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

Implementation fidelity and client satisfaction in HIV testing and counseling services: perspectives from facilities and clients in Gondar city, Northwest Ethiopia

BACKGROUND

Individuals can learn their HIV status through voluntary HIV counseling and testing (VCT), which also serves as a crucial access point for prevention, treatment, care, and support programs. VCT has grown in significance as a component of HIV prevention and care in Ethiopia because of its viability and convenience for the wider community, as well as its ability to provide access to care, treatment, and support for those in need. However, studies on this topic are limited, particularly because the fidelity of Ethiopia's VCT program has not been evaluated or measured. Therefore, this study aimed to assess the current implementation status of VCT services and client satisfaction in public health facilities in Gondar City.

METHODS

This cross-sectional study was conducted out from June to July 2022. This study involved 130 counselors and 423 VCT users. Information on physical facilities, client satisfaction, and counselor impressions of the services was gathered using a standardized and pre-tested questionnaire, observation checklists, and resource inventory checklists developed from Ethiopian national VCT guidelines, the World Health Organization, United Nations AIDS, and previous literature. In the bivariate and multiple logistic regression models, variables with p values ≤ 0.2 and < 0.05 were chosen as candidate variables and associated variables, respectively.

RESULTS

The overall implementation and facility readiness for VCT services was found to be 67%. The overall client satisfaction rate was 71% (95% CI: 69.7%, 72.7%). Age of participants from 25 to 30 years (AOR = 1.11, 95% CI, 1.02-1.21), 31-35 years (AOR = 2.03, 95% CI, 1.88-2.18), higher educational status (AOR = 1.18, 95% CI, 1.03-2.01), and comprehensive knowledge of HIV/AIDS (AOR = 2.42, 95% CI, 1.53,3.32) were positively associated with client satisfaction, whereas fear of confidentiality (AOR = 0.42, 95% CI, 0.20, 0.63) and longer waiting time (AOR = 0.09, 95% CI, 0.04, 0.15) were negatively associated with the outcome variable.

CONCLUSION

The implementation fidelity was evaluated to be low; however, client satisfaction was somewhat good. Based on the descriptive and analytical findings, providers' adherence to standards, strong communication with leaders, and the preservation of client confidentiality and privacy must be ensured by having VCT centers meet the necessary standards as outlined in the HTC guidelines to increase client uptake and satisfaction. To enhance the quality of the program, it is important to address clients' educational levels, improve participants' understanding of VCT, promote youth participation, and provide training to service providers.

Spatial patterns and associated factors of HIV testing and counselling (HTC) as a component of antenatal care services in Ethiopia

BACKGROUND

While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia.

METHODS

A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value < 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised.

RESULTS

In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran's I = 0.138, p-value <0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors.

CONCLUSION

The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women's knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia.

Advanced HIV disease and its predictors among newly diagnosed PLHIV in the Gedeo zone, southern Ethiopia

BACKGROUND

Globally, HIV infection remains a leading cause of morbidity and mortality. Despite reducing new infections, the global response to advanced HIV disease (AHD) remains ineffective, leaving HIV epidemics a significant public health threat worldwide. In Ethiopia, evidence regarding AHD is scarce. Therefore, this study aimed to assess the prevalence and predictors of AHD among newly diagnosed people living with HIV (PLHIV) initiating antiretroviral therapy in the Gedeo zone, southern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from May 29, 2023, to February 06, 2024, at health facilities providing HIV care in the Gedeo zone, southern Ethiopia. A total of 427 PLHIV-initiating antiretroviral therapy (ART) were recruited for the study. The data were collected through face-to-face interviews and record reviews using KoboCollect version 2.4 and analyzed using R version 4.3.3. The Akaike information criterion (AIC) model selection was used to evaluate and choose the best-fitting model to describe the relationship between AHD and predictors. Finally, variables with a p-value less than 0.05 were considered independent predictors in the multivariable regression analysis.

RESULTS

The study participants' mean (±SD) age was 31.3 (±8.7) years. The overall prevalence of AHD among newly diagnosed PLHIV-initiating ART was 34.4% (95% CI: 29.8%, 39.1%). Rural residence (AOR = 3.48, 95% CI: 2.24, 5.47), alcohol consumption (AOR = 2.48, 95% CI: 1.59, 3.90), and being identified through community-based index case testing (ICT) (AOR = 0.26, 95% CI: 0.13, 0.51) were found to be independent predictors of AHD.

