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Knowledge, attitudes and practices about HIV testing and counselling among adolescent girls in some selected secondary schools in Malawi
Abstract
The major objective of this study was to determine knowledge, attitudes and practices about HIV testing services and the uptake of this service amongst girls aged 15-19 in selected secondary schools in Malawi. A questionnaire was administered to 457 students and 18 focus group discussions and 45 in-depth interviews were conducted. The study found that almost every student knew about HTC but uptake was low as only about a third of the students reported having been tested. The uptake of this service also increased with age. Most of those tested wanted to know their sero-status. Others were tested because it was a requirement. Sixty nine per cent of the girls who did not go for the HIV test was mainly because either they were not sexually active or they felt they were not at risk. During FGDs some students did not test because they feared their parents would think they were sexually promiscuous. This study demonstrates the need for intensive campaigns among adolescent girls and their parents to create awareness about the importance of HIV testing as this is an entry point for all HIV and AIDS services.
... A study examined the knowledge, attitudes, practices, and uptake of HCT among girl ages 15 to 19 years in designated secondary schools in Malawi. They discovered that although virtually every student knew about HCT, HCT uptake was low: Only one third of the students had been tested for HIV, and HCT uptake increased with age [38]. Young people have a high knowledge of their serostatus predominantly as the result of provider-initiated HIV testing [28] [39]. ...
... Young people have a high knowledge of their serostatus predominantly as the result of provider-initiated HIV testing [28] [39]. In addition, 69% of the young girls who did not know their serostatus felt that they were not sexually active or not at risk [38]. A comparable negative attitude was observed among university students in Kano and Benin toward the use of ART [30] [40]. ...
... Another element of cognitive awareness addressed in the study was knowledge of They identified specific cultural and societal factors that negated the influence of education in this regard and hence concluded that education alone is not enough to increase HCT uptake [38]. ...
... Adolescents complained that health care workers were harsh to them when they sought care, often asking judgemental questions instead of offering servicesa finding not uncommon about young people's experiences with health care services in sub-Saharan Africa, such as in Malawi (Munthali, Mvula, and Maluwa-Banda, 2013), South Africa (Pettifor et al., 2013;Ramirez-Avilaet al., 2012), Uganda (Bakanda et al., 2011); Zambia (Denison et al., 2009); and Zimbabwe . ...
... Yet, despite the overwhelming evidence of the benefits of HIV testing and the call by the UN agencies (notably UNAIDS, UNICEF, WHO) and the global community to prioritise the testing of youth (including adolescents) in high prevalence settings, programmatic and empirical evidence suggests that very few adolescents are testing for HIV in both developed and developing countries(Idele et al., 2014). For instance, low testing rates among adolescents have been reported across several countries in sub-Saharan Africa, including Malawi(Munthali, Mvula, and Maluwa-Banda, 2013), South Africa(Pettifor et al., 2013; Ramirez- Avilaet al., 2012), Uganda(Bakanda et al., 2011), Zambia (Denision et al., 2009, and Zimbabwe. Swaziland is experiencing a similar challenge in that few adolescents access HIV testing, are linked to, and retained in HIV care and treatment. ...
... This, they believed, derives from the fact that in Swazi society a person ceases to be a child only when s/he moves out of the family home to establish his or her own. They also referred to the fact that decision making generally is a collective matter, particularly when it relates to issues around health and other social endeavours.The barriers to testing as shared by the adolescents in this study are similar to those stated by adolescents and young people in other developing countries in sub-Saharan Africa (cf.Beres et al., 2013) and particularly countries neighbouring Swaziland such as Malawi(Munthali, Mvula, and Maluwa-Banda, 2013), South Africa(Francis, 2010;Hutchinson and Mahlalela, 2006; Mohlabane et al., 2016; Ramirez-Avila et al., 2012;Strauss, Rhodes and George, 2015) ...
... Other studies have also reported low HIV testing rates among AGYW [12][13][14][15]. In a WHO research project (2013), they found that only 65% of AGYW had ever been tested for HIV [15]. ...
... The increase in HIV testing from 2005 to 2015 in Zimbabwe might be attributed to an increased awareness of HIV among AGYW and different interventions, such as provider-initiated HTC offered in healthcare facilities. Other studies have shown higher HIV testing rates among young women than adolescent girls [12,13,19,20]. This could be due to higher HIV awareness in the older age group and that they are more likely to have been pregnant and attended ANC where HIV testing is offered routinely. ...
