Background: HIV testing and counseling (HTC) remains critical in the global efforts to reach a goal of universal access to prevention and timely human immunodeficiency virus (HIV) treatment and health care. Routine HIV testing has been shown to be cost-effective and life-saving by prolonging the life expectancy of HIV patients and reducing the annual HIV transmission rate. However, these benefits of routine HIV testing may not be seen among pregnant women attending antenatal clinic (ANC) due to health facility related factors. This paper presents the influence of health facility related factors on HTC to inform HTC implementation. Methods. The study was cross-sectional in design and used structured questionnaire and interview guides to gather information from 300 pregnant women aged 18 to 49 years and had attended ANC for more than twice at the time of the study. Twelve health workers were interviewed as key informants. Respondents were selected from the five sub metro health facilities in the Kumasi Metropolis through systematic random sampling from August to November 2011. Pregnant women who had not tested after two or more ANC visits were classified as not utilizing HTC. Data was analyzed with STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level. Results: Twenty-four percent of the pregnant women had not undergone HTC, with “never been told” emerging as the most cited reason as reported by 29.5% of respondents. Decisions by pregnant women to take up HTC were mostly influenced by factors such as lack of information, perceptions of privacy and confidentiality, waiting time, poor relationship with health staff and fear of being positive. Conclusions: Access to HTC health facility alone does not translate into utilization of HTC service. Improving health facility related factors such as health education and information, confidentiality, health staff turnaround time and health staff-client relationship related to HTC will improve implementation. © 2014Kwapong et al.; licensee BioMed Central Ltd.
The study was cross sectional in design with both qualitative and quantitative methods. These methods were chosen because combining qualitative and quantitative methods elicit in-depth information and generate extensive discussions on contextual explanations on women’s perceived barriers to HTC [13]. The study was conducted in the Kumasi metropolis because it accounts for a third of population in Ashanti region (2009 projection, 1,889,934) and second urbanized after Greater Accra in Ghana. It is located almost at the centre of Ghana, an economic nerve and has varying health facilities. The Metropolitan Health Services is decentralized and are organized around five (5) Sub Metro Health Teams; namely, Bantama, Asokwa, Manhyia North, Manhyia South and Subin. The Metro Health Team is led by its Director of Health Services who has the overall responsibility for planning, monitoring and evaluating the performance of the Health Sector in the metropolis. The city has many public and private health facilities with one teaching hospital, the Komfo Anokye Teaching Hospital (KATH), one of the three national autonomous hospitals, four (4) quasi health institutions, five (5) health centres owned by the Church of Christ and the Seventh-Day Adventist Church. In 2010 and 2011, a total of 97,852 and 122,708 ANC registrants were recorded in the Kumasi metropolis of which 79% and 88% respectively tested and received post-test counseling [14]. As at 2011, there were 285 counseling and testing (CT) and 268 PMTCT centres in the Ashanti region [14]. The study was conducted in five sub metro health facilities providing HTC services in the Metropolis. These were Kumasi South Government Hospital (62 respondents), Suntreso Government Hospital (68 respondents), Tafo Government Hospital (56 respondents), Maternal and Child Health Hospital (56 respondents) and Manhyia Government Hospital (58 respondents). Pregnant women who had attended ANC more than twice and HIV counsellors at ANC in the selected health facilities in the Kumasi Metropolis were studied. The sample size was determined following [15] as Where n is the sample size; z is the reliability co-efficient (1.96) at 95% confidence level, d the allowable error margin (0.05), p is the proportion of women in fertility age (WIFA) in the population (23%) and q = 1-p. This gave an approximate sample size of 300. Simple random sampling ballot in which health facilities offering PMTCT services in each sub-metro were numbered was used to select study facilities. Five facilities, one each of the five sub-metros were selected without replacement. In each of the selected health facility, the study was explained to all pregnant women presenting at the antenatal clinic after which pieces of papers with inscriptions, ‘YES’ and ‘NO”, were put in a box for pick by respondents. Respondents who picked ‘YES’ and consented to participate in the study were enrolled till the required sample size of 300 for the quantitative survey was reached. The data collection technique was interviewing where trained research assistants interviewed respondents with structured questionnaires. Data was collected from August to November 2011. Questionnaires and interview results were checked for completeness and internal errors during data collection. Questionnaires were then sorted, numbered and kept in files labeled per facility from which the participants were recruited. Data was then coded before entering into SPSS. The perception on quality of PMTCT services and its influence on HIV Counseling and Testing was analysed using logistic regressions. This was done using STATA 11. The dependent variable was utilization of HTC and independent variables were facility related factors that influence HTC and these included waiting time, privacy and confidentiality, feeling attended to, being listened to, being treated with respect and trust for health workers. Pregnant women who had not been tested for HIV after two or more ANC visits were classified as not utilizing HTC and this was coded as 1. Focus group discussions (FGDs) and in-depth interviews using interview guides and tape recorders were the data collection techniques and tools respectively. Five FGDs, involving 40 pregnant women (8 per group per FGD) were conducted. They involved three (3) groups of women who had not undertaken HTC and two (2) groups of pregnant women who had undergone HTC. Topics discussed involved various health facility barriers to HTC. Twelve health workers were also involved in the in-depth interviews. Qualitative data was analyzed using ATLAS.ti. Audio-recorded data from both FGDs and key informants interviews were transcribed verbatim and translated into English. Data was analysed thematically and salient quotes from the themes were presented as results. The Committee for Human Research Publication and Ethics of the School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST) gave ethical clearance. Participants were taken through consenting processes prior to enrolment into the study. There was full disclosure or discussion of relevant information and questions related to the study. Also participants who could not read were informed about the study by translating the consenting information into their local language for adequate comprehension. They were told that enrolment into the study was voluntary. No response was related to participants who were assigned study identification numbers.
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