Predictors of HIV-test utilization in PMTCT among antenatal care attendees in government health centers: institution-based cross-sectional study using health belief model in Addis Ababa, Ethiopia, 2013

Abstract

Background

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is the most dramatic epidemic of the century that has claimed over two decades more than 3 million deaths. Sub-Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Mother-to-child transmission of HIV is responsible for 20% of all HIV transmissions. With no preventive interventions, 50% of HIV infections are transmitted from HIV-positive mothers to newborns. HIV-testing is central to prevent vertical transmission. Despite, awareness campaigns, prevention measures, and more recently, promotion of antiviral regimens, the prevalence of cases and deaths is still rising and the prevalence of prevention of mother-to-child transmission (PMTCT) voluntary counseling test (VCT) use remains low. This study identifies predictors and possible barriers of HIV-testing among antenatal care attendees based on the health belief model (HBM) in Addis Ababa, Ethiopia.

Methods

The study was an institution-based cross-sectional survey conducted from September 1 to September 30, 2013. A total of 308 individuals were interviewed using structured questionnaires adopted and modified from similar studies. Data were collected through face-to-face interviews. A logistic regression was used to identify factors associated with HIV-test use.

Results

In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection, wherein only 51.8% tested for HIV; among the married, only 84.1% and among the gestational age of third trimester, 34.1% mothers tested for HIV. Based on the HBM, failure to use PMTCT-HIV-test was related to its perceived lack of net benefit (adjusted odds ratio [AOR] =0.34, confidence interval [CI] [0.19–0.58], P<0.001), but interviewees with high perceived self-efficacy were 1.9 times more likely to use HIV-test (AOR =1.90, CI [1.09–3.33], P<0.05).

Conclusion and recommendation

This study identifies perceived self-efficacy and perceived lack of net benefit as the main predictors of PMTCT-HIV-test use. Hence, prevention strategies based on increasing perceived risk, perceived severity, or adequate knowledge about HIV/AIDS may not be sufficient to induce PMTCT-HIV-test. These data will be useful in designing and improving HIV/AIDS prevention programs and focused health communication and counseling strategies in relation to PMTCT in Ethiopia.

Keywords:

• PMTCT
• HIV-testing
• health belief model
• perceived net benefit
• perceived threat
• Addis Ababa
• Ethiopia

Acknowledgments

The authors acknowledge Health Education and Behavioral Sciences Department of Jimma University, Addis Ababa Health Bureau, all the health centers, and study participants taking part in this study without whom this study might not be possible.

The authors deeply acknowledge Health Education and Behavioral Sciences Department’s experts for their critical advice, while they had been working on revising the manuscript to increase its readability.

Last but not the least, they deeply thank W/ro Zenebech Asefa who cared them during the previous 3 weeks, more than ever, while they had been rewriting and revisiting all analyses for longer hours per day.

Authors’ contributions

Fikremariam Workagegn (first author). Contributed to the development and write-up of the proposal, presenting to the Ethical Appraisal Committee, and reviewed and corrected the Ethical Appraisal Committee’s comments. He contributed to recruit data collectors, supervise data collection, and collect the filled questionnaire daily. He coded and entered data into Epi Info version 3.2 software for editing and transferring the data to SPSS version 20. He was the primary person to analyze and write draft results.

Getachew Kiros (second author) was the second adviser of this research. He reviewed the proposal, analyzed the final data, and prepared the draft manuscript. He was also involved in supervision of data collection and presentation of the proposal to the Ethical Appraisal Committee. The major revision of the analyses was carried out by him.

Lakew Abebe (third author) was the first adviser of this research undertaking. He also supervised the two authors during the concept development, research design, conceptualization of the research, and adoption and modification of the instruments. He supervised data collection, final analyses, and writing up. He revised the document and prepared the manuscript in detail. He is also the corresponding author of this article.

Disclosure

The authors have declared that there are no competing financial and non-financial competing interests.