Adolescent girls and young women (AGYW), aged 15–24 years, experience higher HIV incidence compared to their male counterparts, especially in sub-Saharan Africa (SSA), where the HIV burden is highest. This study determined trends in self-reported HIV testing and associated factors among AGYW in Zimbabwe using the Zimbabwe DHS datasets for 2005/6, 2010/11, and 2015. The proportion of adolescents aged 15–19 years who had ever tested for HIV increased from 14.7% in 2005/6 to 26.5% in 2010/11 and 47.9% in 2015. Among young women, aged 20–24 years, the proportion increased from 34.8% in 2005/6 to 68.7% in 2010/11 and 84.8% in 2015. The odds of ever having an HIV test were significantly higher for those with a higher education (adjusted odds ratio [aOR] 12.49, 95% CI: 2.69 to 57.92, p = 0.001), comprehensive HIV knowledge (aOR 1.91, 95% CI: 1.31 to 2.78, p = 0.001), knowledge about mother-to-child transmission (MTCT) (aOR 2.09, 95% CI: 1.55 to 2.82, p < 0.001), non-discriminatory attitudes (aOR 1.60, 95% CI: 1.12 to 2.28, p = 0.010), three or more lifetime sexual partners (aOR 2.0, 95% CI: 1.09 to 3.66, p = 0.025), and a history of pregnancy (aOR 6.08, 95% CI: 4.22 to 8.75, p < 0.001). There is need to scale-up programmes targeting AGYW.
... Given the findings of this analysis, regional decisionmakers may want to focus on strategies or campaigns to improve gender equality in test uptake. While the stigma surrounding HIV infection and test uptake is well documented in this and other settings (44Á46), women in Malawi appear to face a more significant risk of social sanction (10,47). As men hold relatively more power within family structures and the Malawian social hierarchy more broadly, changing male perceptions of female testing will be critical to expanding access to HIV testing among Malawian women. ...
... This programme helped change men's perception of women and HIV. Before the programme, many had thought that it was only promiscuous or low-status women who were at risk of contracting the disease (10,47). ...
Background: Human immunodeficiency virus (HIV) is a significant contributor to Malawi's burden of disease. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi. Objective: To assess horizontal inequity (HI) in HIV testing in Malawi. Design: Data from the Demographic and Health Surveys (DHSs) 2004 and 2010 in Malawi are used for the analysis. The sample size for DHS 2004 was 14,571 (women =11,362 and men=3,209), and for DHS 2010 it was 29,830 (women=22,716 and men=7,114). The concentration index is used to quantify the amount of socio-economic-related inequality in HIV testing. The inequality is a primary method in this study. Corrected need, a further adjustment of the standard decomposition index, was calculated. Standard HI was compared with corrected need-adjusted inequity. Variables used to measure health need include symptoms of sexually transmitted infections. Non-need variables include wealth, education, literacy and marital status. Results: Between 2004 and 2010, the proportion of the population ever tested for HIV increased from 15 to 75% among women and from 16 to 54% among men. The need for HIV testing among men was concentrated among the relatively wealthy in 2004, but the need was more equitably distributed in 2010. Standard HI was 0.152 in 2004 and 0.008 in 2010 among women, and 0.186 in 2004 and 0.04 in 2010 among men. Rural–urban inequity also fell in this period, but HIV testing remained pro-rich among rural men (HI 0.041). The main social contributors to inequity in HIV testing were wealth in 2004 and education in 2010. Conclusions: Inequity in HIV testing in Malawi decreased between 2004 and 2010. This may be due to the increased support to HIV testing by global donors over this period.
... Majority of respondents had heard about voluntary counselling and testing (VCT) 106 (86.89%) in our study area. This result is similar with study conducted in Malawi Knowledge about HIV testing is quite high among secondary school students as 98% of the respondents reported having ever heard about HTC and this was regardless of the class and age of respondents [16]. This result is much better than study conducted in school of Nigeria by which is 59.5% [12]. ...
