Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of GPs' experiences

Background

Timely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation.

Aim

To assess the feasibility of offering antenatal SC&T screening in primary care at the time of pregnancy confirmation.

Design of study

Cross-sectional investigation of GPs'' beliefs and perceived practices.

Method

Informal face-to-face interviews with 34 GPs.

Setting

Seventeen inner-city general practices that offered antenatal SC&T screening as part of a trial.

Results

GPs identified both barriers and facilitators. Organisational barriers included inflexible appointment systems and lack of interpreters for women whose first language was not English. Professional barriers included concerns about raising possible adverse outcomes in the first antenatal visit. Perceived patient barriers included women''s lack of awareness of SC&T. Hence, GPs presented the test to women as routine, rather than as a choice. Organisational facilitators included simple and flexible systems for offering screening in primary care, practice cohesion, and training. Professional facilitators included positive attitudes to screening for SC&T. Perceived patient facilitators included women''s desire for healthy children.

Conclusion

GPs reported barriers, as well as facilitators, to successful implementation but the extent to which screening could be regarded as offering ‘informed choice’ remained fundamental when making sense of these barriers and facilitators.     

Does the national program of prevention of mother to child transmission of HIV (PMTCT) reach its target in Ouagadougou,Burkina Faso?

Background

In the context of universal access to prevention, treatment, care and support, each country has to ensure that 80% of women and children in need have access to PMTCT interventions.

Objective

To assess the PMTCT program achievement in Ouagadougou, the capital city of Burkina Faso.

Methods

Between August and October 2008, a cross sectional study was carried out in the five health districts of the Centre Health Region. We reviewed weekly statistics from all health care centres (HCC) to compute the coverage of PMTCT program. In 38 HCC with functional PMTCT program, we extracted data of interest from HCC registers and made direct observations of PMTCT services.

Results

The PMTCT program was implemented in 49% of HCC (target for the national program: 70%). Fifteen to 31% of these centers were often in shortage for PMTCT consumables. Patients'' privacy was not observed in 67% of Voluntary Counselling & HIV Testing wards. Care providers were not qualified enough to deliver PMTCT services. Vitamin A supplementation was not implemented. None of the facilities offered the whole package of PMTCT program interventions. HCC providing HIV testing in labour or in postnatal ward were consistently lacking. Only 86% of antenatal care new attendants benefited from pre-test counselling; 2.4% of pretested women were HIV-positive and 39% of positive mothers received antiretroviral prophylaxis.

Conclusion

Coverage and quality of PMTCT programme in the Centre Health Region in Burkina Faso are still limited. Particular support is needed for training, supervision and infrastructures upgrading.     

Public attitudes towards opt-out testing for HIV in primary care: a qualitative study

Background

The rate of new HIV infections in the UK continues to rise, with one-quarter of cases undiagnosed. Opt-out HIV testing — in which tests are routinely offered to all patients, with the offer to decline — have proved effective in antenatal care. Pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician’s perspective, but not the views of the general public.

Aim

To further understand the public’s perspective on opt-out testing for HIV in England.

Design and setting

Focus groups (n = 9) with a total of 54 participants in Brighton, England, where HIV prevalence is high.

Method

Quota sampling on sexual orientation, age, sex, and testing experience was applied to groups with high and low HIV prevalences, and analysed using framework analysis.

Results

Opt-out testing for HIV was acceptable. Testing on GP registration was regarded as a more appropriate setting than acute medical admission. Participants from groups in which HIV has a higher prevalence felt HIV testing required consideration that may not be possible during acute hospital admission. However, there was concern that screening would still be targeted at groups in which HIV prevalence is higher, based on clinicians’ judgement of patients’ behaviours, sexuality, or ethnicity.

Conclusion

The opt-out method of testing for HIV must be routinely offered to all who are eligible, to increase test uptake and to prevent communities feeling targeted. Any pressure to test is likely to be poorly received. Inaccurate concerns about medical records being shared with financial services are a disincentive to test. Primary care should be an active setting for opt-out HIV testing.     

Counselling at primary health facilities and level of knowledge of antenatal attendees and their attitude on prevention of Mother to Child Transmission of HIV in Dar-es salaam,Tanzania

Background

Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions.

Objectives

To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT.

Methods

A cross sectional study assessing pregnant women''s knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire.

Results

A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one''s serostatus.

