HIV counselling and testing in antenatal care setup in an urban slum setting (Nairobi, Kenya) : factors influencing acceptance of HIV counselling and testing among women attending antenatal care clinic

Abstract

Worldwide it is estimated that three million children under the age of fifteen years have been infected by I BY and more are infected everyday. Mother-to-child transmission of HlV accounts for 90% of these infections. Reported rates of lIl V transmission from mother-to-child range from 15% to 25% in Europe and U.S.A. and from 25'10 to 40% in some African and Asian studies.In order to prevent mother-to-child transmission a threefold strategy is needed. It requires that women are protected against infections and that unwanted pregnancies are avoided among Hl V infected women and women at risk. It also entails preventing transmission of the virus from IllY infected women to their infants during pregnancy, labour and delivery, as well as during breastlccding. The primary strategy to prevent perinatal IllY transmission is to maximize prenatal IllY testing or pregnant women. The main drawback however is that only those who give consent to the tested are offered the test after pre-test counselling. This study was done ill a setting of high prevalence of IllY among women of childbearing age and demand for treatment to prevent mother-to-child transmission. This study aimed to assess factors that influence acceptance of I lIY Counselling and tcsting among women attending antenatal care clinic through a descriptive cross-sectional study that was carried out between April and May 2005. Pregnant women who were attending antenatal care in Mathare North City Council Clinic were recruited into the study. Quantitative data was collected using a pre-tested standardized questionnaire and qualitative data by focus group discussions. Among the 509 women interviewed 78% accepted voluntary counselling and testing. The mean age of respondents was 24 years with a range of 18 to 43 years. Among the respondents 65'Yo had less than primary education and 80% were in monogamous relationships. Eighty percent were married traditionally, 68% were housewives and 92% lived in single rooms. The mean duration of marriage was 4 years with a range of 0.1-23 years. Ninety three percent reported adequate support from partner and 21 % reported of having ever been assaulted by the partner. Although 99% of respondents had a good knowledge of transmission of 1I1V from mother -to-child, knowledge of specific aspects of prevention was lower. Only 55% of the respondents knew that exclusive breastfeeding cao.be an option for PMTCT. Most respondents felt that voluntary counselling and testing should be offered to all pregnant women in the antenatal clinic. Test acceptance was influenced by education status of the respondents with those who had greater than primary education being more likely to accept lIIV testing compared to those who had education less than primary (p=0.009), prior IIIV testing (p=0.02), knowledge that IIIV transmission can occur through breast feeding (p=O.02) and women who knew that vcr was being offered in the clinic through a relative and a health worker (p=0.003) and (,0=0.009) respectively. The study showed that older women with older partners were more likely to accept 1IIV testing (p=0.03) and (p =0.02) respectively. Eighty two percent of women said they accepted to take an 1I1V test because they wanted to know their status. Only 21 % said they took the test for the sake of the baby. Among respondents who declined HIV testing 73% still felt that HIV testing should be offered to everybody. The commonest reason respondents gave for declining HIV testing was that they wanted to tell/ask their partners first and 10% said that they would have preferred to take the test together with their partner/husband while 8% said that they were not ready to take the test on that particular day. Sixty nine percent said that their refusal of I BV testing was not influenced by the counsellor and 63 % said it was not influenced by perception that they were not at risk. The main issue of concern in women who declined HIV testing was that they were scared that they would be blamed for having brought the disease to their partners. Respondents who reported that they had not contracted a sexually transmitted infection especially syphilis were less likely to accept HIV testing (p=0.02). The partner/husband was mentioned as the main impediment to acceptance of vcr in antenatal clinic. Male involvement is crucial if PMTCT interventions programmes are to be successful and therefore prugrammes should be devised that promote antenatal voluntary counselling and testing for couples as this might increase on uptake of PMTCT interventions and provision of treatment, care and support to IlIV positive pregnant women. Efforts should be geared towards ensuring that all women of child bearing age have access to IIIV counselling and testing facilities and to achieve this other health provision personnel like community health workers who in most instances also double as traditional birth attendants should be trained on vcr and administration of Ncvirapine. Another aspect that needs to be addressed is on methods of providing PMTCT information. This might need to be re evaluated so that those with less than primary education should be identified and simple education methods by using pictures be devised so as to ensure that they understand the importance of PMTCT and other health related issues, Modalities to cope with stigma and discrimination need to be addressed as this might be the main reason for reduced uptake of vcr since this might translate to hindrance of access to care and treatment for IIIV positive mothers and their children now that ARVs are available and prcgnr-xt women require earlier commencement of ARV treatment.