... Preceding the study 48.36% students had taken HIV test majority of respondents 86 (69.67%) of those who had tested went and 37 (30.33%) respondents were not willing to go for VCT this result is higher than the study conducted in Malawi which was Respondents were asked if they had ever gone for an HIV test only 31% reported having ever been tested for HIV [16]. When to camper in Ethiopia, a study conducted in Addis Ababa showed 55% study subject had HIV test, 63% to wish to have HIV testing and 45% who did not have HIV test [13]. ...
Background: Acquired immunodeficiency syndrome (AIDS) is a chronic infection disease which is by human
immune suppressive virus. HIV slowly attacks the immune system, the body’s defense against infection, leaving an
individual vulnerable to variety of other in infections and certain malignancies which eventually causes death. There
are various options in reducing of this pandemic such as voluntary counseling and testing, anti-retroviral therapy and
education for behavioral change. The objective was to assess the knowledge, attitude and practice HIV voluntary
counseling and testing among Ambo secondary school students.
Methods: Across sectional quantitative study to be from December 2015 to January 2016 in Ambo secondary
school. The data was entered, coded and analyzed using SPSS 20. The results are presented using numbers,
percentages, tables and charts.
Results: From the total respondents 43.4% were male and 56.6 were females and 62.3% were grade 9 and 37.7
were grade 10. Majority of the respondent’s age were ranged from 15-19 years that was 95.08%. Almost all, ninety
eight (98%) were Oromo in ethnicity, 59.84% were protestant in religion. Majority of respondents to knew the mode
of transmission and protection. Out of total respondents 48.36% were undergone VCT and 69.7% were willingness
to undergo VCT. When compared with a study conducted in Addis Ababa showed 55% study subject had HIV test,
63% to wish to have HIV testing and 45% who did not have HIV test. Majority of respondents were choice hospital 50
(40.87%) and health center 50 (40.98%) on place of VCT.
Conclusion: The needs of adolescents were important to provide youth-friendly services and practice of the study
subjects about HIV/AIDS and VCT.
... Other major barriers identified in the WHO study were the impact of a positive diagnosis, association of HTC with bad or high-risk behavior, lack of information, perceived risk with respect to sexual exposure, denial, poor attitudes of healthcare providers (poor confidentiality, insensitivity, and being judgmental), difficulty accessing testing services (transportation, cost, long waiting times, Review service hours), and parent/guardian consent requirements (16). Other studies conducted across sub-Saharan Africa corroborate with the WHO study with respect to barriers to adolescent HTC (18,20,(22)(23)(24)(26)(27)(28)(29)(30)(31)(32). These studies identified major barriers as fear of a positive test, especially among those sexually active, and fear of stigma and discrimination, including being ostracized by friends and family. ...
... These studies identified major barriers as fear of a positive test, especially among those sexually active, and fear of stigma and discrimination, including being ostracized by friends and family. Fear of loss of current or future partners, and the potential psychological impact of these consequences, including depression and suicide, were also expressed by African adolescents (22)(23)(24)26,28,30,32). ...
More than 80% of HIV-infected adolescents live in sub-Saharan Africa. AIDS-related mortality has increased among adolescents 10 to 19 years old. The World Health Organization has cited inadequate access to HIV Testing and Counseling (HTC) as a contributing factor to AIDS-related adolescent deaths, most of which occur in sub-Saharan Africa. This review focuses on studies conducted in high adolescent HIV-burden countries targeted by the "All In to End Adolescent AIDS" initiative, and describes barriers to adolescent HTC uptake and coverage. Fear of stigma and family reaction, fear of impact of a positive diagnosis, perceived risk with respect to sexual exposure, poor attitudes of healthcare providers and parental consent requirements are identified as major impediments. Most-at-risk adolescents for HIV infection and/or missed opportunities for testing include those perinatally infected, with early sexual debut, high mobility and multiple/older partners, and pregnant and non-pregnant females. Regional analyses show relatively low adolescent testing rates and more restrictive consent requirements for HTC in West and Central Africa as compared to East and southern Africa. Actionable recommendations for accelerating adolescent HTC and timely access to care include minimizing legal consent barriers, healthcare provider training, parental education and involvement, and expanding testing beyond healthcare facilities.Pediatric Research (2016); doi:10.1038/pr.2016.28.
... The main sources of HIV stigma among people living with HIV in Malawi include distant relatives, friends and church members because of its association with behaviours that are often judged such as prostitution or promiscuity [20]. While acknowledging complexities in determining and identifying root causes of HIV stigma, examples of stigma sources as spelled by Hammarlund et al (2018) include social institutions, public opinion and self [21][22][23]. ...