Conclusion

There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.     

Effectiveness of counseling at primary health facilities: Level of knowledge of antenatal attendee and their attitude on Prevention of Mother to Child Transmission of HIV in primary health facilities in Dar es salaam,Tanzania

Background

Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions.

Objectives

To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT.

Methods

A cross sectional study assessing pregnant women''s knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire.

Results

A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one''s serostatus.

Conclusion

There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.     

Rapid screening for co-infection of HIV and HCV in pregnant women in Benin City,Edo State,Nigeria

Background

Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) are both major global health concerns as they cause high mortality and morbidity in the developing countries. However, while data exists for the co-infection in other countries, little or no information can be found with regard to the sero-prevalence of HIV and HCV co-infection in Nigeria, albeit in pregnant women attending antenatal care clinics in Benin City, Nigeria.

Objective

The objective of the study was to determine the sero-prevalence of HIV and HCV among pregnant women seeking antenatal care in Benin City.

Methods

In determining the sero-prevalence in a cross-sectional study, 200 pregnant women, aged between 15 and 49 years were screened for HIV and HCV using rapid screening test kits. Using closed ended structured questionnaires; the respondents volunteered socio-demographic information associated with risk factors of HIV and HCV acquisition.

Results

Results indicated sero-prevalence of HIV and HCV in the sampled population was 3% and 5% respectively. Thirty three percent of the pregnant women that were HCV positive were co-infected with HIV-1 infection. HIV sero-prevalence was highest in the age group, 25–29 representing 5.1%, while HCV sero-prevalence was noted highest among the women in the age group 30–34 years, representing 7.9%. Two percent of the pregnant women had equivocal (ambivalent) HIV-1 results.

Conclusion

The study has shown a prevalence of HIV-HCV co-infection among the tested pregnant women in Benin City and more epidemiological surveys are needed in larger scale to decipher the prevalence in other states of Nigeria.     

Correlates of HIV infection among people visiting public HIV counseling and testing clinics in Mpumalanga, South Africa

Background

HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. Factors associated with HIV infection in VCT clients have not been well characterized in South Africa.

Objectives

A case-control study was carried out to determine the association between socio-demographic and HIV risk variables and HIV infection among people visiting HIV counseling and testing centers in two districts in Mpumalanga province, South Africa. Cases (n=1093) and controls (n=1162) were compared by socio-demographics, exposure to substances, and risky behaviours that predispose them to HIV infection.

Results

In multivariable analysis, having children, having been diagnosed with a a sexually transmitted infection (STI) in the past three months, not having had oral sex in the past three months, lack of condom use consistency in the past three months, and lack of HIV behavioural skills enactments were significantly associated with HIV positive status.

Conclusion

HIV risk behaviour was found to be a significant risk factor for HIV infection in the study population. There is urgent need for health education to bring about behavioural changes to reduce HIV infection in the community.     

Screening for hepatitis C among HIV positive patients at Mulago Hospital in Uganda

Background

In industrialized countries with more resources, it is recommended that HIV infected patients should be screened for hepatitis C virus (HCV) on entry into the health care system. Implementation of these guidelines in a country like Uganda with limited resources requires some modification after taking into account the prevailing circumstances. These include the prevalence of HCV in HIV positive patients and the cost of HCV testing.

Objective

The objective of the study was to estimate the prevalence of HCV in HIV positive patients.

Methods

This was a cross sectional study among HIV positive outpatients in Mulago hospital. HCV screening was done using anti-HCV Enzyme Immuno Assay (Roche Diagnostics)

Results

Between October 2003 and February 2004, one hundred and twenty two HIV positive patients were enrolled into the study with a mean age of 33.9 years. There were more females 81 (66.4%) than males. Only 4 patients had anti-HCV, giving an estimated HCV prevalence of 3.3%.

Conclusion

In view of the low HCV prevalence found in our study and similar studies and considering the high cost of HCV screening, routine HCV testing cannot be recommended among all HIV positive patients in our health care settings with limited resources. We recommend that HCV screening be limited to investigating HIV positive patients with features suggestive of liver disease in order to identify HCV as a possible cause.     

Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi

Objectives

To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women''s perceptions towards selected potential HIV prevention efforts

Design

Cross sectional, questionnaire-administered study

Setting

Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi

Subjects

A total of 321 pregnant women attending ante-natal clinics

Results

Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse.

