Health System Mechanisms Supporting HIV Status Disclosure Among People Living with HIV in Mukono District, Uganda

Abstract

Background: Health system support shapes whether and how people living with HIV disclose their status, yet evidence on the specific mechanisms operating at the facility level in Uganda is limited. This study aimed to describe the mechanisms through which the health system in Mukono District, Uganda, supports clients to disclose their HIV status to partners, family members and friends, and to identify gaps in infrastructure, workforce, policy, and coordination.
Methods: Descriptive cross-sectional study conducted from February to August 2024 in 10 health facilities offering comprehensive HIV care in Mukono District. The sample was 317 HIV-positive clients (finite-population correction), 55 health workers (~80% of eligible providers), and 10 health managers. Quantitative data were analysed in SPSS using descriptive statistics; qualitative data were analysed thematically (Braun and Clarke), with two independent coders and an audit trail.
Results: Counselling was the dominant support mechanism: 294/317 clients (92.7%) received disclosure support through counselling, and health workers delivered post-test (54/55, 98.2%), pre-test (94.5%), and ongoing (89.1%) counselling. However, 6/10 facilities (60.0%) had dedicated private counselling spaces, and only 4/10 (40.0%) had adequate disclosure-related information materials. Just 24/55 workers (43.6%) had disclosure-specific training, and 45/55 (81.8%) reported insufficient time per client. Seven of 10 managers (70.0%) described limited inter-stakeholder communication.
Conclusions: Counselling is the primary disclosure-support mechanism in Mukono, but gaps in private space, disclosure-specific training, time per client, and coordination constrain its quality. These descriptive findings should inform policy attention rather than causal claims on outcomes.