Introduction
HIV-related internalized stigma remains a major contributor to challenges experienced when accessing and providing HIV diagnosis, care and treatment services. It is a key barrier to effective prevention, treatment and care programs. This study investigated experiences of internalized stigma among people living with HIV in Malawi.
Methodology
A participatory cross-sectional study design of participants from eight districts across the three administrative regions of Malawi. Data were collected using Key Informant Interviews (n = 22), Focus Group Discussions (n = 4) and life-stories (n = 10). NVIVO 12 software was used for coding applying both deductive and inductive techniques. Health Stigma and Discrimination Framework was used as a theoretical and analytical framework during data analysis.
Results
Overt forms of stigma and discrimination were more recognizable to people living with HIV while latent forms, including internalized stigma, remained less identifiable and with limited approaches for mitigation. In this context, manifest forms of HIV-related stigma intersected with latent forms of stigma as people living with HIV often experienced both forms of stigma concurrently. The youths, HIV mixed-status couples and individuals newly initiated on ART were more susceptible to internalized stigma due to their lack of coping mechanism, unavailability of mitigation structures, and lack of information. Broadly, people living with HIV found it difficult to identify and describe internalized stigma and this affected their ability to recognize it and determine an appropriate course of action to deal with it.
Conclusion
Understanding the experiences of internalized stigma is key to developing targeted and context specific innovative solutions to this health problem.
... They are also afraid of getting stigmatized if they are HIV positive. 26 Based on the Theory of Planned Behavior, a person's attitude is influenced by belief in behavior. 27 Students still believe that VCT testing is not important for adolescents because adolescents are not at risk of HIV / AIDS (89%). ...
Background: HIV is a health problem of global concern. A large number of HIV cases in Surakarta is due to various factors such as the characteristics of adolescents, knowledge, attitudes, and beliefs to reduce HIV prevention through the use of VCT services. This study aims to analyze the relationship between age, gender, type of study program, information exposure, organizational participation, knowledge, attitudes, and beliefs in using VCT to use Voluntary Counseling and Testing (VCT) services for college students. Method: This research was a quantitative study with a cross-sectional approach. The study population was all students at one university in Surakarta in the 2016-2017 class as many as 12,457 students, while the research sample was 500 students who were taken using a proportional random sampling technique. Data analysis using chi-square test and logistic regression. Results: The results of the multivariate analysis showed that students' knowledge of HIV / AIDS and VCT affected the intention to use VCT services with an OR = 1.776 (CI = 1.170-2.695). The bivariate test results showed that there was a relationship between information exposure (p-value = 0.001), knowledge (p-value = 0.007), attitude (p-value = 0.006) and belief (p-value = 0.013) with the intention to use VCT services. Meanwhile, there was no relationship between age (p-value = 0.118), gender (p-value = 0.579), type of study program (p-value = 1,000), organizational participation (p-value = 0.352) with the intention of using VCT services. Students' knowledge of HIV / AIDS and VCT was the most dominant VCT intention. Therefore, providing information about VCT to students is necessary to increase students' knowledge and confidence in using VCT services.
... Previous literature exploring what discourages adolescents from receiving an HIV test found correlations with fear of a positive result, age, education, and stigma. Fear is one of the most documented barriers to testing, including concerns of stigma and discrimination around testing; fear of a positive test and the impact of a positive diagnosis; ostracization by peers, partners, and family; and being associated with promiscuous behavior [14][15][16]. Fears can be born out of insufficient or incorrect information and knowledge, which that can be exacerbated by peers, partners, and family [16]. ...
Background
HIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. Using a qualitative design, this study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya.
Methods
Study participants were adolescents aged 15–19 years old. The adolescents living with HIV were recruited from HIV support groups at health facilities. Adolescents of unknown HIV status were recruited from existing adolescent groups within the community. In both Zambia and Kenya, four focus group discussions (FGDs) were conducted with adolescents living with HIV and four FGDs were conducted with adolescents whose HIV status was unknown, for a total of 16 FDGs. FGDs consisted of 6–12 participants, a moderator, and a note-taker. FGDs were audio-recorded, transcribed, and translated into transcripts. Transcripts were coded in the qualitative analysis software program MAXQDA v. 12. Data reduction and summary tables were generated to help identify themes across the two study population groups. Data were interpreted within the health belief model.
