A qualitative study on the voluntariness of counselling and testing for HIV amongst antenatal clinic attendees: do women have a choice?

BACKGROUND: Mother-to-child transmission (MTCT) of the Human Immunodeficiency -Virus (HIV) is a serious public health problem, contributing up to 90% of childhood HIV infections. In Tanzania, the prevention-of-mother-to-child-transmission (PMTCT) feature of the HIV programme was rolled out in 2000. The components of PMTCT include counselling and HIV testing directed at antenatal clinic attendees. It is through the process of Provider Initiated Counseling and Testing (PITC) that counselling is offered participant confidentiality and voluntariness are upheld and valid consent obtained. The objective of the study was to explore antenatal clinic attendees' experiences of the concept of voluntariness vis- a- vis the implementation of prior counseling and subsequent testing for HIV under the PITC as part of their antenatal care. METHODS: In-depth interviews were conducted with17 antenatal clinic attendees and 6 nursing officers working at the Muhimbili National Hospital (MNH) antenatal clinic. The study data were analyzed using qualitative content analysis. RESULTS: Antenatal clinic attendees' accounts suggested that counselling and testing for HIV during pregnancy was voluntary, and that knowledge of their HIV status led them to access appropriate treatment for both mother and her newborn baby. They reported feeling no pressure from nursing officers, and gave verbal consent to undergo the HIV test. However, some antenatal clinic attendees reported pressure from their partners to test for HIV. Healthcare providers were thus faced with a dilemma of disclosure/ nondisclosure when dealing with discordant couples. CONCLUSION: Antenatal clinic attendees at MNH undertook the PITC for HIV voluntarily. This was enhanced by their prior knowledge of HIV, the need to prevent mother- to- child transmission of HIV, and the effectiveness of the voluntary policy implemented by nursing officers.

Intervención basada en pruebas diagnósticas para un enfoque integral de las infecciones de transmisión sexual / Intervention based on diagnostic tests for a sexual transmitted diseases' integral approach

Se realizó un estudio transversal descriptivo en diversas comunidades del municipio Manicaragua para Identificar la infección por el Virus de Inmunodeficiencia Humana, Virus de Hepatitis B, Virus de Hepatitis C y Treponema pallidum en 448 personas sexualmente activas entre 15 y 59 años de población general. A partir del consentimiento informado y con una explicación de la dinámica de la investigación se procedió a la toma de la muestra y a la entrevista personal. Se aplicaron los principios de Atención Primaria de Salud (APS): equidad, integración y empoderamiento. Se realizó intervención educativo-preventiva y consejería. Las muestras fueron procesadas por tecnología SUMA y se realizó la determinación de anticuerpos al Treponema pallidum por serología VDRL. La positividad general fue de 2,6 por ciento a expensas de los virus de hepatitis y dentro de éstos la reactividad serológica al Virus de Hepatitis C fue 1,33 por ciento y al Virus de Hepatitis B de 0,88 por ciento. A su vez se detectaron dos personas con serología VDRL débil reactiva. No se identificaron personas infectadas por el VIH. Las personas con reactividad serológica VHC y VHB desconocían su estatus serológico. La población que resultó reactiva a las pruebas realizadas fueron mayoritariamente mujeres, en las edades medias de la vida. Se hizo entrega de los resultados al médico de atención primaria. Las personas que accedieron voluntariamente a la prueba de VIH tuvieron otras opciones pues dispusieron de información sobre las ITS-VIH, participaron de un instante de reflexión y análisis personal sobre su percepción de riesgo y finalmente conocieron su estatus serológico ante cuatro agentes causales de estas infecciones.

We carried out a cross-sectional, descriptive study in several communities of the municipality of Manicaragua to identify the infection by the Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Treponema pallidum in 448 sexually active people aged 15-59 years from the general population. Starting with the informed consent and a dynamic explanation of the investigation we took samples and did personal interviews. We applied the principles of the Primary Health Care: equity, integration and empowering. We developed an educative-preventive intervention and advisory. The samples were processed by SUMA technology, and the determination of the Treponema pallidum was made by VDRL serology. The general positivity was 2,6 per cent at the expenses of the hepatitis viruses, and among them, the serologic reactivity to the Hepatitis C Virus was 1,33 per cent, and to the Hepatitis B Virus of 0,88 per cent. We also detected two persons with mild reactive VDRL serology. We did not identified persons infected with the HIV. The persons with VHC and VHB serologic reactivity did not know their serologic status. The population who resulted reactive to the tests was mainly middle/aged women. We gave the results to the primary care physician. The persons who voluntarily agreed the HIV tests had other options because they had information on STD/HIV, made a reflection and personal analysis on their risk perception and finally knew their serologic status about four causal agents of these infections.