Uptake of HIV voluntary counseling and testing and associated factors among students in the Higher Institutions of Learning in Kigali, Rwanda: A cross-sectional study

Background HIV/AIDS remains a significant global public health challenge with youth bearing the brunt of the burden. One essential method for preventing and accessing AIDS care is through Voluntary Counselling and Testing (VCT). Regardless of this, youth population continues to have low utilization of VCT services. Objective To assess the uptake of HIV VCT services and associated factors among university students in Kigali. Methods A cross-sectional study among 374 students recruited using stratified sampling was conducted. A structured questionnaire was used to gather information. A multivariable logistic regression analysis was used to assess the independent factors associated with VCT uptake. Results The prevalence of VCT uptake was 59.9%. The logistic regression revealed that being Catholic (AOR = 11.99, 95%CI: 5.44-26.41) and Moslem (AOR = 37.34, 95%CI: 2.67-128.36) compared to Protestant, as well as availability of VCT services (AOR = 5.15, 95%CI: 3.11 - 8.541) favored the use VCT. On the other hand, being aged 20 to 24 years (AOR = 0.112, 95%CI: 0.04 - 0.29) had low likelihood of using VCT than those more than 24 years of age. Conclusion VCT uptake was significantly positively associated with religion and VCT services availability, and negatively associated with age 20-24 years in the campus. Therefore, targeted actions of disseminating information on benefits of VCT and enhancing accessibility of VCT services among students are necessary for the increased VCT uptake to be attained.

Perspectives on HIV self-testing among key and affected populations in Kenya

Background: Kenya's Key and Affected Populations (KAP) ­ men who have sex with men (MSM), female sex workers, peoplewho inject drugs (PWID), and young women aged 18-24 ­ often experience stigma and discrimination in Kenyan health care settings due to their identity and/or behaviors, which can deter facility-based testing for HIV. Kenya has promoted self-testing as a means to reach these communities. Objectives: To identify KAP perspectives on self-testing and place our findings within Kenya's human rights and legal context. Methods: We conducted 4 focus group discussions (FGD) and 16 in-depth interviews (IDI). One FGD was conducted with each of the following communities: MSM, female sex workers, PWID, and young women aged 18-24. 1-4 IDI were conducted with each KAP community, and 1-3 IDI were conducted with health professionals working on HIV care in each study site. The semi-structured question guideline included one question soliciting opinions on self-testing. Results: KAP support self-testing in concept, however prevailing concerns among participants included access to pre- and posttest counseling services, as well as risk for harms (self-inflicted and otherwise) that might result from a positive result. Conclusion: Kenya should ensure that human rights are promoted and respected through implementing rights-based policies and practices for HIV self-testing, including pre- and post-test counseling.

Perceptions of nurses on TB with HIV adherence counselling skills in a health sub-district, Cape Town: A qualitative study

Background: People living with HIV (PLHIV) co-infected with Tuberculosis (TB) account for one in three HIV-related deaths. Retention in care and adherence to medication remain key behaviours that PLHIV co-infected with TB must adopt to achieve better health outcomes. Nevertheless, TB with HIV adherence-counselling services provided by nurses designed to enhance these behaviours remain inadequate. Additionally, limited information is found in the literature on the perceptions of nurses regarding their TB with HIV adherence counselling skills pertaining to PLHIV co-infected with TB. Aim: To explore and describe the perceptions of nurses regarding their TB with HIV adherence counselling skills of PLHIV co-infected with TB. Setting: The study was conducted in a health sub-district of Cape Town. Method: An exploratory, descriptive qualitative design was followed. A total of 14 purposively sampled nurses were interviewed individually. Nurses caring for PLHIV co-infected with TB were included and nurses not offering care to PLHIV co-infected with TB were excluded. All interviews were audio recorded with the participants' permission followed by verbatim transcriptions. Thematic analysis was done using ATLASti.8 electronic software. Results: It was established that the varied roles of these nurses increased their workload. Nonetheless, despite the gap in their counselling skills, the majority still maintained work expertise, professionalism and empathy towards the patients. Additionally, there were perceived barriers impacting patients' attendance of their follow up appointments. Conclusion: Based on the findings of this study, there is a need to equip nurses caring for PLHIV co-infected with TB with adherence counselling skills to improve practice.

Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees

Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies. Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA. Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA. Methods: A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants' CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed.Results: Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates.Conclusion: Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study

Lifestyle counselling and behavioural change: role among adult hypertensives in a rural tertiary institution

Background: In spite of the availability of myriads of antihypertensive medications, the control of high blood pressure is still low.Studies on effect of lifestyle behavioural changes through counselling on blood pressure control are scant in Nigeria. Therefore,this study set out to determine the role of lifestyle counselling on behavioural change among hypertensive patients attending the Federal Medical Centre, Ido-Ekiti.Methods: A total of 322 adult hypertensive participants who had been on treatment for at least three consecutive months were randomised into two groups. Relevant data were collected using an interviewer-administered semi-structured questionnaire and clinical parameters were measured pre- and post-intervention. The intervention group was counselled on lifestyle behaviours, namely regular exercise, eating adequate fruits and vegetables, moderate alcohol intake and cessation of smoking. Results: Post-intervention, among the intervention group 22.4%, 71.4% and 100%, as compared with the control group at 6.2%, 41.0% and 87.6%, met recommendations for physical activity, fruit and vegetable consumption and alcohol consumption respectively. The difference in each category was statistically significant (p < 0.001). However, the difference in smoking habits between the two groups (83.9% vs. 79.5%) was not statistically significant (p = 0.313). There was a statistically significant difference (p ≤ 0.001) in the difference in mean arterial pressure (96.4 ± 8.1 vs 106.2 ± 7.6 mmHg) between the intervention and control group post-intervention.Conclusion: Lifestyle modifications form part of an important and effective treatment modality for hypertension. It is desirable that primary care physicians devise and implement clinical and public health strategies that promote and maintain a combination of pharmacologic interventions and lifestyle modifications

Effect of counselling on the family function of intimate partner violence victims attending antenatal clinic in a tertiary hospital in North Central Nigeria

Background and aim: Intimate partner violence (IPV) is a global problem. Family dysfunction is an integral characteristic of IPV homes. However, not much has been done regarding restoration of these families. The aim of this study was to explore the effect of counselling on the family function of pregnant IPV victims, with a view to recommending an appropriate interventional strategy.Methods: The study was a single-blinded randomised controlled trial of pregnant IPV victims. The Abuse Assessment Scale (AAS)was used to recruit 72 IPV victims who were randomised into the control and intervention arms of 36 each. Their sociodemographic data were collected. The family function of the victims was assessed using the SCORE-15 index of family function at the beginning the study. The intervention arm had three sessions of counselling lasting one to two hours fortnightly using the SOS DoC protocol. The family function was repeated post intervention. Data were analysed using SPSS version 20 and a p-value of < 0.05 was considered significant.Results: The majority (82%) of the IPV victims had dysfunctional families. Baseline mean family function score across the groups showed no statistically significant difference. Post intervention, the mean family function score improved from 2.92 ± 0.92 to 2.16 ± 0.63 and this change was statistically significant (p < 0.0001). In the control arm, the change from 2.48 ± 0.73 to 2.29 ± 0.82 was not statistically significant (p = 0.116).Conclusion: Short-term counselling significantly improved the family function of IPV victims

Teenage pregnancies in Mozambique: the experience of "Servicios Amigos dos Adolescentes" clinics in Beira

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10­14; 15­19; 20­24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15­19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4­5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10­14 year old girls; 8% amongst 15­19 year olds; 10% amongst 20­24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique

Prevalence of hepatitis B virus, its risk factors and co-infection with human immune deficiency virus among clients of voluntary counseling and testing center in Hosanna, Southern Ethiopia