Results
Adolescents discussed the challenges of facing a positive HIV test result, including fear of a positive result and need to change their lifestyle, fear of social isolation, and perception of the lost opportunity to achieve future dreams. Most adolescents of unknown status were not as aware of the benefits of learning their HIV status, nor were they aware of the ability to live a long and healthy life on ART. HIV-positive adolescents reported that the messages targeted towards adolescents focus on the need to remain HIV-negative, as opposed to the benefits of knowing one’s status. Adolescents described age and requirements for parental permission as a significant limitation in their ability to access HIV testing.
Conclusions
Adolescents require more information about the benefits of testing early and the ability to live a long and healthy life on ART. Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents.
... As such, for male OSY who had tested before, HIV testing was a known, and potentially somewhat positive, experience. In fact, studies have shown that youths who have more positive attitudes towards HIV testing [35,36], who want to know their status [37,38] or perceive it to be important to know their status [39][40][41], are more likely to test for HIV than those who do not have such feelings. Yet, these studies were not conducted explicitly among orphaned youth. ...
In parts of sub-Saharan Africa, where HIV prevalence is high, HIV is a leading cause of death among youths. Orphaned and separated youths are an especially vulnerable group, yet we know little about what influences their testing behavior. We conducted multiple logistical regression to examine theory-based predictors of past-year HIV testing among 423 orphaned and separated youths in Ethiopia, Kenya and Tanzania. We also conducted moderation, assessing whether predictors varied by sex. Over one-third of our sample reported past-year HIV testing. Those with greater perceived social support and those who reported sexual HIV risk behavior were more likely to report past-year testing. Furthermore, boys who reported ever previously testing for HIV were more likely, a year later, to report past-year HIV testing. In conclusion, our findings have important implications for intervention development, including the potential for enhanced perceived social support to positively influence HIV testing among orphaned and separated youths.
... Single respondents were more likely in this study to have used condom at last sex compared to the married ones p<0.001, age was also associated with condom use, higher proportion of young drivers less than thirty years of age were using condoms compared to the older ones p=0.006. About one third of the drivers had been tested for HIV mainly to know their status which is similar to the result gotten from a study carried out among girls in some selected schools in Malawi where 31% of respondents had done HIV testing in the past and2087.1% took the test to be sure of their status . ...
... As predicted from the model, our findings showed that a more positive attitude toward HIV testing was associated with a greater likelihood to intend to use HCT services, the first time found in Thai youth. This is consistent with prior global evidence (Gadegbeku, Saka, & Mensah, 2013;Munthali, Mvula, & Maluwa-Banda, 2014). Scaling up HCT service use in Thailand, the campaign "Early Detection as Treatable" through public media and in schools has promoted favorable attitudes toward HIV testing among the youth (Sirinirund et al., 2012). ...
This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.
... Understanding acceptability of HIV testing at schools from the perspective of students is essential to the success of the proposed roll out of the HTC campaign in schools. While an understanding of HTC practices and sexual behaviour will inform the design of appropriate interventions in order to increase uptake of HTC services amongst youth in school [13]. Improving access to appropriate HIV testing and counselling for young people is important for prevention of HIV transmission [14]. ...
The proposal by the South African Health Ministry to implement HIV testing and counselling (HTC) at schools in 2011 generated debates about the appropriateness of such testing. However, the debate has been between the Ministries of Education and Health, with little considerations of the students. The main aim of the study was to assess the students' opinions and uptake of HIV testing and counselling in general, and the acceptability of the provision of HIV testing and counselling in schools. The study also determined the association between socio-demographic characteristics, sexual behaviour, and HIV testing behaviour of the students.
A survey was conducted among grade 10-12 high school students in North West and Gauteng provinces, South Africa. Seventeen high schools (nine rural and eight urban) were randomly selected for the administration of a researcher-assisted, self-administered, semi-structured questionnaire.