CONCLUSIONS

The prevalence of AHD among newly diagnosed individuals initiating ART was high. PLHIV who consume alcohol should receive detailed counseling on how it can negatively impact their progress with antiretroviral treatment. HIV testing should be enhanced in rural communities by strengthening community health campaigns. Furthermore, community-based index case testing should be strengthened for early identification of PLHIV.

Factors associated with voluntary HIV counseling and testing among young students engaging in casual sexual activity: a cross-sectional study from Eastern China

OBJECTIVES

To investigate the factors associated with voluntary HIV counseling and testing (VCT) among young students engaging in casual sexual activity and to establish a scientific rationale for developing targeted intervention strategies for preventing HIV/AIDS in this population.

METHODS

Stratified cluster sampling was used to conduct a survey using questionnaires to collect demographic and behavioral information for statistical analysis.

RESULTS

Data from 611 young students, who reported engaging in casual sexual activity, were included in the statistical analysis. Among these, 68 (11.13%) students underwent the VCT. Among young students who engaged in casual sexual activity, those who were non-Zhejiang residents (adjusted odds ratio [aOR]: 2.11; 95% Confidence Interval [CI]: 1.17-3.80), those who had received AIDS-themed lectures or health education courses from the school in the past year (aOR = 3.96, 95% CI = 1.49-10.50), those who had received HIV risk self-assessment conducted by the school in the past year (aOR = 2.31, 95% CI = 1.17-4.59), and those who had engaged in commercial sex activity in the past year (aOR = 1.98, 95% CI = 1.07-3.66) were more inclined to have undergone VCT. Male students (aOR = 0.37, 95% CI = 0.18-0.77) and those who used condoms consistently during casual sexual activity (aOR = 0.45, 95% CI = 0.21-0.97) were less likely to undergo VCT.

CONCLUSION

Casual sexual activity was relatively prevalent among young students, posing a potential risk for HIV transmission. These findings will be instrumental in the development more effective HIV prevention and control strategies for young students. Additionally, it highlights the necessity of promoting and popularizing VCT among young students without Zhejiang province residency, who are involved in commercial sexual activity, and/or those who lacking HIV education. Moreover, additional research and implementation of refined HIV behavioral interventions specifically tailored to young students are necessary to enhance their awareness and knowledge of HIV prevention.

Effectiveness of Linkage to Care and Prevention Interventions Following HIV Self-Testing: A Global Systematic Review and Meta-analysis

Over 38.4 million people were living with HIV globally in 2021. The HIV continuum includes HIV testing, diagnosis, linkage to combined antiretroviral therapy (cART), and retention in care. An important innovation in the HIV care continuum is HIV self-testing. There is a paucity of evidence regarding the effectiveness of interventions aimed at linking self-testers to care and prevention, including pre-exposure prophylaxis (PrEP). To bridge this gap, we carried out a global systematic review and meta-analysis to ascertain the effectiveness of interventions post-HIV self-testing regarding: (1) linkage to care or ART, (2) linkage to PrEP, and (3) the impact of HIV self-test (HIVST) interventions on sexual behaviors. We searched PubMed, Web of Science, SCOPUS, Cochrane Library, CINAHL Plus (EBSCO), MEDLINE (Ovid), Google Scholar, and ResearchGate. We included only published randomized controlled trials (RCTs) and quasi-experiment that compared HIVST to the standard of care (SoC). Studies with sufficient data were aggregated using meta-analysis on RevMan 5.4 at a 95% confidence interval. Cochrane's Q test was used to assess heterogeneity between the studies, while Higgins and Thompson's I2 was used to quantify heterogeneity. Subgroup analyses were conducted to identify the source of heterogeneity. Of the 2669 articles obtained from the databases, only 15 studies were eligible for this review, and eight were included in the final meta-analysis. Overall, linkage to care was similar between the HIVST arm and SoC (effect size: 0.92 [0.45-1.86]; I2: 51%; p: 0.04). In the population subgroup analysis, female sex workers (FSWs) in the HIVST arm were significantly linked to care compared to the SoC arm (effect size: 0.53 [0.30-0.94]; I2: 0%; p: 0.41). HIVST interventions did not significantly improve ART initiation in the HIVST arm compared to the SoC arm (effect size: 0.90 [0.45-1.79]; I2: 74%; p: < 0.001). We found that more male partners of women living with HIV in the SoC arm initiated PrEP compared to partners in the HIVST arm. The meta-analysis showed no difference between the HIVST and SoC arm regarding the number of clients (effect size: - 0.66 [1.35-0.02]; I2: 64%; p: 0.09) and non-clients FSWs see per night (effect size: - 1.45 [- 1.45 to 1.38]; I2: 93%; p: < 0.001). HIVST did not reduce the use of condoms during insertive or receptive condomless anal intercourse among MSM. HIVST does not improve linkage to care in the general population but does among FSWs. HIVST intervention does not improve linkage to ART nor significantly stimulate healthy sexual behaviors among priority groups. The only RCT that linked HIVST to PrEP found that PrEP uptake was higher among partners of women living with HIV in the SoC arm than in the HIVST arm. More RCTs among priority groups are needed, and the influence of HIVST on PrEP uptake should be further investigated.