Hepatitis B infection (HBV) infection is a serious public health problem worldwide and its co-infection with human immune deficiency virus (HIV) is common due to shared routes of transmission. An increased mortality due to accelerated hepatic disease progression and the frequent hepatotoxicity caused by antiretroviral therapy are the challenges in the clinical management of HIV. Epidemiological studies on HBV and HBV/HIV co infection are scarce in Ethiopia, particularly at the study area. The aim of this study was to determine the magnitude of HBV, its risk factors and co-infection with HIV among clients of a voluntary counseling and testing (VCT) center in Southern Ethiopia. A facility based crosssectional study was conducted from 1st February 2016 to 15th March among clients of Nigist Eleni Memorial Hospital VCT Center. Data were collected by face-to-face interview and specific formula sheet as well recorded results of laboratory diagnosis of blood sample from each participant. Both descriptive and inferential statistics were used for data analysis. Multivariable logistic regression modeling was done to identify predictors of HBV. Overall, 331 participants were included in the study. The prevalence of HBV was 8.8%, HBV/HIV co-infection was found in 3.6%. Individuals with a history of multiple sexual partner [AOR = 10.3; 95% CI, 3.71 - 28.83], previous history of invasive procedure [adjusted odds ratio (AOR) = 10.88; 95% CI, 3.84 - 30.86] and history of surgical procedure [AOR = 9.2; 95% CI, 3.1 - 27.88] were identified as in dependent predictors of HBV infection. High HBV infection and HBV/HIV coinfection was found in the study.Previous history of surgical procedure, invasive procedure and multiple sexual partners were identified as independent predictor of HBV infection

Effect of volunteer household counseling in improving knowledge of birth preparedness and complication readiness of pregnant women in northwest Nigeria

Maternal and Child Health Integrated Program (MCHIP), a program by Jhpiego global, implemented maternal and newborn health project between 2006 and 2010 in Kano and Zamfara States, Nigeria. This was evaluated with an objective to characterize the effects of volunteer household counselors (VHCs) upon improving knowledge of birth preparedness and complication readiness (BPCR) among pregnant women. VHCs were trained to educate women and their families at home about BPCR. Knowledge of BPCR was compared among 152 and 594 women who did and did not receive household counseling. Mothers' knowledge of BPCR among those who did and did not receive counseling was 32.2% and 11.2% respectively. Mothers who received counseling had better knowledge of BPCR compared to women who did not (Relative Risk [R.R.] 2.30, 95% [C.I.] 1.50, 3.51, P = 0.0001) in a multivariable logistic regression model adjusting for potential confounders. Mothers who received counseling had better odds of knowledge of danger signs during delivery (R.R. 1.48, 95% C.I. 1.05, 2.09, P = 0.02), and post-partum period (R.R. 1.69, 95% C.I. 1.22, 2.32, P = 0.001), but not during pregnancy (R.R. 1.26, 95% C.I. 0.97, 1.64, P = 0.08), compared with women who received no counseling. VHCs can substantially increase knowledge of BPCR and danger signs among women in Nigeria

Male involvement in prevention of mother-to-child transmission of HIV in the context of partner testing in Goba town, Ethiopia: A facility-based cross-sectional study

Background. Antenatal care (ANC) is an entry point for the prevention of mother-to-child transmission (PMTCT), particularly when a man accompanies his spouse for voluntary counselling and testing (VCT), even though this seldom happens in Ethiopia.Objective. To study the role of male partners in improving PMTCT/ANC, which is essential to prevent HIV/AIDS transmission in this country. Our study focused on identifying barriers for the low involvement in PMTCT/ANC among male partners whose spouses received ANC.Methods. A total of 422 male partners in Goba town, Oromia regional state, Ethiopia, were recruited in September - October 2014 and enrolled by a systematic sampling method. A facility-based cross-sectional study and two focus group discussions (FGDs) were conducted. Binary logistic regression and odds ratios were calculated to ascertain sociodemographic and other important information compared with the outcome variable and PMTCT/ANC, while the findings of the FGDs were grouped according to the emerging themes and analysed manually by means of a thematic approach.Results. The percentage of male partners (22.7%) accompanying their spouses for HIV testing and counselling at antenatal clinics improved three-fold when an invitation letter was introduced as a new initiative to increase male participation. Individuals in the age group 15 - 29 years (adjusted odds ratio (AOR) 5.4, 95% confidence interval (CI) 1.66 - 17.85), and whose duration of marriage was ˂5 years (AOR 5.6, 95% CI 1.83 - 17.30), were more likely to be tested than their referent groups. Men without a higher education (AOR 0.1, 95% CI 0.02 - 0.50), who disagreed with legal enforcement (AOR 0.1, 95% CI 0.07 - 0.32), were less likely to be tested, while those who did not notify their partners (AOR 8.4, 95% CI 1.92 - 37.12) were more likely to use the service. Being busy, proxy testing, fears of testing HIV-positive, neglecting the importance of VCT, and inadequate knowledge about the PMTCT/ANC programme were other barriers that came to the fore in the FGDs.Conclusion. Identified barriers have to be addressed, and helpful practices, such as using invitation letters to increase the uptake of the service by male partners, have to be instituted

