Assessment of Provider–Initiated HIV Testing and Counseling Acceptance and Disclosure of HIV Status and Factors Related to them, among Out Patient Department Patients in the DebreBirhan Referral Hospital, N. Shoa Administrative Zone, Amhara National Regional State
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Date
2011-03
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Addis Abeba Universty
Abstract
Background
HIV counseling and testing is the critical entry-point for engagement into treatment and care as well as
for primary and secondary HIV prevention efforts. Despite the importance of this step, most HIV-infected
patients globally, and particularly in resource-poor settings, are unaware of their HIV status and the
uptake of Voluntary Counseling and Testing (VCT) services is relatively limited. Missed opportunities
for addressing HIV testing remain unacceptably high when patients seek medical care in the period before
their HIV diagnosis. HIV counseling and testing is increasingly shifting from the client-initiated towards
other modalities, especially provider-initiated testing and counselling.
Objectives: The objective of this study was to asses the magnitude of PITC acceptance and disclosure
and factors related to them among out patient department patents.
Methods: A facility based cross sectional quantitative survey was conducted from Dec. 1 to Jan. 10 on
414 clients attending out patient department in Debre Birhan Referral Hospital. Data were collected using
structured questionnaire, entered into EPI info version 3.5.1 and analyzed by SPSS version 16. Logistic
regression model was used to assess factors associated with PITC acceptance and disclosure of test result.
Result: A total of 414 subjects (response rate, 100 %) responded to the questionnaires. Acceptance of
PITC among OPD patients was 83.6%. Adjusted correlates of PITC acceptance included female gender
(AOR=2.27, 95% CI=1.16-4.42) and knowledge of HIV transmission (AOR=4.08, 95% CI=1.98-9.91).
Individuals with protestant religion were less likely to accept PITC (AOR=0.21, 95% CI=0.06-0.72). Key
barriers to accept PITC included being apparently healthy (25%), being tested before (22.1%) and fear of
stigma and discrimination (19.1%).
The vast majority 120 (90.5%) of the married respondents who had ever been tested for HIV disclosed
their result to at least one person. Of 346 respondents, who accepted PITC, 288 (83.2%) had a plan to
disclose their result to any other person. Compared with the age group 45 and above, subjects 15-24 years
old were less likely to disclose their HIV status (AOR=0.16, 95% CI=0.04-0.62). Disclosure of test result
was associated with occupation (AOR=5.42, 95% CI=1.44-20.43) and test result negative (AOR=4.00,
95% CI=1.53-10.47). The reasons for non disclosure were fear of stigma 37 (62.7%) followed by fear of
blame 8 (13.6%).
Conclusion and recommendation: In this study, PITC acceptance was promising and should be
expanded to other health facilities. Efforts should be strengthened to decrease factors which impede HIV
test result disclosure.
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Keywords
Assessment of Provider–Initiated HIV Testing and Counseling Acceptance