Conclusion

Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.     

Opportunities and barriers for implementation of integrated TB and HIV care in lower level health units: experiences from a rural western Ugandan district

Background

As countries with a high burden of TB and HIV roll out integrated TB/HIV care, there is need to assess possibility of lower level health units treating TB to provide integrated TB/HIV care.

Objective

To determine barriers and opportunities for provision of integrated TB/HIV care in lower level health units offering TB treatment in Mbarara district, Uganda.

Methods

Conducted key informant interviews, interviewed health workers and observed services offered.

Results

22 health units were assessed and 88 health workers were interviewed. Of the 18 health units mandated to offer laboratory services, 55.6% and 38.9% were able to offer rapid HIV-testing and ZN staining respectively. Understaffing, lack of capacity to diagnose HIV and TB, lack of guidelines to inform care options of TB/HIV co-infected patients and insufficient knowledge and skills among health workers towards provision of integrated TB/HIV care were mentioned as barriers to provision of integrated TB/HIV services.

Conclusion

To offer integrated TB/HIV services at lower level health units currently offering TB stand alone services, there is need to address gaps in knowledge and skills among health workers, laboratory diagnostics, staffing levels, medical supplies and infrastructure.     

Attitude of antenatal attendees to people living with HIV/AIDS in Uyo, south-south Nigeria

Background

Stigmatization and discrimination of people living with HIV/AIDS has a negative impact on the global efforts to control the HIV/AIDS pandemic. Due to fear of stigmatization and discrimination, many people are reluctant to undergo voluntary counseling and testing, infected individuals are often unwilling to disclose their status and some of them still engage in high-risk behaviours leading to increased transmission of the virus.

Study design and setting

A study of the attitudes to people living with HIV/AIDS was carried out among antenatal clinic attendees at the University of Uyo Teaching Hospital with the aim of developing site-specific information and counseling interventions to reduce stigmatization and discrimination of people living with HIV/AIDS. Information was elicited from 265 randomly selected women who booked for antenatal care between September and December 2005 with the use of a self-administered questionnaire.

Results

263 questionnaires were duly completed and analyzed. The mean age of the respondents was 27 ± 5.1 years, majority of them (52.1%) were either unemployed or unskilled workers and 42.9% of them had tertiary education. Awareness and knowledge of HIV/ AIDS was high, (95.8%) and (86.7%) respectively. Majority of the respondents (55.6%) were also assessed as having a positive attitude to people living with HIV/AIDS (PLWHA). There was a statistically significant association between good knowledge of HIV/AIDS and a positive attitude to PLWHA (P=0.000) and a high educational status with a positive attitude to PLWHA (P=0.009).

Conclusion

combating stigma and discrimination is an important process in controlling the epidemic. Specific information and counseling interventions aimed at dispelling misconceptions about HIV/AIDS should be reinforced.     

A qualitative study on the voluntariness of counselling and testing for HIV amongst antenatal clinic attendees: do women have a choice?

Background

Mother-to-child transmission (MTCT) of the Human Immunodeficiency –Virus (HIV) is a serious public health problem, contributing up to 90% of childhood HIV infections. In Tanzania, the prevention-of-mother-to-child-transmission (PMTCT) feature of the HIV programme was rolled out in 2000. The components of PMTCT include counselling and HIV testing directed at antenatal clinic attendees. It is through the process of Provider Initiated Counseling and Testing (PITC) that counselling is offered participant confidentiality and voluntariness are upheld and valid consent obtained.The objective of the study was to explore antenatal clinic attendees’ experiences of the concept of voluntariness vis- a- vis the implementation of prior counseling and subsequent testing for HIV under the PITC as part of their antenatal care.

Methods

In-depth interviews were conducted with17 antenatal clinic attendees and 6 nursing officers working at the Muhimbili National Hospital (MNH) antenatal clinic. The study data were analyzed using qualitative content analysis.

Results

Antenatal clinic attendees’ accounts suggested that counselling and testing for HIV during pregnancy was voluntary, and that knowledge of their HIV status led them to access appropriate treatment for both mother and her newborn baby. They reported feeling no pressure from nursing officers, and gave verbal consent to undergo the HIV test. However, some antenatal clinic attendees reported pressure from their partners to test for HIV. Healthcare providers were thus faced with a dilemma of disclosure/ nondisclosure when dealing with discordant couples.

