Determinants of HIV voluntary counseling and testing: a multilevel modelling of the Ethiopian Demographic and Health Survey

Background Human immunodeficiency virus (HIV) counseling and testing services are vital to reduce the spread of HIV infection, and to create an opportunity for early treatment and reduction of HIV/AIDS-related mortality. However, only 12 sub-Saharan African (SSA) countries reached the first 90% target (90% of people living with HIV to know their status). Hence, this study aimed to investigate the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. Methods Ethiopian Demographic and Health Survey (EDHS 2016) data was used to identify the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. A weighted sample of 14,599 reproductive age women was included in the study. A multilevel binary logistic regression model was fitted to identify the determinants of HIV counseling and testing. The odds’ ratio with a 95% Confidence Interval (CI) and the corresponding P-value ≤ 0.05 was employed to declare the statistically significant variables. Results In this study, both individual and community-level variables were significantly associated with Voluntary Counseling and Testing (VCT) uptake among women. Women aged 25–34 years (Adjusted Odds Ratio (AOR) 2.29, 95% CI 2.05, 2.56), aged ≥ 35 years (AOR 1.55, 95% CI 1.38, 1.75), attending primary education (AOR 1.68, 95% CI 1.51, 1.88), secondary education (AOR 3.07, 95% CI 2.64, 3.58), and higher education (AOR 5.15, 95% CI 4.17, 6.36), women with medium household wealth (AOR 1.56, 95% CI 1.32, 1.84), richer (AOR 1.88, 95% CI 1.58, 2.24), and richest wealth index (AOR 2.37, 95% CI 1.91, 2.94), having comprehensive knowledge (AOR 1.21, 95% CI 1.06, 1.37), ever married (AOR 3.87, 95% CI 3.46, 4.32), having sexual risky behavior (AOR 2.09, 95% CI 1.69, 2.49), women from communities with high HIV knowledge (AOR 2.03, 95% CI 1.68, 2.45), women from communities with high literacy level (AOR 1.16, 95% CI 1.05, 1.51) and women from communities with high wealth quintile (AOR 1.20, 95% CI 1.03,1.57) had higher odds of VCT uptake. However, those women having stigma (AOR 0.81, 95% CI 0.74, 0.92) had reduced odds of VCT uptake. Conclusion This study revealed that not only individual level factors but also community level factors determine the status of HIV voluntary counseling and testing. Hence, strengthening both individual and community based interventions are crucial to increase the women HIV counseling and testing practice in the country.

Voluntary HIV Counseling and Testing (VCT): Knowledge, attitudes, hinderances, and practices of adults seeking treatment at Gulu Regional Referral Hospital on the spread of HIV in Northern Uganda. A cross-sectional study

Background: In 2011, Uganda had a national HIV prevalence of 6.7%. Between 2008 and 2009, there was an upsurge in HIV in Gulu District from 9.4% to 16.0% with Gulu Municipality at 22.1%. Similarly, in 2020, the prevalence of HIV in Gulu District persistently remained high at 14.0%, much higher than the national average at 6.0%.The objective of this study was to assess knowledge, attitudes, hindrances, and practices on voluntary HIV counseling and testing (VCT) and determine factors associated with VCT practices among adults seeking treatment at the outpatient department of Gulu Regional Referral Hospital.Methods: A cross-sectional study was conducted with 384 participants. Simple random sampling was used to recruit participants. Knowledge and practices on VCT were determined using knowledge ratings and attitudes using a modified Likert scale. A questionnaire with an internal validity of Cronbach’s α=0.71 was used. Ethical approval was obtained, and SPSS was used for data analysis at univariate, bivariate and multivariable logistic regression. A p-value less than 0.05 was considered significant.Results: The most significant findings were that knowledge and attitude significantly affect VCT practices among adults in Gulu Hospital. Most participants had adequate knowledge (297/379, 78.4%), the most common source of VCT information was radio (236/372, 63.4%) and few from parents (30/372, 8.1%). 158/380(41.6%) had strongly positive attitudes however, 4/10(40.0%) believed knowing HIV status was not beneficial because of fear of stigma, 299/380(78.7%) had good practices,13/45(28.9%) did not undertake VCT due to ignorant on the importance, 9/45(20.0%) feared positive results, and 5/45(11.0%) for far-off service centers. Among those who discouraged others, 15/45 (83.0%) did it for no reason, while 2/45 (11.0%) believed it was a risky and painful process.Knowledge and attitude on VCT practices had an adjusted R square of 0.421, p<0.001. The independent predictors of VCT practices in a multivariable regression analysis was knowledge (β=0.478, t=10.374, p<0.001) and attitudes (β=0.257, t=5.570, p<0.001).Conclusion: Knowledge and attitudes significantly influenced VCT practices among adults attending outpatient services at Gulu Hospital. The independent determinants of VCT practices were knowledge and attitudes. However, HIV stigma, fear of positive results and divorce/separation were the most deterring factors on VCT practices among participants.

