0.22-0.98) and SDA religion (PR=0.53, P=0.022, 95% CI: 0.45-0.71), those who were married (PR=0.65, P=0.031, 95%CI 0.60-0.81) and those who were usually brought to the health facility by their distant relatives (PR=0.55, P<0.001. 95%CI: 0.39-0.80) or friends/neighbors (PR=0.322, P<0.001, 95%CI: 0.20-0.534. Uptake was also significantly low among individuals who had spent more than 6 months on anti-psychotic treatment (PR=0.78, P=0.021, 95%CI: 0.44-0.90) and who had a record of poor adherence to ART on last visit (PR=0.92, P=0.029, 95%CI: 0.84-1.00), while uptake was significantly high among individuals who had received at least three routine counselling sessions before APN service was offered (PR=1.84, P=0.018,95%CI: 1.72-1.98). The socio-cultural barriers to uptake of APN were summarized using the following themes; inability to maintain confidentiality, lack of trust in HCW, stigma and discrimination, fear to cause domestic violence, loss of economic support, lack of awareness about APN and health workers disclosing HIV status to the partners HIV index clients in their absence. Conclusion: Uptake of APN among PLHIV with a diagnosis of SMI was low. Factors significantly associated with uptake of APN were religion, marital status, relationship with next of kin, duration on anti-psychotic treatment, adherence level and counselling. However, supportive counselling of these patients before they are offered APN services may improve uptake in this group.