Effects of peer education on the knowledge and use of HIV counselling and testing services among young persons in Ibadan, Nigeria

Although HIV counselling and testing (HCT) service plays important roles in prevention and control of AIDS; many young Nigerians under-utilize it. A peer education intervention was implemented to promote use of HCT among secondary school students and apprentices in Ibadan; Nigeria. Baseline data were collected from 1281 students from six schools and 100 apprentice workshops in four Local Government Areas of Ibadan. A total of 897 students from four schools and apprentices from 25 workshops were assigned as experimental group while 682 students from two schools and apprentices from 25 workshops were the controls. Three intervention activities were implemented: a one-day sensitization workshop for 31 apprentice instructors and 20 secondary school teacher-supervisors; training of 75 students and 46 apprentices as Peer Educators (PE); and development of Behaviour Change Communication (BCC) materials including posters and handbills. Six months after implementing these interventions; a follow-up survey was conducted to assess the effects of the PE on young person's knowledge of HIV and HCT and reported use of HCT services. Follow-up data were collected from 760 respondents from the experimental sites and 298 from the control areas using the same questionnaire administered during the baseline survey. PE educated a total of 1;917 persons with information on HIV/HCT-related issues. In addition; at follow-up; records of use of HCT services were obtained from two HCT centres situated in the experimental sites and one from the control. Data were analysed using descriptive statistics and t-tests. The results showed significant increase in knowledge of HCT among experimental (1.3 to 7.5) (p0.05) and control groups (0.6 to 6.8) (p0.05) at follow-up. At baseline; 29.0% of the experimental and 36.0% of control knew of the location of a HCT centre; at follow-up the percentage of experimental groups who could do so increased to 62.0%; while the number dropped to 34.0% among controls. Records at HCT centres showed that a greater number (309) of experimental groups used HCT services than control (43). PE were successful in influencing behaviour of their peers to use HCT services

Outcomes from the Implementation of a Counselling Model Supporting Rapid Antiretroviral Treatment Initiation in a Primary Healthcare Clinic in Khayelitsha; South Africa

Background: Lengthy antiretroviral treatment (ART) preparation contributes to high losses to care between communicating ART eligibility and initiating ART. To address this shortfall; Medecins Sans Frontieres implemented a revised approach to ART initiation counselling preparation (integrated for TB co-infected patients); shifting the emphasis frompre-initiation sessions to addressing common barriers to adherence and strengthening postinitiationsupport in a primary healthcare facility in Khayelitsha; South Africa.Methods: An observational cohort study was conducted using routinely collected data forall ART-eligible patients attending their first counselling session between 23 July 2012 and 30April 2013 to assess losses to care prior to and post ART initiation. Viral load completion andsuppression rates of those retained on ART were also calculated.Results: Overall; 449 patients enrolled in the study; of whom 3.6% did not return to the facility to initiate ART. Of those who were initiated; 96.7% were retained at their first ART refill visitand 85.9% were retained 6 months post ART initiation. Of those retained; 80.2% had a viralload taken within 6 months of initiating ART; with 95.4% achieving viral load suppression.Conclusions: Adapting counselling to enable rapid ART initiation is feasible and has thepotential to reduce losses to care prior to ART initiation without increasing short-term lossesthereafter or compromising patient adherence

Factors infuencing the use of voluntary counselling and testing by university students

