Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania

Clients' perceptions and satisfaction with HIV counselling and testing: A cross-sectional study in 56 HCT sites in South Africa

BACKGROUND

Client satisfaction serves as a predictor for acceptance of HIV counselling and testing (HCT) services. Therefore, the study of clients' perception and satisfaction may offer insights on how to improve HCT programmes.

AIM AND SETTING

The aim of this study was to assess clients' satisfaction with HCT as well as describe perceived barriers to and facilitators of HIV testing by HCT clients in South Africa.

METHODS

A cross-sectional survey was conducted through interviews with 498 clients purposefully selected at the end of an HCT visit at 56 HCT sites throughout the country.

RESULTS

All the 498 study participants had tested for HIV with 98.8% receiving their results. Most (88.2%) reported testing for HIV before. The vast majority (75.5%) of clients reported that they had decided to be tested for HIV by themselves. High levels of satisfaction with HCT service (89.8%), low levels (27.7%) of difficulty in making the decision to have an HIV test and high levels of perceived confidentiality (94.6%) of the HIV test results were reported in this study. The most cited perceived barrier to HIV testing was lack of awareness about the HCT service (98%), while staff attitudes (37%), confidentiality (29.6%) and privacy (23.6%) were perceived facilitators. In multivariate logistic regression, staff attitude was significantly associated with client satisfaction (p < 0.05).

CONCLUSION

High levels of client satisfaction with HCT services were observed. Various barriers to and facilitators of - including staff attitude - HCT were identified which can help guide the improvement of HCT services in South Africa.

Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: a cross sectional study

Background

Voluntary HIV counseling and testing (VCT) is a key strategy towards HIV prevention yet, the uptake of VCT services among young people remains low. This study determined the factors that influence the uptake of VCT among secondary school students in Arusha City, Tanzania.

Methods

A cross sectional study using quantitative methods was conducted. A multi-stage sampling method was applied to randomly select the secondary schools. Stratification, random and systematic sampling techniques were used to identify the study participants. Interviews were conducted using structured questionnaires. Data analysis was done using statistical package for social sciences version 16. Analytical statistics were done using odds ratio to measure strength of association between VCT uptake and independent variables. Association with p-value < 0.05 was considered significant. Binary logistic regression was used to identify predictors of VCT uptake.

Results

Of 400 study participants, 50.5% were male and 49.5% were female. 93.5% of the respondents were aware of the VCT services, 79.1% had high knowledge on VCT services and 75.9% had positive attitude towards VCT services. On VCT uptake, only 29.3% had ever tested. VCT uptake was found to be significantly predicted by age (p = 0.003), sex (p < 0.001), religion (p < 0.001), exposure to VCT information from a VCT centre (p < 0.001) and type of school ownership (p < 0.013).

Conclusion

Despite high knowledge on VCT services, the uptake of VCT among secondary school students was found to be low. The uptake of VCT was mainly found to be influenced by fear of HIV test results, knowledge and attitude on VCT services, age, education, engagement in sexual relationships, stigma and distance to the VCT centre. Integration of youth friendly VCT services in secondary schools would increase VCT uptake among secondary school students. Support and care received after knowing the test results should be clearly communicated as it helps motivate more young people towards VCT uptake and reduce stigma among them.

Health service barriers to HIV testing and counseling among pregnant women attending Antenatal Clinic; a cross-sectional study

BACKGROUND

HIV testing and counseling (HTC) remains critical in the global efforts to reach a goal of universal access to prevention and timely human immunodeficiency virus (HIV) treatment and health care. Routine HIV testing has been shown to be cost-effective and life-saving by prolonging the life expectancy of HIV patients and reducing the annual HIV transmission rate. However, these benefits of routine HIV testing may not be seen among pregnant women attending antenatal clinic (ANC) due to health facility related factors. This paper presents the influence of health facility related factors on HTC to inform HTC implementation.

METHODS

The study was cross-sectional in design and used structured questionnaire and interview guides to gather information from 300 pregnant women aged 18 to 49 years and had attended ANC for more than twice at the time of the study. Twelve health workers were interviewed as key informants. Respondents were selected from the five sub metro health facilities in the Kumasi Metropolis through systematic random sampling from August to November 2011. Pregnant women who had not tested after two or more ANC visits were classified as not utilizing HTC. Data was analyzed with STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level.

RESULTS

Twenty-four percent of the pregnant women had not undergone HTC, with "never been told" emerging as the most cited reason as reported by 29.5% of respondents. Decisions by pregnant women to take up HTC were mostly influenced by factors such as lack of information, perceptions of privacy and confidentiality, waiting time, poor relationship with health staff and fear of being positive.

