Growth curve analysis of a community-based intervention reducing non-disclosure burden among Malian women living with HIV: the ANRS 12373 Gundo-So randomized trial

Women accounted for 57.8% of new HIV infections in Mali in 2022. Although HIV disclosure is a recognized facilitator of prevention and engagement with the HIV care continuum, Malian women living with HIV (WLHIV) face several challenges to disclosing their serostatus to loved ones; this is because of the fear of stigma, violence, and social rejection. This study evaluated the effectiveness of a community-based interventional trial in reducing the burden of non-disclosure in Malian WLHIV. We conducted a longitudinal, randomized, interventional trial from February 2019 to December 2020 as part of the ANRS 12373 Gundo-So mixed-methods study in six community-based clinics in Bamako, Mali. The intervention aimed to reduce the burden of non-disclosure among WLHIV by (i) empowering them to decide whether or not to disclose their serological status, and (ii) helping them to identify, develop and implement strategies to manage the consequences of their decision. The intervention comprised nine weekly sessions with psychosocial counsellors where WLHIV discussed their concerns and experiences regarding disclosure. Participants were randomized into two groups: an ‘immediate’ and ‘deferred’ intervention group (i.e., the latter was a control group which started the intervention later). Questionnaires at enrolment and follow-up collected data on sociodemographics, antiretroviral treatment (ART), social support, and other characteristics. A Likert scale, with stones representing the level of perceived psychological burden, was used to measure the reduction in the burden of non-disclosure; longitudinal growth curve models were applied to assess the intervention’s impact nine months post intervention. Among the 240 WLHIV enrolled in the trial, at baseline, 54.6% and 95% declared that no family member or friend, respectively, knew their serological status. At baseline, 36% reported a heavy or very heavy burden of non-disclosure; this rate dropped to 9% nine months post intervention. The estimation of the growth curve model showed the absence of difference between the immediate and deferred intervention groups. Overall, the intervention contributed to the decrease of the burden of nondisclosure starting from the post-intervention and persisting over time until M9. In addition, the model showed that older age, not feeling alone, receiving material support, and easy adherence to ART were associated with reduced burden. The ANRS 12373 Gundo-So interventional trial was effective in reducing the burden of non-disclosure among Malian WLHIV. In a context where most HIV interventions focus on increasing disclosure, reducing the associated burden constitutes an innovative approach to HIV care.