The study explored the factors influencing the use of voluntary counselling and testing (VCT) by university students. This was done by undertaking an exploratory and descriptive qualitative study. Data were collected using focus group discussions (FGDs) and field notes. Thematic analysis was done. The study revealed several factors and challenges regarding the uptake of VCT services by university students. Among the factors are: knowing one's HIV status; illness; pregnancy; blood donation; getting a reward; influence of significant others; media; awareness campaigns; compulsion; getting a job; curiosity; being positive role model; and the attitude of the health care provider. And among the challenges these include: HIV/AIDS-related stigma and discrimination; fear; low perception of risk to HIV infection; lack of student friendly VCT services; shortage of resources; inaccessibility of VCT services; long waiting period for test results; negative perceptions about VCT; pre-test counselling and ignorance

Healthcare Workers' Experiences of HIV Testing in Tshwane; South Africa

Background: In an era when antiretroviral (ARV) therapy has become part of the Human Immunodeficiency Virus (HIV) prevention strategy; early testing and introduction to ARVs iscritical for improving public health outcomes in general and; in particular; the lives of people living with HIV. South Africa has the highest number of people living with HIV as compared with the rest of the world. Initiated voluntary HIV counselling and testing and provider initiated counselling and testing (PICT) are required in order to increase the uptake of HIV testing.Objectives: To explore and describe the experiences of healthcare workers who are themselves in need of HIV testing.Method: A descriptive; exploratory design was used. In-depth interviews were conducted with the 26 healthcare workers who were involved in HIV testing in the Tshwane district of South Africa. The participants were sampled purposively from two healthcare settings. A thematic framework was used for data analysis.Results: There was a complication with regard to PICT as healthcare workers felt they could not initiate HIV testing for themselves and or their work colleagues without their confidentiality being compromised. This was complicated further by both the perceived and actual fear of stigmatisation and discrimination. It was difficult for qualified staff to support and encourage the uptake of HIV testing by students nurses as this was seen; albeit incorrectly; as targeting the students in a negative manner. Conclusion: There is a need for accessible HIV testing policies for healthcare workers in order to increase access to HIV testing and prevent the progression of the disease

Provider-initiated HIV counselling and testing (PICT) in the mentally ill

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this; HIV testing is not yet standard practice among the mentally ill population; and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it; on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services; and that this is within the parameters of existing policies and legislations in South Africa

Evaluation of a Task-Shifting Strategy Involving Peer Educators in HIV Care and Treatment Clinics in Lusaka; Zambia

Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics delivering ART in Lusaka; Zambia. Closed surveys were conducted with 148 patients receiving ART; 29 PEs; and 53 HCWs. Data was imported into Microsoft Excel to calculate descriptive statistics. Six focus group discussions and eight key informant (KI) interviews were conducted; recorded; transcribed; and coded to extract relevant data. Survey results demonstrated that 50 of 53 (96.1) HCWs agreed PEs reduced the amount of counseling duties required of HCWs. HCWs felt that PEs performed as well as HCWs in counseling patients (48 of 53; 90.6) and that having PEs conduct counseling enabled clinical staff to see more patients (44 of 53; 83). A majority of patients (141 of 148; 95.2) agreed or strongly agreed that PEs were knowledgeable about ART; and 89 of 144 (61.8) expressed a high level of confidence with PEs performing counseling and related tasks. Focus group and KI interviews supported these findings. PEs helped ease the work burden of HCWs and provided effective counseling; education talks; and adherence support to patients in HIV care. Consideration should be given to formalizing their role in the public health sector

From caution to urgency: the evolution of HIV testing and counselling in Africa

Objective:To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC. Methods A review of the published literature and of national HIV testing policies; strategic frameworks; plans and other relevant documents was carriedout. Findings Of the African countries reviewed; 42 (79.2) had adopted a PITC policy. Of the 42; all recommended PITC for the prevention of mother-to-child HIV transmission; 66.7recommended it for tuberculosis clinics and patients; and 45.2for sexually transmitted infection clinics. Moreover; 43.6adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However; women in antenatal clinics were not always aware that they had the right to decline an HIV test. Conclusion Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However; other approaches are needed to reach people who do not consult health-care services