Factors associated with uptake of home based HIV counselling and testing by men in old Kumi district.

Abstract

BACKGROUND: Voluntary HIV counselling and testing (VCT) is one of the key strategies for the prevention and control of HIV/AIDS in Uganda. However, despite the introduction of home based HIV counselling and testing (HBCT), the uptake of VCT services particularly among men is low in old kumi district. We therefore conducted a study to determine the factors associated with the uptake of HBCT among men in old kumi district. METHODS: A population based cross sectional study employing both quantitative and qualitative techniques of data collection was conducted in june 2008, using interviewer administered data collection tools (semi-structured questionnaires) and key informant interviews (23). Using multi stage sampling, 240 men aged 15-60 years, the resident in old kumi district were sampled from 24 randomly selected villages. Data were collected on uptake of HBCT and on other factors including marital status, knowledge of process and benefit of HBCT programme, fear and stigma, cultural beliefs and programmatic factors like attitude of service provider and appointment for visit called independent variables. The odds ratios and their 95% confidence intervals (CI) of uptake of HBCT by the independent variables were estimated. In the multivariabe logistic regression, backward selection was done and at each step factors that were not significant at p<0.05 and potential cofounders were eliminated from the model. RESULTS: Overall, the uptake of HBCT was 66.9% with about 35.3% reporting to have taken HIV test more than 12 months earlier. Factors associated with lower odds of HBCT uptake were being married (OR 0.11, 95% CI (0.04-0.28)), Lack of knowledge and awareness regarding HBCT implementation (formation of post test clubs) (OR 8.07, 95% CI (1.26-51.48)) and having alternative testing sites (OR 5.17, 95%CI (1.57-17.02)), not involving men when making appointments for HBCT visits (OR 6.50 95% CI (1.45-29.16)), and absence of men at home during the time of home visits (OR 0.39, 95%CI (0.17-0.89)). Stigma and fear for HIV results though not significantly associated (OR 1.32 95% CI (0.63-2.76)) was raised by key informants as a contributing factor to low uptake of HBCT. CONCLUSION: Overall, about a third of men take up home based counselling and testing, 66%. Lack of knowledge regarding procedure of HBCT implementation and not involving men in making appointments for home visits continue major barriers to uptake of HIV counselling and testing through the home based model. RECOMMENDATIONS: In order to increase uptake of HBCT among men, the programme needs to enhance community participation through involvement of men in making appointments for the home visits and carry out sensitization campaigns pointing out HBCT programme benefits and addressing the issue of fear of testing a test, stigma and discrimination.