Study design and settings
This cross-sectional analytical study was conducted between January to May 2018 on a sample of parturient women with HIV enrolled in the electronic database of the East London Prospective Cohort Study . This database was created for research purposes between September 2015 and May 2016 to track the PMTCT outcomes of parturient women with HIV and their infants in three hospitals in Buffalo City and the Amathole district of the East Cape Province of South Africa. These hospitals serve a combined population of 1.7 million people residing in the rural and urban communities of the central region of the Eastern Cape .
Participants and Sample size
The sample size for this sub-study (exit interview) was estimated as 485, using the Cochran formula for categorical data, at a confidence level of 95%, a precision level of +/−4% and 10% possible attrition. Parturient women with HIV enrolled in the East London Prospective Cohort Study database, who were accessible telephonically, were considered eligible for this exit survey. Each participant was offered a choice to either complete an interviewer-guided interview face-to-face or telephonically. A few participants (n=43) who chose to attend interviews at one of the three hospitals were reimbursed for the cost of transportation. Those who chose to complete telephonic interviews agreed to a scheduled time with our research team.
We employed and trained two research assistants, who were fluent in both IsiXhosa (local language) and English for this study. The research team successfully contacted 509 participants who responded to the study questionnaires. Some of the eligible participants were no longer accessible through any of the three contactable mobile numbers obtained from the electronic database. We designed a questionnaire specifically for the exit interview, which was piloted with 12 parturient women with HIV in one of the hospitals to ascertain the validity of the instrument. We subsequently adjusted the questionnaire using feedback from the participants and the investigators.
The questionnaire consisted of three main sections: socio-demographic, lifestyle behaviours, and clinical information.
Socio-demographic characteristics: We obtained information on the participants’ ages (which were coded as continuous variables), level of education, and marital status. We obtained information on the employment status of the participants, occupation in the preceding 12 months at the time of the study, and whether they were engaged in a salary paying job. We obtained additional information on whether participants were receiving child support grants (social grants) from the South African government.
Lifestyle behaviours: We obtained information on the smoking status and alcohol consumption in the past year as categorical data with "yes" or "no" response.
Clinical characteristics: The following clinical information was obtained through self-reporting by the participants: awareness of partner's HIV serostatus, disclosure of HIV serostatus to a sexual partner, and complete adherence to ART (no missed dose of ART in the preceding week of the study). A binary response of "yes” or “no" was provided for the participants. We also documented the duration of HIV infection (period since diagnosis) among the participants, which was categorised as a continuous variable. We asked participants to provide open responses to reasons for not disclosing their status to their respective partners.
Disclosure of HIV serostatus to sexual partners was the main outcome measure of this study. Complete responses were available for 485 respondents on the main outcome measure and were included in this analysis. All analyses were conducted with the IBM Statistical Packages for Social Sciences, version 24.0 (SPSS, Chicago, IL, USA). Descriptive statistics (means, frequency, and percentages) were used to summarise the characteristics of the participants disaggregated by their disclosure status. We performed adjusted and unadjusted logistic regression models to examine the associations between marital status, knowing the partner's status, and HIV positive status disclosure. The 95% confidence intervals were reported for all analyses, and p-values less than 0.05 were considered statistically significant.