Uptake of assisted partner notification among HIV-positive adults with severe mental illness at a national referral hospital in Uganda: A cross-sectional study

Abstract

Abstract Background: HIV more negatively affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the uptake of the APN strategy among PLHIV who had a diagnosis of SMI. Methods:This was a cross-sectional study to determine APN uptake among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants’ demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined uptake of APN as the number of HIV clients with SMI diagnosis who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the uptake of APN. Results: A total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age (interquartile range (IQR)) was 30 (25-34), and 41 (33%) of them accepted APN (95% CI: 25.05 - 41.61). Receipt of at least three counseling sessions before enrollment in APN (aPR=1.8, 95% CI: 1.72 - 1.98) was the most significant factor associated with increased uptake of APN. Poor adherence to ART (aPR=0.62, 95% CI: 0.54 - 0.80), being escorted to hospital by a distant relative (aPR=0.55, 95% CI: 0.39-0.80), being married/cohabiting (aPR=0.65, 95% CI: 0.60 - 0.81), and being a Seventh Day Adventist (SDA) (aPR=0.53, 95% CI: 0.45-0.71) or Pentecostal (aPR=0.44, 95% CI: 0.22-0.98) by faithwere associated with reduced uptake of APN. Conclusion. Uptake of APN is low among PLHIV with a diagnosis of SMI. More structured counseling would facilitate earlier identification of undiagnosed HIV-positive partners.