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      Acceptance of HIV Counseling and Testing among Antenatal Clinic Attendees in Southern Ethiopia

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          Abstract

          Background

          Counseling and testing for Human Immunodeficiency Virus (HIV) (HCT) during antenatal care (ANC) is a critical entry point for the prevention of mother-to-child transmission (PMTCT) of HIV. However, in Ethiopia limited evidence exists regarding the extent of acceptance of the service. The study aimed to assess the level and factors associated with acceptance of HCT in Hawassa city, Southern Ethiopia.

          Methods

          Cross-sectional study was conducted in four public health facilities found in the city. Five hundred and four ANC clients were selected using multistage sampling technique. Data were collected via interviewer administered questionnaire and analyzed using multivariable binary logistic regression analysis. The outputs are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI).

          Results

          The vast majority, 84.1% (95% CI: 80.6–87.2%), of the respondents accepted the HCT. Acceptance was positively associated with being married [AOR=5.60 (95% CI: 1.87–16.50)], having two or more ANC visits [4.93 (95% CI: 2.40–10.07)], history of prior HIV testing [4.23 (95% CI: 1.90–9.74)], having good knowledge about MTCT [4.91 (95% CI: 2.07–11.6)] and PMTCT [6.22 (95% CI: 2.87–13.50)] and having no fear of stigma and discrimination [3.32 (95% CI: 1.57–7.02)].

          Conclusion

          Acceptance of HCT can be further improved by enhancing the knowledge of mother about PMTCT and combating stigma and discrimination.

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          Barriers to participation in the prevention of mother-to-child HIV transmission program in Gaborone, Botswana a qualitative approach.

          P M Kebaabetswe (2007)
          The existing belief that if money and free antiretroviral drugs were offered to developing countries, people would flock to use the services does seem to hold for the Prevention of Mother-to-Child Transmission of HIV Program (PMTCT) in Botswana. The government offers free counseling, testing, free antiretroviral drugs and free infant formula for babies born to infected mothers and yet some women are reluctant to enroll in this program to protect their infants. A qualitative study on factors that motivated and hindered pregnant women from participating in the PMTCT program was conducted in Gaborone, Botswana. Forty subjects (ten HIV-positive pregnant women who accepted the program, eleven who rejected the program, nine PMTCT health workers and ten key informants) participated in in-depth interviews. Thematic content analysis yielded the following barriers to participation in the program: fear of knowing one's own HIV status, infant feeding distribution stigma, lack of male partners' support and negative attitudes of health workers. Reinforcing factors were: availability of free antiretroviral drugs and free infant formula. In conclusion, stigma and discrimination are still the main impediments to women's participation in the PMTCT program. Mitigating these barriers could reduce AIDS-related infant mortality in this country.
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            Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda.

            Fred Nalugoda, Joseph Matovu, R. Gray … (2005)
            To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.
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              Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital.

              Rosette Mugumya, J Ojwang, John Obonyo … (2006)
              In Africa, prevention of mother-to-child HIV transmission (PMTCT) programs are hindered by limited uptake by women and their male partners. Routine HIV counseling and testing (HCT) during labor has been proposed as a way to increase PMTCT uptake, but little data exist on the impact of such intervention in a programmatic context in Africa. In May 2004, PMTCT services were established in the antenatal clinic (ANC) of a 200-bed hospital in rural Uganda; in December 2004, ANC PMTCT services became opt-out, and routine opt-out intrapartum HCT was established in the maternity ward. We compared acceptability, feasibility, and uptake of maternity and ANC PMTCT services between December 2004 and September 2005. HCT acceptance was 97% (3591/3741) among women and 97% (104/107) among accompanying men in the ANC and 86% (522/605) among women and 98% (176/180) among their male partners in the maternity. Thirty-four women were found to be HIV seropositive through intrapartum testing, representing an 12% (34/278) increase in HIV infection detection. Of these, 14 received their result and nevirapine before delivery. The percentage of women discharged from the maternity ward with documented HIV status increased from 39% (480/1235) to 88% (1395/1594) over the period. Only 2.8% undocumented women had their male partners tested in the ANC in contrast to 25% in the maternity ward. Of all male partners who presented to either unit, only 48% (51/107) came together and were counseled with their wife in the ANC, as compared with 72% (130/180) in the maternity ward. Couples counseled together represented 2.8% of all persons tested in the ANC, as compared with 37% of all persons tested in the maternity ward. Intrapartum HCT may be an acceptable and feasible way to increase individual and couple participation in PMTCT interventions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ethiop J Health Sci
                Journal ID (iso-abbrev): Ethiop J Health Sci
                Title: Ethiopian Journal of Health Sciences
                Publisher: Research and Publications Office of Jimma University (Jimma, Ethiopia )
                ISSN (Print): 1029-1857
                ISSN (Electronic): 2413-7170
                Publication date (Print): July 2018
                Volume: 28
                Issue: 4
                Pages: 413-422
                Affiliations
                [1 ]Hawassa City Administration Health Department, Hawassa, Ethiopia
                [2 ]School of Public Health, Hawassa University, Hawassa, Ethiopia
                Author notes

                Funding: Hawassa City Administration Health Department

                Competing Interests: The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists.

                Article
                Publisher ID: jEJHS.v28.i4.pg413
                DOI: 10.4314/ejhs.v28i4.7
                PMC ID: 6308730
                PubMed ID: 30607054
                SO-VID: a941df54-a186-49fe-8686-c48f0b83962f
                Copyright © © 2018 Rahel Gizaw., et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 20 December 2017
                Date accepted : 9 February 2018
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Medicine
                Keywords: hiv testing acceptance,antenatal care,stigma and discrimination,prevention of mother-to-child transmission of hiv,hawassa,ethiopia
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: hiv testing acceptance, antenatal care, stigma and discrimination, prevention of mother-to-child transmission of hiv, hawassa, ethiopia

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