A total of 115 case-control pairs were recruited into the study with a response rate of 96%.
4.1.1 Socio-demographic characteristics of study participants
Table 2 below displays the sociodemographic characteristics of study participants.
Table 2: Socio demographic characteristics of study participants, Seke District, 2019.
Variable Category Cases
n=115 (%)
Control n=115 (%)
P value
Gender Male
Female
38 (33) 77 (67)
40 (34) 75 (66)
0.78
Age (years) <31
31-40 41-50
>50
11 (10) 22 (19) 47 (41) 35 (30)
18 (16) 40 (35) 36 (31) 21 (18)
0.001
Median age (years) 46.5
(Q1=38.5,Q3=52.5) 40.5
(Q1=34,Q348) Marital status Never married
Divorced Widowed Cohabitating Married
7 (6) 15 (13) 25 (22) 7 (6) 61 (53)
13 (11) 12 (10) 17 (15) 10 (9) 63 (55)
0.62
Highest Level of education None Primary Secondary Tertiary
16 (14) 31 (27) 51 (44) 17 (15)
26 (23) 44 (38) 35 (30) 10 (9)
0.003
Employment status Employed Not employed
61 (55) 54 (47)
48 (42) 67 (58)
0.09
Monthly income (ZW$) <200 200-500
>500
60 (52) 40 (35) 15 (13)
71 (62) 25 (22) 19 (16)
0.46
Level of statistical significance p<0.05
28 Cases and controls were comparable with respect to gender, marital status, monthly income and employment status. The majority of cases 59% (68/115) had at least secondary educational level as compared to only 39% (45/115) of the controls. In terms of age cases were older than controls. The median ages were 46.5 (Q1=38.5, Q3=52.5) for cases and 40.5 (Q1=34, Q3=48) for controls.
29 4.1.2 Socio demographic factors associated with participation in CARGs.
Table 3 below displays the sociodemographic factors associated with participation in CARGs.
Table 3: Socio demographic factors associated with participation in CARGs, Seke District, 2019.
Factor Cases
n=115 (%)
Control n=115 (%)
OR (95% CI)
P value Gender
Male Female
38 (33) 77 (67)
40 (34) 75 (66)
0.90 (0.54-1.59)
0.78 Age (years)
> 40
≤ 40
82 (71) 33 (29)
57 (49) 58 (51)
2.53 (1.47-4.36)
<0.001 Marital status
Single (divorced, widow, never married)
Married (married, cohabitating)
47 (41) 68 (59)
42 (37) 73 (63)
1.20 (0.71-2.04)
0.50 Level of education
≥Secondary
< Secondary
68 (59) 47 (41)
46 (40) 69 (60)
2.17 (1.28-3.67)
0.003 Employment status
Employed Not employed
61 (53) 54 (47)
48 (42) 67 (58)
1.58 (0.94-2.66)
0.09 Monthly income (ZW$)
>500
≤500
15 (13) 100 (87)
19 (17) 96 (83)
0.76 (0.36-1.58)
0.46 Place of residents
Urban Rural
71 (62) 44 (38)
69 (60) 46 (40)
1.08 (0.63-1.83)
0.79 Level of statistical significance p<0.05
Participants who were more than 40 years old (OR 2.53; 95% CI 1.47-4.36) and those with at least secondary level of education (OR 2.17; 95% CI 1.28-3.67) were significantly more likely to participate in CARGs. There was no statistically significant association between employment status (OR 1.58, 95% CI 0.94-2.66), average monthly income (OR 0.76; 95% CI 0.36-1.58), gender (OR 0.90, 95%CI 0.54-1.59) and participation in CARGs.
30 4.1.3 Health care related factors associated with participation in CARGs.
Table 4 below displays the health care factors associated with participation in CARGs.
Table 4: Health care factors associated with participation in CARGs, Seke District, 2019.