Risky sexual behavior among people living with HIV/AIDS in Andabet district, Ethiopia: Using a model of unsafe sexual behavior

Introduction

Human immunodeficiency virus (HIV) infection continues to be a major public health problem in Ethiopia. Previous studies have described risky sexual behavior and associated factors among HIV-positive people. These studies, however, did not use a model of unsafe sexual behavior that could address both subjective and objective factors of sexual activity, and there is no study that examines the distal aspects of risky sexual behavior among people living with HIV/AIDS in Ethiopia. Therefore, this study aimed to examine the risky sexual behavior among people living with HIV/AIDS using a model of unsafe sexual behavior.

Methods

An institutional-based study was conducted from March to April 2022. The sample size was determined by using Sloven's formula. In this study, both quantitative and qualitative methods were employed. Study participants were selected using systematic sampling method. An interviewer-administered questionnaire was used to collect the data. Descriptive statistics and correlation tests were computed to analyze the data. The qualitative data was analyzed thematically.

Results

This study included a total of 181 PLWHA clients. The average score for participants' perception regarding the facts of HIV/AIDS was 48.7% (95% CI: 38.9, 58.4). Three months prior to the study, 46.3% of study participants had engaged in at least one risky sexual activity (95% CI: 33.8, 65.4). The correlation model revealed a positive correlation between living in a rural area and risky sexual behavior (p-value = 0.001). Furthermore, a poor perception of HIV risks was associated with risky sexual behavior (p-value = 0.003). Economic issues, stigma and discrimination, and usage of substances were also identified as contributing factors to unsafe sexual activity in the qualitative data.

Conclusions

A high proportion of PLWHA clients had engaged in at least one risky sexual activity in the 3 months prior to the study. It is not enough to be on ART; additional educational interventions that shape the sexual behavior of PLWHA clients must be considered.

Utilization of Voluntary Counseling and Testing Experience among Mizan-Tepi University Students in Southwestern Ethiopia

Background

Voluntary counseling and testing (VCT) is the primary gateway to HIV prevention, caution, and handling, where people learn whether they are infected. This study was aimed to assess the determinants of voluntary counseling and testing experience among students.

Methods

An institution-based cross-sectional study was conducted between November and January, 2020. A simple random sampling procedure was used to select participants from the target group. The Chi-square test, descriptive analysis, and a binary logistic regression analysis were used to identify the factors associated with VCT experience among students.

Results

Out of 398 participants, 42.5% experienced VCT services. From 59.5% of female participants in the study, only 22.9% experienced VCT services. The logistic regression results revealed that male participants less likely experienced VCT (AOR = 0.549; 95%CI: 0.330, 0.910; p=0.020) compared to female students. Students who had VCT service access in their surroundings (AOR = 2.348; 95%CI: 1.371, 4.020; p=0.002), a sexual partner (AOR = 3.795; 95%CI: 1.214, 11.868; p=0.022), and media access (AOR = 2.374; 95%CI: 1.059, 5.320; p=0.036) were more likely to utilize VCT services than their reference categories.

Conclusions

VCT utilization among students remains limited. In this study, sex, age, region, the education of mother and father, having boy/girlfriend, the source of information, service access, media access, and attitude were the identified factors of VCT utilization. To enhance the usage of VCT services, the facilities should be publicized, and all information regarding VCT should be made available to teenagers.