Assessment of Quality of Antenatal–Linked HIV Counseling and Testing for Intervention of PMTCT in Addis Ababa, Ethiopia
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Date
2008-06
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Addis Ababa University
Abstract
Background: The most important component of PMTCT program is HIV Counseling and Testing (HCT).
A high quality of HCT is essential for success. In Ethiopia PMTCT services began in 2003, but only
0.8% of HIV infections among births to HIV positive women was averted in 2005/6 through PMTCT
Objective: the aim of this study was to assess the quality of antenatal–linked HIV counseling and
testing as an intervention for PMTCT at ten public Health Centers in Addis Ababa City.
Methodology: a cross sectional study was conducted at purposively selected 10 health centers in
Addis Ababa from April to May 2008. Methods included structured observations of counseling
sessions, interviews of 10 PMTCT site coordinators, 9 counselors and 422 exit clients. Data on client
satisfaction, counselors’ communicative skills, duration and content of pre- and post test counseling
was collected using a structured questionnaire adapted from UNAIDS tools. SPSS version 15.0 was
used to enter, clean, and analyze the data. Descriptive and analytic statistics were computed.
Result: 6 of the 10 health centers had an HCT uptake rate of 90 to 100% of those counseled, and 8 of
the health centers had a client return rate of 90% to 100% to collect the test results. A total of 66 (31
pre- and 35 post test) counseling sessions were observed. The mean duration of pretest counseling
was 5.37 minutes (+3.34) and that of post test was 3.0 minutes (+ 2.24). In 25.8% of the sessions, the
mothers were not given the chance to freely consent or dissent for blood test. During the post test
sessions, in 42.9% of the session the clients’ understanding of the meaning of their test results was not
explored. At exit interview, 21.3% of the clients didn’t know why they were offered HCT particularly
during their pregnancy time. The odds of knowing why HCT is offered during pregnancy was higher
among those residents of Addis Ababa and clients who spent 5-15 min on discussion with their
counselors [OR = 4.48, 95% CI: 1.84, 10.9 and OR=2.1, 95%CI: 1.03, 4.24 resp.]. Generally, 89.8%
of the clients reported being satisfied with the pre-and/or post-testing counseling discussions.
Conclusion: The communicative skill of the counselors was generally ‘satisfactory’. The majority of
pre- and post-test sessions included the basic information on HIV transmission/prevention and
PMTCT. However the discussions were unusually too brief, rudimentary and lacking depth and
coverage. Nearly a quarter of the exit clients didn’t understand why they were offered HCT
particularly during their pregnancy time; however, the vast majority of the women interviewed were
satisfied with the counselling and counsellors interactions.
Key words: PMTCT, HIV, HCT, Quality, Counselors’ skills, Satisfaction: Addis Ababa
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Keywords
PMTCT, HIV, HCT, Quality, Counselors’ skills, Satisfaction: Addis Ababa