Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal

Abstract

A problem commonly encountered in programs for prevention of mother-to-child-transmission (PMTCT) of HIV in sub-Saharan Africa is low rates of HIV test acceptance among pregnant women. In this study, we examined risk factors and reasons for HIV test refusal among 432 women attending three antenatal care clinics offering PMTCT in urban and semi-urban parts of the Mbarara district, Uganda. Structured interviews were performed following pre-test counselling. Three-hundred-eighty women were included in the study, 323 (85%) of whom accepted HIV testing. In multivariate analysis, testing site (Site A: OR = 1.0; Site B: OR = 3.08; 95%CI: 1.12–8.46; Site C: OR = 5.93; 95%CI: 2.94–11.98), age between 30 and 34 years (<20 years: OR = 1.0; 20–24 years: OR = 1.81; 95%CI: 0.58–5.67; 25–29 years: OR = 2.15; 95%CI: 0.66–6.97; 30–34 years: OR = 3.88; 95%CI: 1.21–13.41), mistrust in reliability of the HIV test (OR = 20.60; 95%CI: 3.24–131.0) and not having been tested for HIV previously (OR = 2.15; 95%CI: 1.02–4.54) were associated with test refusal. Testing sites operating for longer durations had higher rates of acceptance. The most common reasons claimed for test refusal were: lack of access to antiretroviral therapy (ART) for HIV-infected women (88%; n=57), a need to discuss with partner before decision (82%; n=57) and fear of partner's reaction (54%; n=57). Comparison with previous periods showed that the acceptance rate increased with the duration of the program. Our study identified risk factors for HIV test refusal among pregnant women in Uganda and common reasons for not accepting testing. These findings may suggest modifications and improvements in the performance of HIV testing in this and similar populations.

Keywords:

• PMTCT
• HIV
• attitudes
• vertical transmission
• pregnant

Acknowledgements

We would like to thank the participating women, the doctors and the midwives at the Mbarara University Teaching Hospital, in Kinoni and Bwizibwera and the Lund University – Mbarara University of Sciences and Technology exchange program. We also would like to thank Helene Jacobsson at RSKC (The region of Scania′s competence centre for clinical research) for helping us with the statistics and the Swedish International Development Cooperation Agency for partial funding of the study.

Additional information

Notes on contributors

V. Dahl

The first and second authors contributed equally to the study

L. Mellhammar

The first and second authors contributed equally to the study