Coverage, Uptake And Barriers To Utilization Of Provider Initiated HIV Testing And Counseling Among Women Seeking Post Abortion Care Services At Kenyatta National Hospital, Nairobi County

Abstract

Introduction: Provider-initiated HIV testing and counseling (PITC) refers to HIV testing and counseling which is routinely recommended by health care providers to persons attending health care facilities as a standard component of medical care. It provides a critical opportunity to diagnose HIV infection, to begin chronic care, and to prevent mother to child transmission. In 2007, the World Health Organization (WHO) issued guidelines recommending that countries and organizations adopt PITC to increase HIV testing rates. These guidelines were developed because HIV testing rates globally remained low, despite increased access to HIV treatment, care, support and prevention services, and few people living with HIV were aware of their status. However, little is known about its uptake and barriers to its utilization among women seeking post abortion care services in the country and particularly in the present study area. Objectives: To assess the uptake and barriers to utilization of provider initiated HIV testing and counseling among women seeking post abortion care services at Kenyatta National Hospital. Methodology: Health institution based cross-sectional quantitative study complemented by a qualitative data was conducted at clinical areas of Kenyatta National Hospital offering post abortion care from August 22 to 06 October, 2015. A total of 188 women who had received post abortion care services were recruited on discharge using a census sampling technique. A structured questionnaire was used to collect quantitative data. Some of them participated in four focused group discussions for qualitative data. Three Key informant interviews and two focused group discussions among the HCWs were used to collect qualitative data. Quantitative data was entered in Microsoft excel and transported to SPSS version 17 for analysis. Qualitative data was recorded using a digital voice recorder. A code book was generated from the study guide and the study objectives into ATLAS.ti qualitative data analysis software. Using this software the word documents were then coded into themes. Results: A total of 95 (50.5. %) clients were offered PITC before discharge while 93 (49.5%) were not offered PITC before discharge. 81.1 % out of those who were offered PITC accepted to be tested while 18.9% declined HIV testing. Age, occupation, marital status, number of children, number of miscarriages and type of partner did not have any association with uptake of PITC after bivariate and multivariate analyses. The main reasons given by the clients for not accepting the tests were was the knowledge of a partner being HIV negative (34.6%), followed up by not being ready for HIV test (23.6%), afraid of HIV-positive results (12.7%), use of condom consistently during sex (12.7%) and not being sure of the confidentiality of the test (9.1%).The main system/provider associated barriers to uptake of PITC were, a shortage of staff, a busy work environment, a lack of private rooms, and a lack of refresher training. HIV prevalence among those who accepted to be tested was 4%. Conclusion: A PITC represents a paradigm shift and is feasible and acceptable to patients receiving post abortion care services. Clear directives are nevertheless required to enhance uptake and coverage. When offered to these clients, PITC identifies large numbers of persons requiring HIV care and hence an entry point to PMTCT. Community sensitization, staff training, multitasking and access to HIV care can contribute to high rate of acceptance of HIV testing.