Factors influencing uptake of HIV voluntary testing among women attending antenatal care in Tororo District, Uganda

Abstract

Background: HlV/AlDS is a major public health problem in Uganda, ranked the 2nd cause of mortality and morbidity in all age groups. Of HIV positive pregnant mothers, 30% transmit the virus to their babies. In 2001 Tororo established prevention of Mother to Child HIV Transmission services, to reduce the rate of transmission to children. However, VCT uptake among pregnant women was only (9%). The objective of this study was to establish the factors influencing uptake of HIV voluntary testing among pregnant women attending antenatal care in the district. Methods: This was an un-matched case-control study. We conducted face-to-face interviews with 280 women attending all the seven antenatal care sites in Tororo district in April 2004. A semi-structured questionnaire was used for the interviews. A case was a pregnant woman who tested for HIV following counseling, while a control was a pregnant woman who declined the test following counseling. Odds Ratios were used for testing associations and confidence intervals for statistical significance testing. Results: At bivariate analysis, no education, peasantry, individual counseling, satisfaction with services, importance of taking HIV test, discussion with spouse, fear of stigmatization, fear of partner and source of information on VCT, were associated with uptake of an HIV test. After backward logistic regression, no education OR=0.26 (95%CI: 0. 09-0.71), peasantry OR=O.I6 (95%CI: 0.06-0.48), and fear of stigmatization OR=O.O08 (95%CI: 0.002-0.031), were factors associated with a less likelihood of taking an HIV test. Individual counseling OR=28.60(95%CI: 8.60-95.1O), satisfaction with services OR=3.18(95%CI: 1.20-8.40), prior discussion with spouse OR=8.84(95%CI: 2.96-26.41), and perceiving test as important OR=4.95(95%CI: 1.03-23.71), were factors associated with greater likelihood of taking an HIV test. Conclusion: Factors that hinder HIV testing were; peasantry, having no education and fear of stigmatization. While factors that promote testing were; having had discussion about taking a test with spouse, individual counseling, and knowledge of importance of HIV test during pregnancy, and satisfaction with VCT services. Recommendations: The district health team (DHT) should intensify health education through information; education and communication materials geared towards encouraging pregnant women for VCT and these materials should target peasants, those with no education, and sensitizing communities to reduce stigmatization. The DHT should emphasize and promote individual counseling and discourage group counseling. It should also take steps to encourage male involvement in PMTCT through sensitization seminars for couples at village level and continue with radio messages to widen knowledge on importance of taking HIV test during pregnancy, and encourage all other good practice that promote HIV testing among women. The district local council should seek loan a loan scheme to help reduce poverty.