Conclusion

Antenatal clinic attendees at MNH undertook the PITC for HIV voluntarily. This was enhanced by their prior knowledge of HIV, the need to prevent mother- to- child transmission of HIV, and the effectiveness of the voluntary policy implemented by nursing officers.

     

Risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda

Objective

To determine the risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda.

Design

A case control study.

Setting

Mulago hospital labour suite

Participants

Between 15^th November 2001 and 30^th November 2002 we identified and recruited thirty six parturients with placenta previa who developed severe bleeding and 180 women with normal delivery. The risk factors were studied.

Variables of interest

Socio demographic characteristics, social and family history, gynaecological operations, blood transfusion, medical conditions, past and present obstetric performance and HIV status.

Results

Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6, CI: 1.1–12.5), delivery by caesarean section in previous pregnancy (O.R. 19.9, CI: 6.4–61.7), residing more than ten kilometres from Mulago hospital (O.R. 2.4, CI: 1.0–5.7) and recurrent vaginal bleeding during the current pregnancy (O.R. 7.3, CI 2.4–63.7).

Conclusion

Severe bleeding in placenta praevia is associated with high maternal morbidity and mortality. The determinants of severe bleeding in placenta praevia can be used in the antenatal period to identify mothers at risk. These, with prompt interventions to deliver the women can be used to reduce the maternal morbidity associated with this condition.     

Factors influencing disclosure of HIV positive status in Mityana district of Uganda

Background

Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose.

Objective

To identify factors associated with disclosure among PHAs in Mityana district of Uganda.

Methods

Using a case control design, we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics, sexual behaviour, individual experiences and perceptions about disclosure, as well as on health facility/community correlates of disclosure.

Results

The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00, 95 % confidence interval (95% CI) 3.03–16.95, having communication skills to disclose (AOR 12.08, 95% CI 4.94–29.51), having initiated anti-retroviral therapy (AOR 7.51, 95% CI 3.42–16.49), not having tested for HIV during ante-natal clinic (AOR 5.07, 95% CI 1.95–13.10), receiving ongoing counselling (AOR 4.33, 95% CI 1.50–12.51) and having ever seen a PHA publicly disclose his/her HIV status AOR 2.73, 95% CI 1.24–6.02).

Conclusions

PHAs that have not initiated anti-retroviral therapy (ART), test for HIV in ante-natal clinic and fear negative outcomes need more help in disclosure. Measures that empower PHA to disclose such as those that lead to improved communication skills should be reinforced during ongoing counselling.     

Brucella sero-prevalence and modifiable risk factors among predisposed cattle keepers and consumers of un-pasteurized milk in Mbarara and Kampala districts,Uganda

Background

Brucellosis is an important zoonotic disease in developing countries yet it is often not recognized, goes unreported and does not attract public health action by these governments including Uganda.

Objective

To estimate the sero-prevalence and assess modifiable risk factors associated with Brucella seropositivity in cattle keepers and consumers of unpasteurized milk in Uganda.

Methods

One group comprised of 161 individuals randomly selected from households living on farms that had Brucella sero-positive cattle and/or goats in Mbarara District from an earlier survey; the second group comprised of 168 randomly selected individuals attending an HIV voluntary counseling and testing clinic in Kampala District. Sera samples were tested using Rapid Plate Agglutination Test, Standard Tube Agglutination Test and cELISA.

Results

The sero-prevalence of brucellosis among exposed cattle keepers in Mbarara and consumers of unpasteurised milk in Kampala Districts was 5.8% (95%CI: 3.3%, 8.3%) and 9% (95%CI: 13.3%, 4.7%), respectively. Consumption of unboiled milk was significantly (p=0.004) associated with seropositivity in Mbarara District. There was no association between sero-positivity with age, sex and awareness of human brucellosis.

Conclusion

Human brucellosis is prevalent among livestock rearing communities and consumers of unpasteurised milk. The continued consumption of unboiled milk is a major health risk.     

Hypercholesterolaemia in pregnancy as a predictor of adverse pregnancy outcome

Background

Prevention of viable spontaneous preterm birth and low birth weight through screening is one of the key aims of antenatal care as these have implications for the child, mother and society. If women can be identified to be at high risk of these adverse birth outcomes in early pregnancy, they can be targeted for more intensive antenatal surveillance and prophylactic interventions.