Factor Cases
n= 115 (%)
Controls n=
115(%)
OR (95% CI)
P value
Fear of inadequate monitoring under CARG
Yes No
52 (45) 63 (55)
86 (75) 29 (25)
0.28 (0.16-0.48)
<0.001 Received education on CARGs
within 6 months of diagnosis Yes
No
87 (76) 28 (24)
43 (37) 72 (63)
5.2
(3.00-9.20)
<0.001 Experienced delays at clinic
Yes No
90 (78) 25 (22)
86 (75) 29 (25)
1.21 (0.66-2.24)
0.53 Distance to clinic ≥10 km
Yes No
69 (60) 46 (40)
53 (46) 62 (54)
1.75 (1.04-2.96)
0.03 Perceived clinic staff friendly
Yes No
94 (82) 21 (18)
96 (83) 19 (17)
0.89 (0.45-1.75)
0.73 Confidentiality at clinic
Yes No
87 (76) 28 (24)
95 (83) 20 (17)
0.65 (0.34-1.24)
0.19 Level of statistical significance p <0.05
Participants whose homes were more than 10 kilometres from the clinic (OR 1.75; 95% CI 1.04-2.96) and received CARG education within six months of diagnosis (OR 5.2; 95% CI 3.00-9.20) were significantly more likely to participate in CARGs. Those with fear of inadequate monitoring under CARG (OR 0.28; 95% CI 0.16-0.48), were significantly less likely to participate in CARGs. There was no statistically significant association between perception that clinic staff were friendly and welcoming (OR 0.89, 95% CI 0.45-1.75), perceived confidentiality at the health facility (OR 0.65, 95% CI 0.34-1.24) and participation in CARGs.
31 4.1.4 Client related factors associated with participation in CARGs
Client related factors associated with participation in CARGs are displayed in table 5 below.
Table 5: Client related factors associated with participation in CARGs, Seke District, 2019
Factor Cases
n=115(%)
Controls n=115(%)
OR (95% CI)
P value Having a family member in
CARGs Yes No
63 (55) 52 (45)
26 (23) 89 (77)
4.15 (2.34-7.34)
<0.001 Fear of community stigma
Yes No
40 (35) 75 (65)
79 (69) 36 (31)
0.24 (0.14-0.42)
<0.001 Non-disclosure of status within 6
months of HIV diagnosis Yes
No
45 (39) 70 (61)
90 (78) 25 (22)
0.18 (0.10-0.32)
<0.001 Perceived peer support in CARGs
Yes No
68 (59) 47 (41)
21 (18) 94 (82)
6.48 (3.55-11.8)
<0.001 Perceived privacy in CARGs
Yes No
85 (74) 30 (26)
28 (24) 87 (76)
8.80 (4.90-16.0)
<0.001 Aware of a CARG in my area
within 6 months of diagnosis Yes
No
115 (100) 0 (0)
31 (27) 84 (73)
- -
Level of statistical significance p<0.05
Clients who had a family member participating in CARGs (OR 4.15, 95% CI 2.34-7.34), perceived peer support in CARGs (OR 6.48, 95% CI 3.55-11.8) and perceived privacy in CARGs (OR 8.80, 95% CI 4.90-16.0) were significantly more likely to participate in CARGs.
Clients with fear of community stigma (OR 0.24, 95% CI 0.14-0.42) and those who failed to disclose HIV status to other people other than spouse/ guardians within 6 months of diagnosis (OR 0.18, 95% CI 0.10-0.32) were significantly less likely to participate in CARGs.
32 4.1.5 Stratified analysis: Non-disclosure of HIV status to other people other than spouse/
guardians within six months of diagnosis was stratified by age to control for confounding and assess effect modification.
The effect of non-disclosure of HIV status to other people other than spouse/ guardians within 6 months of diagnosis on participation in CARGs stratified by age is shown in table 6 below.
Table 6: The effect of non-disclosure of HIV status to other people other than spouse/
guardians within 6 months of diagnosis on participation in CARGs stratified by age, Seke District, 2019
Factor Cases Controls OR 95% CI
≤40 years
Non-disclosure of HIV status within 6 months of diagnosis
Yes No
11(33) 22(67)
46(79) 12(21)
0.13 0.05-0.34
>40 years
Non-disclosure of HIV status within 6 months of diagnosis
Yes No
34(41) 48(59)
44(77) 13(23)
0.21 0.10-0.45
Crude
Non-disclosure of HIV status within 6 months of diagnosis
Yes No
45(39) 70 (61)
90(78) 25(22)
0.18 0.10-0.32
Adjusted OR (MH) 0.18 (0.10- 0.32) χ2 =0.57; p=0.45
Level of significance p<0.05
The test of homogeneity proved that stratum specific ORs were not significantly different (p=0.45), neither were they different from the crude OR. Therefore, the effect of non-disclosure of HIV status to other people other than spouse/ guardians within 6 months of diagnosis on participation in CARG was neither confounded nor modified by age.