A total of 2970 students aged 14-27 years participated in the study; 1632 (55%) were girls, 1810 (61%) ever had sex, and 1271 (49.8%) had more than one sex partner. The mean age of first sexual activity was 15.6. Half (n = 1494, 50.1%) had been tested for HIV. Having multiple sexual partners, age, and gender were significantly associated with increased odds of having had a HIV test. Fear, being un-informed about HTC, and low HIV risk perceptions were the reasons for not getting tested. The acceptability of HTC at school was high (n = 2282, 76.9%) and 2129 (71.8%) were willing to be tested at school. Appropriateness, privacy, and secrecy were the main arguments for and against HTC at school. One-third (n = 860, 29%) had intentions to disclose their HIV status to students versus 1258 (42.5%) for teachers. Stigma, discrimination and secrecy were the primary reasons students did not intend to disclose.
A high acceptability of HTC and willingness to be tested at school suggest that HIV prevention programs tailored to youth have a high potential of success given the readiness of students to uptake HTC. Bringing HIV testing to the school setting will increase the uptake of HTC among youth and contribute towards efforts to scale up HTC in South Africa.
Purpose
HIV/AIDS is a major public health problem in many parts of the world. Voluntary counseling and testing (VCT) is one of the essential strategies for its prevention and an entry point to AIDS care. Nevertheless, utilization of VCT is low in Ethiopia. Hence, the aim of this study was to assess the prevalence of VCT utilization and associated factors among Merawi preparatory school students, West Gojjam, Ethiopia.
Methods
An institution-based cross-sectional study was conducted from December 2 to 20, 2019 using a stratified random sampling method to enroll 365 participants. Data were collected using pretested structured self-administered questionnaires, entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. A logistic regression was used to determine an association between a number of independent variables and dependent variables. Adjusted odds ratios were calculated at 95% CI and considered significant with a p value of ≤ 0.05.
Results
The mean age of participants was 20.2 ± 2.6 years and more than half (52.6%) of the respondents were male. From the study participants, 77.5% had good knowledge of VCT, 75% had a positive attitude towards VCT for HIV and 31.5% had undergone VCT for HIV. According to the multivariable logistic regression, having a boyfriend or girlfriend (AOR = 10.49; 95% CI: 5.48, 20.09), discussing with parents about HIV (AOR = 3.63; 95% CI: 1.97, 6.68), good knowledge (AOR: 3.9; 95% CI: 1.80, 8.46) and positive attitude (AOR: 3.14; 95% CI:1.45, 6.82) were significantly associated with VCT utilization.
Conclusion
The majority of the respondents had good knowledge and a positive attitude towards VCT; however, its utilization was low. Having a boyfriend or girlfriend, discussion with parents about HIV, good knowledge and positive attitude towards VCT were significantly associated with VCT utilization. Therefore, a health education program aimed at bringing behavioral change should be planned and implemented.
HIV Testing and Counselling (HTC) is a critical strategy to reduce the rate of new HIV infections and the key entry point to HIV treatment, care and support services. This study aimed to determine the uptake of HTC among students of tertiary institutions in the Hohoe Municipality of Ghana. This was a quantitative cross-sectional study. A structured questionnaire was used to collect data among a proportionate stratified sample of students from tertiary institutions. Chi-square and Logistic regression analyses were performed using Stata version 12.0 at the 0.05 level of significance. Only 30.6% of the total respondents had ever tested for HIV/AIDS of which, only 22.9% tested less than 6 months before the current study. Students above twenty-four years of age were 3 times more likely to go for HTC than those below 20 years [OR=2.56 (95% CI: 1.07-6.11; p=0.034)]; those in the fourth year of study were 3 times more likely get HTC than those in the first year [OR=3.05 (95%CI: 1.10-8.49; p=0.033)]; and those attending THERESCO, the Midwifery training college and UHAS were more than 2 times more likely to get tested for HIV than those attending FRANCO [OR =2.67 (95% CI: 1.14-6.15; p=0.024)], [OR=2.40 (95% CI: 1.04-5.54; p=0.040)] and [OR=2.63 (95% CI: 1.13-6.13; p=0.026)] respectively. The uptake of HTC among ter-tiary institution students in Hohoe municipality was considerably low. Policymakers should design programs and interventions that would increase uptake of HTC among tertiary students, with focus on those aged less than 20 years, those at the lower level of study and those in the non-health related institutions.
Purpose
Many adolescent girls in Nigeria do not test for HIV despite being at high risk. While the influence of psychosocial factors on HIV testing has been examined, there is less evidence regarding the impact of assets and control of assets on HIV testing. This study investigated the protective effects of specific adolescent girls’ assets on decision-making regarding HIV testing.
