Uptake of provider initiated testing and counselling among acute gynaecology patients at the Kenyatta National Hospital

Abstract

Uptakeof Provider Initiated Testing and Counselling (PITe) for HIV testing among Acute Gynaecologypatients seen at the KNH. Background: Womenare at a higher risk of contracting HIV infection than men. Evidence from resourceconstrained settings suggests that many HIV infected persons are not being picked early enough.PITe for HIV infection and that disclosure to spouse/ sexual partner facilitates early accessto HIV-related services. Objectives: Todetermine the uptake of Provider Initiated Testing and Counselling among acute gynaecology patients. The specific objectives were to determine perception of risk for HIV infection, willingness to be tested and willingness to disclosure status, determine sociodemographic, reproductive health attributes and willingness to disclose serostatus. Methodology: Thestudy design was a cross - sectional study carried out between July 2010 and September 2010 at the Kenyatta National Hospital. 206 participants were enrolled from the Accident and Emergency Department as well as Ward 10 (Acute Gynaecology Ward) presenting with acute gynaecology conditions. Data was collected using an interviewer administered questionnaire which was followed by HIV testing. Results: Atotal of 206 study participants who met the eligibility criteria and consented to participate were enrolled into this study. The mean age of study participants was 30'years (50=8.2)' 65% were married, 37% and 35% had attained primary and secondary education respectively, 40% were unemployed. Of the 206 participants enrolled, 81% had ever been tested before for HIV, majority (72%) at VeT centres. Those had never had a HIV test were 19% and of these majority, 41 %, of them did not believe to be at risk of HIV infection. Interestingly 50% of study participants had never used condoms. Despite this, the uptake of PITefor HIV testing among the study participants was 76% with a HIV prevalence of 7%. Thosewho were not willing to undergo PITe were 24%, 39% of these were not emotionally prepared for HIV testing and 28% needed to consult their spouses. Of those who underwent 10 PITC,68%were willing to disclose their HIV status to their partner/ spouses while 32% were not willing to disclose their HIV results to their spouse/partner. Of those not willing to disclose,76% was because they did not know their partners HIV status or wanted to undergoretesting with their partners. Study participants who had prior testing for HIV were morewilling to undergo PITC, majority 72%, having been tested at VCT centres. Conclusion: Therewas an uptake of PITC of 76% among the study participants which is a marked improvement over the years. PITC reduces missed opportunities for HIV testing. Those who underwent PITe, 68% were willing to disclose their HIV status and of 32% who were not willing to disclose their HIV status, 76% wanted to be retested with their partners. This would encourage their partners to be tested for HIV and hence increase coverage of HIV testing. Recommendations: Thereshould be implementation of PITC at all levels of health care as well as upscale in training on PITCfor health workers. There should be integration of FP counselling in PITC andVCTseeing that majority of participants who had prior HIV testing were tested at a VCT centre (72%). Also recommended is the upscale of community based programmes to improvemale improvement. From this study, 32% were not willing to disclose their HIV test resultsand of these 76% wanted to be retested in the presence of their partners. 1