Educational status and religion influence uptake of voluntary HIV counseling and testing by Ghanaian antenatal clinic attendees.

Abstract

A cross-sectional survey of 150 gravidae, randomly sampled from three antenatal clinics in Tema was conducted to investigate factors influencing their acceptance of routine “opt-out” counseling and testing. Descriptive analysis was done for participants’ demographic characteristics, as well as knowledge of vertical transmission and its implications for mother and child. Other measures of interest were rate and potential determinants of acceptance. Associations between respondents’ socio-demographic variables and acceptance behaviour were determined using odds ratios, with p-values and 95% confidence intervals. P-values were obtained from Fisher’s exact tests and significance levels set at a p-value of 0.05. Participants’ mean age was 29.7years±1.31 (95% CI 24.15-35.25). Of 150 participants, 76.7% (115/150) were married, 9.3% (14/150) had received no formal education, 25.3% (38/150) were unemployed and 78.7% (118/150) were Christians. Most (96%; 144/150) respondents knew about the disease and 89% (128/144) of this proportion identified vertical transmission as a means for its spread. Within the latter, 69% (87/128) knew of preventive interventions against vertical transmission. Acceptance rate of counseling and testing was approximately 93% (140/150). Main reasons cited for acceptance were to safeguard mother’s own health (92.1%, 129/140) and to prevent transmission to baby (87.1%, 122/140). Respondents identified fear (80%, 8/10) and stigmatization (70%, 7/10) as perceived barriers to acceptance. Age (OR=2.78; 95% CI=0.62-12.42; p=0.16), parity (OR=1.98; 95%CI=0.39-10.14; p=0.41) and marital status (OR=2.04; 95%CI=0.46-9.02; p=0.34) did not influence acceptance behaviour. Educated women were about 1.5 times [(132/136)/(9/14); OR=24.44; 95%CI=5.02-118.99; p=0.001)] more likely than their uneducated counterparts to accept counseling and testing services, while Christian women were 1.2 times [(115/118)/(26/32]); OR=13.27; 95%CI=2.53- 69.51; p=0.001)] more likely to do so than Muslims. Counseling and testing services were highly acceptable among our sample irrespective of age, parity and marital status. Educational status and religion were potential determinants of acceptance.

Keywords: HIV, voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), Ghana.