Leveraging Expertise from Community Resources to Improve the Role of the Pharmacist in HIV Testing and Counseling

The human immunodeficiency virus (HIV) epidemic continues to be a major global public health issue. Moreover, disparities continue to persist in HIV among racial and ethnic minority populations, with the highest rates of new diagnoses in Black/African American and Hispanic/Latino men who have sex with men in the United States. Pharmacists are one of the most accessible and trusted health care professionals. Therefore, it is imperative that student pharmacists are educated on culturally-competent HIV testing and risk behaviors counseling. This study describes the development of a partnership between a pharmacy school and a community-based organization to offer an HIV counseling and testing training program to help develop skills in delivering HIV testing services. The HIV counseling and testing training program contains learning modules that provide a wide array of in-depth information about HIV patient care in the community. The partnership allows for the enjoyment of a myriad of benefits for students, the pharmacy program, the community-based organization, and the public health of the community-at-large. Students feel more prepared and comfortable working with patients in discussing HIV transmission risk factors and test results as a result of this training. Such partnerships support the pharmacist’s role in the public health arena. A successful and durable relationship between a community partner and a school of pharmacy is a feasible strategy for pharmacy progress in public health.

Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China

Background HIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model. Methods A total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization. Results Only 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services. Conclusions To increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services.

Study on Influencing Factors to HIV Health Services Among Men Who Have Sex with Men (MSM) from 2013 to 2021

Background We assessed the utilization of HIV health services and its influencing factors on consistent condom use, HIV testing and HIV counseling among men who have sex with men (MSM) based on Andersen Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation.method This is a cross-sectional study from 2013 to 2021. A sample survey was conducted in southwest China including Chongqing, Sichuan, Xinjiang and Guangxi, and an anonymous self-administered questionnaire survey was conducted among MSM who met the requirements and were recruited. Based on Anderson Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. There were 2908 valid questionnaires. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of health services.Results In the survey of HIV health services, 36.49% of respondents consistently used condoms, 82.81% had HIV testing, and 65.61% had HIV counseling. It can be obtained that among the predisposing factor, older age is a factor that promotes HIV testing but is a hindrance to consistent condom use. Condom use was higher among MSM who were Ethnic Han and had an education level of "junior high or below". Among the enabling factor, not finding a sexual partner through the Internet, not having commercial sex were associated with consistent condom use. Urban and high income were enablers of HIV testing and HIV counseling. Among the need factor, improved HIV knowledge could promote HIV testing and HIV counseling among MSM.Conclusions For these groups, MSM with high-risk characteristics should be identified as a priority in the future public health services. HIV knowledge should be promoted in health education, and mental health diagnosis and treatment also should be strengthened.

Unraveling Counseling Practices in HIV Prevention Targeted Intervention in India

Counseling is an essential strategy for preventing sexually transmitted infections, including human immunodeficiency virus (HIV). However, research on counseling practices in targeted HIV prevention interventions is limited. We conducted a grounded theory study to develop a theoretical model explaining HIV counseling practices within Targeted Interventions (TI) in Gujarat. Using constructivist grounded theory methodology, we conducted in-depth interviews of 14 counselors and observed counseling sessions of five counselors. Data were analyzed using a constant-comparative method, performing four levels of coding: open, axial, focused, and theoretical. Our theoretical model illustrates key culture-specific features in HIV counseling and how counselors facilitate the counseling process in the local cultural context and programatic environment. Present study reveals the values and practices reflective of the Indian culture that inform the counseling process and yield behavior change in clients. In the end, authors highlight challenges and recommendations for HIV counselors.

Acceptance of Couples’ HIV Counseling and Testing among Pregnant Women Attending Antenatal Clinic in Likoni sub-County, Mombasa County, Kenya

