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SUMMARY
HIV Counseling and Testing play a vital role in HIV prevention and control as an entry point of
care and support. Globally > 6,800 people became infected and > 5,700 die from AIDS daily,
mostly because they have no access to HIV services. In sub-Saharan Africa, most infection
occurs due to heterosexual intercourse leading to mother –to- child transmission. In Nigeria,
heterosexual sex remains the primary mode of transmission; 80-95%, yet uptake of HIV
Testing services was low in Bunkure; 1.2 % in 2015, only 2 centers for PMTCT , one offers
HCT, ART and PMTCT. In 2013, Bunkure was ranked 44 out of 44 LGAs in terms of PMTCT,
due to 100% absent of HIV services with prevalence of 3.4% and 354 HIV positive pregnant
women. The study aimed at determining individual, community and health facility factors
affecting HCT uptake in Bunkure.
A cross sectional descriptive study was used to select 350 adults using multistage sampling
technique. Data was collected using a pre-tested interviewer administered questionnaire and
analyzed using Epi-info.
Univariate analysis showed age range of 16-62years, mean of 34.5yrs ±10.9, 51.4% were female,
about 60% had no formal education, >70% were Hausa farmers and traders, 75% were aware of
HCT site in Bunkure, 60% had information through health worker and 79% were willing to do
the test although uptake of HCT was 19% due to cultural belief (73%), stigmatization (86%),
fear of test (70.5%), location of facility (90.1%), distance (83.1%) and confidentiality (65.2%).
Bivariate analysis showed association between uptake of HCT and gender in favor of female
(OR 0.3 CI 0.19-0.6 p<0.05), education (OR 2.0, CI 1.2-3.4 p=0.01), Awareness of HCT site
(OR 0.9 CI 2.8-30.7 p<0.05), and Willingness to do the test (OR 22.8 CI 3.1-167.6 p<0.05),
stigmatization (OR 0.2, CI 0.1-0.3 p<0.05) and fear of test (OR 0.3, CI 0.2-0.5, p<0.05). On
xii
logistic regression, tertiary education/ none (p= 0.02), gender male/female (0.00) knowledge of
site of HCT (p=0.0002) and stigmatization (p=0.00) were statistically significant.
Less than a quarter of adults in Bunkure obtained HIV testing services, being female, having
attained tertiary level of education and being aware of HCT site enhanced uptake, and although
willingness to do the test was high, stigmatization hindered uptake while health facility factors
were not likely. The community, Government and supporting agencies should collaborate in
creating awareness and funding research to improve HIV uptake from 19% to 40% by the end of
2018 and PEPFAR target of 90-90-90 model for interruption of HIV transmission by the year
2020.
Key words: Factors, uptake, HIV counselling and testing, adults
xiii
CHAPTER ONE
INTRODUCTION
1.1 Background Information
HIV Counseling and Testing (HCT) play a vital role in HIV prevention and control. For people
with HIV infection, HCT acts as an entry point of care and support as it also provides people
with an opportunity to learn about and accept their HIV sero-status early, in a confidential
manner backed by counseling and referral for ongoing emotional support and medical care. This
measure has been shown to be a successful approach in many countries. Counseling helps HIV
discordant couples accept safer sex practices to prevent HIV transmission to the un-infected
partner, as such couple counseling on HIV can, thus, be provided as part of premarital
counseling. 1 It is disheartening that globally, more than 6,800 people become infected with HIV
and more than 5,700 die from AIDS every day, mostly because they have no access to HIV
prevention, treatment and care services intervention. 2 In sub-Saharan Africa, most HIV infection
occurs due to heterosexual intercourse between couples in a relationship and mother –to- child
transmission. 3 In Nigeria, heterosexual sex remains the primary mode of transmission for HIV
and accounts for 80-95% of HIV infections in the country.4
As there is no effective vaccine and cure for HIV infection, HCT has been used as entrance for
change of behavior and accessibility to continue treatment with antiretroviral drugs and
subsequently prevention of mother –to- child transmission through use of antiretroviral drugs and
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