Objectives

This study is therefore aimed to determine the association between elevated maternal serum cholesterol level in pregnancy and adverse pregnancy outcome.

Methods

It was a prospective observational cohort study in which eligible participants were enrolled at gestational age of 14 to 20 weeks. Blood samples were obtained to measure total serum cholesterol concentrations and the sera were then analyzed enzymatically by the cholesterol oxidase: p-aminophenazone (CHOD PAP) method. Pregnancy outcomes were obtained by extraction from medical records and the labour ward register.

Results

The incidences of the two adverse pregnancy outcomes examined in the study (preterm births and low birth weight (LBW) in term neonates) were 8.0% and 14.4% respectively. Preterm birth was 6.89-times more common in mothers with high cholesterol than in control mothers with normal total cholesterol level (38.5% versus 5.4%, P=0.029) while LBW was 7.99-times more common in mothers with high total maternal cholesterol than in mothers with normal cholesterol (87.5% versus 10.5%, P=0.019).

Conclusion

We can infer that the high maternal serum cholesterol (hypercholesterolaemia) is associated with preterm delivery/ low birth weight (LBW) in term infants. However, further validation of these findings with more robust prospective and longitudinal characterization of maternal serum cholesterol profiles is required in subsequent investigations.     

Collaboration between the national tuberculosis programme and a non governmental organisation in TB/HIV care at a district level: experience from Tanzania

Background

The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care.

Objective

To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/HIV care at a district level in Tanzania.

Methods

Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002.

Results

A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. . Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff.

Conclusion

The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level.     

Ocular manifestations in paediatric HIV/AIDS patients in Mulago Hospital,Uganda

Background

In Uganda the prevalence of HIV averages 12% as was reported to the STD/AIDS control surveillance unit. In Uganda there are approximately 30,000 HIV infected infants per year. The burden of HIV disease is high in Uganda and patients present with ocular complications. However, there is paucity of information and knowledge concerning ocular manifestations in the paediatric HIV/AIDS population and how they may differ from those of adults.

Objectives

To describe the ocular manifestations of HIV/AIDS infection in an African paediatric population. Generally the study will record the external ocular manifestations seen but specifically to document the intra-ocular lesions, in particular the retinal changes associated with paediatric HIV/AIDS.

Design

A cross-sectional hospital based study.

Setting

The study was conducted at the Paediatric Infectious Disease Clinic at Upper Mulago Hospital, in Kampala, Uganda.

Patients

Patients are those with positive HIV sero status, with or without symptoms and signs of AIDS.Parents/caretakers of the children were interviewed to obtain the socio-demographic data of the patients and a general physical as well as an ophthalmic examination were conducted to document any ocular problems.

Results

A total of 158 HIV -infected children were examined. The overall rate of ophthalmic involvement was 35%. The most common finding was a non-purulent conjuctivitis, observed in 12% of the patients, followed by perivasculitis of the peripheral retinal vessels, in 12 % of patients and molluscum contagiosum.     

Determinants of HIV testing among young people aged 18 – 24 years in South Africa

Background

Although recent estimates of the HIV/AIDS burden in South Africa show the particular vulnerability of youth to HIV, HIV testing and its determinants are largely understudied in this age group.

Objective

To investigate the prevalence and determinants of HIV testing among young people aged 18 to 24 years, as part of an evaluation of the impact of loveLife.

Methods

South Africa''s national HIV prevention campaign for young people, on HIV and related risk behaviours. A cross-sectional population-based household survey was conducted using a multistage stratified cluster sampling approach. The total sample included 3123 participants, aged 18–24, 54.6% men and 45.4% women, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga).

Results

The results indicated that over half (52.2%) of the youth reported testing for HIV, with more young females (60.1%) testing for HIV compared to their male counterparts (39.9%). In the multivariate analysis, older age, being female, HIV knowledge, having ever talked to the mother or female guardian about HIV and having ever been pregnant or made someone pregnant were found to be associated with testing for HIV.

Conclusion

There is still room for improving the low proportion of young people who test for HIV. Specific attention needs to be paid to younger males, with lack of HIV knowledge, having never talked to the mother or female guardian about HIV and having never been pregnant or made someone pregnant were less likely to be tested. Outreach at individual and community levels and public health messages targeting these youth should be implemented.