Predictors of Refusal of Provider Initiated HIV Testing (PIHT) among Clients Visiting Outpatient Departments (OPDS) in Jimma Town: Unmatched Case Control Study.

Abstract

Background: Provider initiated HIV testing and counselling (PIHTC) is one of the current strategies for prevention of HIV/AIDS. Though HIV testing is critical for behavior modification, getting support and entry point for engagement on treatment, the number of people knowing their status is still low and many HIV infected people are missing existing opportunities. Objective: this study intends to identify predictors of refusal of PIHCT among clients visiting OPDs in public health facilities in Jimma town using modified health belief model. Methods and materials: unmatched case control study was conducted as March 20 to April 29, 2011. Of a total sample of 304 clients (152 case and 152 controls) of age > 15 years who were initiated for HIV testing sought to be studied, 97% (296) clients were included in the study. Written informed consent were sought to recruit client participants’ in the study. Both in-depth interview with health providers (qualitative) and face to face interview (quantitative) with pretested questionnaires adapted considering constructs of Health Belief Model (HBM) were considered in the study. Data was analyzed using SPSS v 16. Logistic and linear regressions were executed in which OR, β, mean difference, 95%CI and PV <5% were considered. Result: In this study; perceived susceptibility to HIV/AIDS, perceived benefits of testing for planning future health care, perceiving early testing as opportunity, self efficacy to live with HIV, non disclosure concerned, perceived obedience to providers, perceived explicitness of opt-out right, perceived selectiveness of initiation to the suspected and being resident outside Jimma town had protective effect while perceived severity of HIV/AIDS, clients’ perceived unmet preferred condition, perceived unpreparedness to test and recent testing had positive effect on odds of refusing PIHT in OPDs. There was existed client’s acceptance of PIHT just with obedience to provider. Client’s rights to opt-out were not fully kept and all clients were not being initiated. Conclusion and recommendations: perceived unpreparedness, self efficacy to live with HIV were best predictors of clients’ decision suggesting the need to work on ways that can improve clients’ readiness for testing through health messages at health facilities and via mass media and the need of further study on nature of preparation for testing.