33 4.1.6 Independent predictors of participation in CARGs.
Displayed in table 7 below are the independent predictors of participation in CARGs.
Table 7: Independent predictors of participation in CARGs, Seke District, 2019
Factor AOR 95% CI p value
Perceived privacy in CARGs 5.23 2.44-11.2 <0.001
Having a family member in CARG 2.65 1.27-5.51 0.009
Perceived peer support 3.98 1.90-8.30 <0.001
Non-disclosure of HIV status within 6 months of diagnosis
0.43 0.20-0.90 0.03
Level of statistical significance p < 0.05
Having a family member in CARGs (AOR 2.65, 95% CI 1.27-5.51), perceived privacy in CARGs (AOR 5.23, 95% CI 2.44-11.2) and perceived peer support in CARGs (AOR 3.98, 95% CI 1.90-8.30) were the independent factors associated with clients being more likely to participate in CARGs. Failure to disclose HIV status to people other than spouse/guardian within 6 months of diagnosis (AOR 0.43, 95% CI 0.20-0.90) was an independent factor associated with clients being less likely to participate in CARGs.
34 4.1.7 Knowledge of cases and controls on CARGs.
Displayed in figure 3 below is the knowledge of cases and controls on CARGs.
Figure 3: Knowledge of cases and controls on CARGs, Seke District, 2019
The majority of cases 65% (75/115) had good knowledge as compared to 29% (33/115) of controls. A comparable number 20% (23/115) of cases and 17% (20/115) of controls had fair knowledge. A high proportion 54% (62/115) of controls had poor knowledge as compared to only 15% (17/115) of cases. Cases were more knowledgeable that controls (p<0.01).
15 20 54 65 17
29
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cases Controls
Pr opor tio n (%)
Case status
Poor knowledge
Fair knowledge
Good knowledge
35 4.1.8 Treatment and behavioural outcomes of participation in CARGs.
Table 8 below displays the treatment and behavioural outcomes of participation in CARGs.
Table 8: Treatment and behavioural outcomes of participation in CARGs, Seke District, 2019
Level of statistical significance p<0.05
This study looked at acquisition of STIs and adherence as the behavioural outcomes of interest.
Viral load suppression and acquisition of TB were the treatment outcome of interest. Sixteen percent (18/115) of those not participating in CARGs acquired STIs as compared to only 7%
(8/115) of those participating. The difference was statistically significant (p<0.05). There was no statistically significant difference on viral load suppression, acquisition of TB and adherence to ART medication between clients who were participating and those who were not participating in CARGs. The main reasons for failing to adhere were forgetfulness 90%
(18/20), being at work 25% (5/20) and severe side effects 20% (4/20).
Variable Outcomes P value
CARG participation
Viral suppression (<1000copies/ml) Yes No
Yes No
107(93) 8 (7) 100(87) 15 (13)
0.12
CARG participation
Tuberculosis Yes No Yes
No
7 (6) 108 (94) 9 (8) 106 (92)
0.60
CARG participation
Sexually Transmitted infections Yes No
Yes No
8 (7) 107 (93) 18(16) 97 (84)
0.04
CARG participation
Adherence to ART Yes No Yes
No
109 (95) 6 (5) 101 (88) 14 (12)
0.06
36 4.1.9 Barriers to participation in CARGs reported by non CARG members.
Displayed in table 9 below are barriers to participation in CARGs as reported by non CARG members.
Table 9: Barriers to participation in CARG reported by non CARGs, Seke District, 2019
Barrier Frequency n= 115 Percentage
No convenience 62 54
Fear of stigma 42 37
I do not need one 42 37
There are no benefits 27 24
My support is enough 26 23
I do not know where to find one 12 10
The main barriers to participation in CARGs which were reported by non CARG members were inconvenience 54% (62/115), fear of stigma 37% (42/115), no need for participating in CARGs 37% (42/115), lack of benefits 24% (27/115) and perceiving enough support at home 23% (26/115).
37