Couples’ HIV Counseling and Testing (CHCT) is an essential component of an effective response to AIDS pandemic worldwide and serves as an entry point to HIV care and support. However, it has become increasingly apparent that couples have overlooked the services yet they are too at risk of HIV infection. This study sought to determine level of acceptance of CHCT among pregnant women attending antenatal care services in Likoni sub-County, Mombasa County, Kenya. A descriptive cross-sectional study design was used with structured questionnaires and an observation checklist to collect data from couples while an interview schedule was used to solicit data from health care workers. Results showed uptake of CHCT in the study area was relatively low (33.5%). Statistically significant associations were found between CHCT and demographic factors such as education (χ2 = 29.54; p = 0.005), marital status (χ2 = 12.41; p = 0.010), occupation (χ2 = 18.18; p < 0.001), income (χ2 = 23.02; p < 0.001). In operation factors, statistically significant associations were found between CHCT and distance to health facility (χ2 = 8.31; p = 0.040), means of transport (χ2 = 10.28, p = 0.040), cost of transport (χ2 = 10.92; p = 0.010), appropriateness and convenience of time allocated (χ2 = 11.88, p <, 0.001), an individual’s working hours per day (χ2 = 14.46; p < 0.001), and education/information on CHCT (χ2 = 5.97; p = 0.020). In HIV related knowledge, attitude and practice of couples on HIV risk behavior, significant associations were found between CHCT and prevention of discordant partners from contracting HIV (χ2 = 53.71; p < 0.001), helping couples adhere to ART (χ2 = 43.34; p < 0.001), helping to reduce morbidity and mortality due to HIV and other opportunistic infections (χ2 = 48.66; p < 0.001), increasing trust among partners (χ2 = 45.16; p < 0.001), and increasing marital cohesion among partners (χ2 = 65.78; p < 0.001). Logistic regression revealed that determinants of CHCT were significant for married status (p < 0.001), unemployed (p = 0.020), that CHCT increases trust among partners (p = 0.020), and that CHCT increases marital cohesion among partners (p = 0.001). Based on these findings, there is need to improve awareness on CHCT to enhance positive attitudes towards couples testing.

Psychosocial counseling when testing for human immunodeficiency virus: what to focus on?

Introduction. Voluntary anonymous HIV counseling and testing can be an effective tool to reduce the behavior that has high risks of HIV, hepatitis C (HCV) and B (HBV) transmission. The dissemination of general information on HIV, HCV, HBV to reduce risky behavior is not as much of importance as counseling on specific individual infection-related sexual risk behavior. The objective was to identify HIV/HCV/HBV-related risk factors that have to be discussed during psychosocial counselingto help the individual to focus on his/her sexual risk behavior.Methods and materials. The study was conducted on the base of Saint-Petersburg Center for Control of AIDS with participation of 90 individuals who voluntary applied for HIV counseling and testing. Participants’ behavioral risks and HIV knowledge were assessed by the specifically developed structured questionnaire. The level of anxiety was measured by State-Train Anxiety Inventory (STAI adapted by Hanin), the level of need for extreme-risk behavior was measured by the Sensation Seeking Scale (Zuckerman).Results. Only 50 % of participants use condom with their steady sexual partner always or almost always. In 62 % cases, the steady sexual partner’s HIV-status is unknown. Many participants agree that HIV transmission occurs always after sexual contact with HIV-infected person. The level of situational anxiety is higher by those who do HIV testing repeatedly. Those who are more likely to seek new sensations use condom with their steady or other partner more often.Conclusion. Motivational intervention during pre- and post-counseling by HIV/HCV/HBV testing has to focus on the discussion of individual difficulties of condom use as the means for protection and on the individual’s resources for changing sexual behavior to protect him/her-self and his/her partner from infection with HIV and viral hepatitis.

Why Counseling Intervention Fails to Improve Compliance towards Antiretroviral Therapy: Findings from a Mixed-Methods Study among People Living with HIV in Bali Province, Indonesia

This study explores the contribution of counseling to improving acceptance of and adherence to anti-retroviral therapy (ART) among people living with HIV (PLHIV) and identifies key issues associated with its implementation. We conducted a longitudinal mixed-methods study in Bali Province between 2015 and 2017. The study participants were 170 newly diagnosed PLHIV and 17 outreach-counselor workers (OWs). We interviewed PLHIV for their experiences in receiving counseling, and acceptance of and adherence to ART. We surveyed four counseling domains (privacy, contents, frequency, and duration) and explored the key findings through in-depth interviews. In addition, 24 exit interviews and record reviews were performed. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Out of 170 PLHIV who received the counseling program, 139 (81.76%) accepted ART, and 52 (37.4%) discontinued ART in six months of follow up. Although counselors covered most of the content (16/17 components), the median time and frequency of counseling were insufficient. Despite a high score of HIV counseling provided to PLHIV in our study location, the overall acceptance of and adherence to ART remains fair or moderate. Our study suggests that counseling before ART initiation is inadequate for improving acceptance and adherence to ART in Bali Province. This reduced effectiveness is influenced by internal issues (interpersonal skills, limited technical capacity) and external factors both from PLHIV and society (stigma, disclosure, discrimination).