CONCLUSIONS

Access to HTC health facility alone does not translate into utilization of HTC service. Improving health facility related factors such as health education and information, confidentiality, health staff turnaround time and health staff-client relationship related to HTC will improve implementation.

Who Is Going for VCT? A Case Study in Urban Burkina Faso

Introduction. Voluntary HIV counselling and testing (VCT) is a key element of treatment and is essential for prevention of vertical HIV transmission. Little information is available on the uptake of VCT in Burkina Faso. This study aims to assess the prevalence of VCT in urban Burkina Faso, where the epidemic is still highly concentrated. Methods. We conducted a two-stage clustered population-based survey among 1,694 subjects living in Ouagadougou, Burkina Faso. After informed consent was obtained, a behavioural questionnaire was administered to participants. Results. Overall, 10.2% of individuals had used VCT, while 9% were women. Among women who had a child after the launch of the programme to prevent mother-to-child transmission (PMTCT), only 10.4% have been tested for HIV. Almost all participants (99.3%) were aware of HIV/AIDS, and 65% knew the main methods of prevention. In multivariate analysis, older age and being married and better educated were independent factors associated with VCT. Conclusions. Despite high public knowledge and awareness about HIV, VCT uptake was still very low and PMTCT coverage was poor. New strategies are required to increase VCT uptake in urban areas, in particular among the youngest age.

Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project

Voluntary counselling and testing (VCT) is an important component of HIV prevention and care. Little research exists on its acceptability and feasibility in rural settings. This paper examines the acceptability and feasibility of providing VCT using data from two sub-studies: (1) client-initiated VCT provided in rural health centres (RHCs) and (2) researcher-initiated VCT provided in a non-clinic community setting. Nurses provided client-initiated VCT in 39 RHCs in three Zimbabwean provinces (2004-2007). Demographic data and HIV status were collected. Qualitative data were also collected to assess rural communities' impressions of services. In a second study in 2007, VCT was offered to participants in a population-based HIV prevalence survey. Quantitative data from clinic-based VCT show that of 3585 clients aged > or =18, 79.4% (95% CI: 78.0-80.7%) were female; young people (aged 18-24) comprised 21.1%. Overall, 32.9% (95% CI: 31.4-34.5%) tested HIV positive. Young people were less likely to be HIV positive 13.5% (95% CI: 11.1-16.1%) vs. 38.1% (95% CI: 36.3-39.9%). In the second study conducted in a non-clinic setting, 27.0% (n=1368/5052) of participants opted to test. Young people were as likely to test as adults (27.3% vs. 26.9%) and an equal proportion of men and women tested. Overall during the second survey, 18.8% (95% CI: 16.7-21.0%) of participants tested positive (youth = 8.4% (95% CI: 6.4-10.7%); adults = 29.1% (95% CI: 25.7-32.7%)). Qualitative data, unique to clinics only, suggested that adults identify RHCs as acceptable VCT sites, whereas young people expressed reservations around these venues. Males reported considering VCT only after becoming ill. While VCT offered through RHCs is acceptable to women, it seems that men and youth are less comfortable with this venue. When VCT was offered in a non-clinic setting, numbers of men and women testing were similar. These data suggest that it may be possible to improve testing uptake in rural communities using non-clinic settings.

The associations of voluntary counseling and testing acceptance and the perceived likelihood of being HIV-infected among men with multiple sex partners in a South African township

This paper examines the socio-demographic factors and sexual risk behaviors (condom use, number of sexual partners, STI symptoms) associated with voluntary counselling and testing (VCT) acceptance and self-perceived risk of being HIV-infected among black men with multiple and younger sex partners in a South African township outside of Cape Town. Using respondent driven sampling, we interviewed 421 men, of whom 409 (97.3%) consented to provide a dried blood spot, 12.3% were HIVinfected (95% confidence intervals [CI.] 8.3, 16.9) and 47.2% (CI. 41.1, 53.6) accepted on site VCT. Twenty six percent (CI. 20.2, 30.7) reported having an HIV test in the past year. Few men perceived themselves as very likely to be infected with HIV (15.6%; CI. 10.4, 20.5). VCT acceptance was significantly associated with being older, married or living with a partner, having higher education, having four to six partners in the past three months and testing HIV positive. Self-perceived likelihood of being HIV infected was significantly associated with low condom use and having seven or more partners in the past three months, and testing HIV positive. These findings indicate that men correctly understand that engaging in certain HIV risk behaviors increases the likelihood of HIV-infection. However, those who perceive themselves at high risk of having HIV do not seek testing. Further investigation into the psychological and cultural barriers to reducing risky sexual behaviors and accessing VCT and other HIV services is recommended.

Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India

The study examined the influence of socio cultural factors, perception of risk and exposure to violence on consent to HIV testing among at risk women in an urban slum. Married women chosen via a multistage probability sampling in a section of Bangalore, India, between 18 and 44 years, sexually active and considered to be at risk because of their husband's hazardous drinking were recruited for the study. Written informed consent was obtained and measures of risk behavior and violence were administered. Pretest HIV counseling was then conducted and consent for HIV testing was sought. Factors influencing refusal of and consent to HIV testing were documented. Data collected on 100 participants indicated that over half the sample (58%) refused consent for HIV testing. There were no significant differences between the groups who consented and those who refused on perception of risk and exposure to violence. Reasons women refused testing include the following: spouse/family would not allow it (40%), believed that they were not at risk or would test negative (29%) and underwent HIV testing during an earlier pregnancy (21%). Among those who consented for HIV testing, 79% did so because the testing site was easily accessible, 67% consented because testing was free and because the importance of HIV testing was understood. The findings highlight the role of social, logistic and awareness related factors in utilizing voluntary counseling and testing services by women in the slum community. They have important implications for HIV testing, particularly among at risk monogamous women.

Correlates of HIV testing among South African women with high sexual and substance-use risk behaviours

Despite its importance in raising awareness of HIV risk behaviour and in linking HIV-positive individuals to care and treatment, research findings indicate that the HIV antibody testing rate in the general South African population remains relatively low, although knowledge of HIV testing services is high. The identification of important correlates of testing behaviour can be used to improve HIV testing campaigns by refining messages that target individuals at highest risk for infection. This study uses data from an ongoing prevention intervention study in Pretoria, South Africa to identify factors that may have a greater influence on facilitating or hindering HIV testing among South African women who face a high risk for infection. The data for this study (n=425) are derived from the baseline interviews and HIV test results collected between June 2004 and January 2007. HIV testing for this study was significantly associated with education level, alcohol and cannabis use, sex trading, number of STI symptoms, physical abuse and number of visits to a clinic for medical treatment. Results suggest that more focused efforts need to be made to provide HIV testing to women who report substance use behaviour, experience violence and report high-risk sexual behaviour. Interventions also need to address denial of HIV infection and fear to test for HIV.

Availability of supplies and motivations for accessing voluntary HIV counseling and testing services in Blantyre, Malawi

BACKGROUND

HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV). Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment.

METHODS

A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT) and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city.

RESULTS

102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were < or =29 years, 58.8% were females and only 7% reported no formal education. 42.2% were single, 45.1% married, 8.8% widowed and 3.9% divorced or separated. The primary reasons for seeking HIV counseling and testing were: recent knowledge about HIV (31.4%), current illness (22.5%), self-assessment of own behavior as risky (15.5%), suspecting sexual partner's infidelity (13.7%) and seeking HIV confirmatory test (9.8%) and other reasons (6.9%). Of the 26 VCT counselors, 14 were lay volunteers, 7 health surveillance assistants and 5 nurses. All except one had been trained specifically for HIV counseling and testing. All 6 facilities were conducting rapid HIV testing with same day test results provided to clients. Most of the supplies were considered adequate for testing.

CONCLUSION

HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection.

The utilization of testing and counseling for HIV: a review of the social and behavioral evidence

Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.

Factors determining prenatal HIV testing for prevention of mother to child transmission in Dar Es Salaam, Tanzania

BACKGROUND

The objectives of the study were (i) to evaluate the Prevention of Mother to Child Transmission (PMTCT) services in Temeke district, Tanzania and (ii) to identify factors for non-acceptance of HIV testing among pregnant mothers in the area.

METHODS

A structured questionnaire was used in face-to-face interviews at five health centers in the district. Univariate and multiple logistic regression analyses were used to assess the association of the refusal of human immunodeficiency virus (HIV) testing with risk factors.

RESULTS

Two hundred and seventy-three (68.1%) of the participants had already had HIV testing, while 128 (31.9%) had not. Participants' general knowledge of HIV was high, but specific knowledge of mother to child transmission (MTCT) was relatively low. In the multiple logistic regression analysis, frequencies of antenatal clinic visits, awareness of MTCT and intensive family support were significantly and inversely associated with the refusal of HIV testing.

