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

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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

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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