Methods
Cross-sectional data from the 2013 Nigeria Demographic and Health Survey was analyzed. The main outcome variables were self-reports of having been tested for HIV and knowledge of a place that offers HIV testing. Binary logistic regression was used with employment, education, wealth index, home ownership, land ownership and decision making as potential predictors. Demographic characteristics were controlled in the analysis.
Results
Age [odds ratio (OR = 1.49)], employment (OR = 3.38), education (OR = 3.16), wealth index (OR = 1.33) and decision making (OR = 3.16) were positively associated with HIV testing. Age (OR = 1.20), employment (OR = 1.33), education (OR = 1.38), wealth (OR = 1.64), land ownership (OR = 1.42), and decision making (OR = 1.26) were positively associated with knowledge of an HIV testing location.
Conclusion
Our findings suggest that assets play an important role with HIV testing decisions for adolescent girls. Further research to elucidate the specific asset-based needs of adolescent girls will be needed to enhance decisions surrounding uptake of HIV testing and receipt of test results in Nigeria.
More research is needed to document both the value of eHealth for strengthening resource-limited health systems and the challenges involved in their implementation and adoption, so that insights from such research may be used to inform future initiatives. While many studies of eHealth for patient care in low- and middle-income countries (LMIC) are taking place, evidence of its role in improving administrative processes such as financial management is lacking, despite the importance of ‘good governance’ (transparency and accountability) for ensuring strong and resilient health systems.
The overall objective of this PhD was to elucidate the enablers, inhibitors and outcomes characterising the implementation and adoption of a modular eHealth system in a group of healthcare facilities in rural Malawi. The system included both clinical and billing modules. The specific objectives were (i) to understand the socio-technical, organisational and change management factors facilitating or hindering the implementation and adoption of the eHealth system, (ii) to assess the quality of data captured by the eHealth system compared with conventional paper-based records, and (iii) to understand how information within the eHealth system was used for service delivery, reporting and financial management. A further aim was to contribute to the corpus of mixed-methods case studies exploring eHealth system implementation processes and outcomes (including data quality) in LMIC. As described in the following chapters, the research also gave rise to unanticipated and serendipitous findings, which led to new lines of enquiry and influenced the theoretical perspectives from which the analysis drew.
For the hospital case study (Case Study 1), a retrospective single-case embedded design was employed, with outpatient and inpatient departments being the two units of analysis. Qualitative data included document review and in-depth key informant interviews, while quantitative data was obtained from the web-based District Health Information System (DHIS2), patient files and the hospital’s finance records. For the study of primary health centres (Case Study 2), a single-case embedded design was also used, with the rollout project as the case and the three units of analysis being 3 Early Adopter Facilities, 4 Late Majority facilities and 2 Laggard facilities. This case study used a prospective design, with data being collected 7 months and 24 months after implementation of the eHealth system due to a mismatch between the independent eHealth implementation project and the PhD research. Data sources included documentation screened against the criteria listed in the Performance of Routine Information System Management (PRISM) tools, information extracted from the eHealth system, health indicators drawn from DHIS2 and qualitative data from focus group discussions. In both case studies, framework analysis was used for qualitative data with the aid of NVivo, while quantitative data was analysed by calculating data completeness, accuracy and agreement. Descriptive statistics and the Mann-Whitney U-test were used for analysing finance data in Case Study 1. Content analysis was also used to gain insights from Case Study 2 aided by SPSS.
Converging the results of these two case studies illustrates the potential of eHealth to strengthen LMIC health systems through developing human resource capacity (skills, staff roles), facilitating service delivery, and improving financial management and governance. However, realising such improvements is dependent upon understanding the socio-technical interactions mediating the integration of new systems into organisational processes and work practices, and implementing appropriate change management interventions. The results of this study suggest that, for effective implementation and adoption of eHealth systems, healthcare leaders should (1) recruit data entry clerks to relieve clinical staff, improve workflow and avoid data fraud, (2) facilitate appropriate data use among system users and an information culture at the facilities, and (3) strengthen knowledge and skills transfer from eHealth system developers to local implementers and system champions, to optimise responsiveness and ensure sustainability. Further interdisciplinary research is needed to obtain additional insights into factors affecting the quality of eHealth data and its use in the management of LMIC health systems, including the role of social, professional and technological influences on financial good-governance.
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