CONCLUSIONS

Frequency of antenatal care visits, spreading information on HIV/acquired immune deficiency syndrome especially MTCT, and husbands' intensive support are significant factors for increase of HIV test acceptance among pregnant women in the study area.

Voluntary testing for HIV among a sample of Tanzanian teachers: A search for socio-demographic and socio-psychological correlates

Knowledge of HIV status is paramount in prevention, treatment and care. This study determined the prevalence and factors associated with testing for HIV. We collected data through a cross-section questionnaire survey among 918 primary school teachers in Mwanza region, Tanzania (mean age 38.4 years). About 20% (181) of the participants had voluntarily tested for HIV. Teachers who: were aged between 21 to 30 years, had easy access to HIV testing services, had a partner with tertiary education, and perceived their health status positively were significantly more likely to have tested for HIV. Teachers who had tested for HIV were significantly less likely: to perceive that it is not necessary to test for HIV in absence of vaccine or cure for HIV/AIDS; to support that only people who suspect that they are HIV infected should test for HIV; and to believe that HIV infected people are likely to die quicker if they are tested for HIV and be informed about their positive results. The results of this study underscore the need to promote positive views of voluntary testing for HIV among Tanzanian teachers.

Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Acceptance of HIV Testing Among Pregnant Women in Dar-es-Salaam, Tanzania

BACKGROUND

Increased prevention of maternal-to-child transmission of HIV-1 has now become possible due to the availability of effective antiretroviral drugs in developing countries. It is necessary for pregnant women to know their HIV status in order to administer timely treatment to reduce transmission of the virus. This study assesses correlates of acceptance of testing for HIV infection in the antenatal setting in Dar-es-Salaam, Tanzania.

METHODS

Between August 13, 2001 and November 27, 2002, 14,235 pregnant women were offered screening for HIV as part of routine prenatal care. Demographic information pertaining to the women and their partners, if applicable, was collected. Univariate and multiple logistic regression analyses were carried out.

RESULTS

The majority of women were married monogamously (60.0%), had < or =7 years of education (75%), and were unemployed (70.4%). Of the 14,235 women offered screening for HIV, 10,991 (77.2%) accepted. Site of recruitment was significantly associated with screening acceptance (P for trend < 0.0001). Additionally, age, education, marital status, and partner's occupation were significant predictors of testing acceptance.

CONCLUSION

The site at which recruitment occurs is a significant factor in determining a woman's odds of accepting HIV testing. The site covariate includes such factors as individual counselor effects, length of waiting time, and length of time the site has been operational.

Profiles of HIV voluntary counseling and testing of clients at a district hospital, Chiang Mai Province, northern Thailand, from 1995 to 1999

Voluntary HIV counseling and testing (VCT) is a central component of comprehensive HIV prevention strategies targeting individual risk reduction. VCT data are essential for planning and improving HIV/AIDS intervention strategies. The objective of this study is to describe demographic profiles, reasons for seeking HIV counseling and testing, rate of declining HIV testing after pretest counseling, rate of failure to return for HIV test results, and HIV prevalence and associations among 3570 clients who sought VCT at Sansai Hospital in northern Thailand from 1995 to 1999. Data were abstracted retrospectively from client-level data recorded by the hospital counselors on a standard form. HIV prevalence was 29% and remained high throughout the study period. Reasons for seeking VCT for men and women were markedly different and highly correlated with rates of declining the test, failure to return for test results, and HIV prevalence. Declining VCT and failing to return were high among uneducated clients (p <.001). Failure to return among men was associated with HIV prevalence (OR = 1.72, p =.003), particularly for those who had risk behaviors (OR = 5.92, p <.001) and those who wanted to know their HIV serostatus (OR = 4.44, p =.002). Overall, VCT acceptance and returning for test results were high. VCT services at the community level can reach high-risk individuals, especially male partners of women tested as part of routine prenatal care.

Low impact of a community-wide HIV testing and counseling program on sexual behavior in rural Uganda

Study results on the assessment of a community-wide HIV counseling and testing program are presented. The aim of this study was to elucidate whether HIV counseling and testing was effective in reducing high risk sexual behavior of a rural population in Uganda. From a total of 2,267 persons of Kigoyera Parish, western Uganda, who were HIV tested and counseled, 495 persons were selected and interviewed about their sexual behavior. Persons who were HIV tested showed no difference in sexual behavior compared to those who were not tested (condom use 4.3% vs. 5.5%, mean number of sexual partner in the past three months 1.8 vs. 2.0). The conclusion is that only knowing the HIV serostatus is not enough to reduce high risk behavior. The study results also showed that there is a demand for HIV counseling services without being HIV tested.