Acceptance of routine counselling and testing for HIV among medical patients at Mulago Hospital casuality unit.

Abstract

Introduction: HIV counseling and testing is an entry point to comprehensive HIVIAIDS prevention and care. In Uganda, VCT is available in ambulatory settings where clients present by self-selection. Routine Counseling and Testing for HIV (RCT) is not widely offered as part of medical care at Mulago hospital. Data on patient acceptability of RCT in an acute care setting is still limited in Sub-Saharan Africa and Uganda in particular. This study determined the acceptability of RCT and the patient factors influencing uptake of the service in a hospital Methods: This was a cross-sectional study. Participants were selected by systematic sampling of patients attending the medical casualty unit at Mulago Hospital; Interviews were conducted to determine whether patients knew their HIV serostatus. HIV counseling and testing was offered to all eligible patients and results were delivered within 30minutes. WHO clinical staging was performed for the HIV positive patients. Acceptability of RCT was measured by the proportion of patients that agreed to be tested for HIV. Bivariate analysis was done to determine the sociodemographic, socio-economic and medical factors affecting the acceptability of RCT. Results: One hundred ninety three out of 233 patients that came to the Mulago casualty unit between October and December 2004 (83%) were not aware of their HIV serostatus. One hundred seventy one out of the 193 (88%) had sought treatment at a health unit in the previous six months where HIV testing had not been offered. Seventy out of 17 1 (5 1%) who had sought medical care in the previous six months had been to both private and public health units. One hundred ninety eight out of 208 (95%) that were offered HIV testing accepted to test for HIV. The very high acceptability precluded analysis of the factors associated with decline to test for HIV. One hundred and eleven out of 223 (50%) study participants were infected with HIV and 86 of the 111 HIV infections (77%) were diagnosed during the study period. Seventy eight out of 111 HIV infected participants (70%) were in WHO clinical stage 3 and 4. No immediate psychological breakdown was observed following delivery of HIV positive results. Conclusions: Acceptability of routine HIV testing was high at the medical casualty unit at Mulago Hospital. RCT in this setting identified a significant number of HIV infected patients. RCT has a potential public health impact of increasing the number of HIV infections diagnosed and hence the number of persons with access to HIV/AIDS prevention and treatment services. We recommend that RCT should be adopted as standard of care for patients at the medical casualty unit at Mulago hospital and other private and public health units in Uganda in order to meet patients at their earliest contact with the health care system.