Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project

Abstract

Voluntary counselling and testing (VCT) is an important component of HIV prevention and care. Little research exists on its acceptability and feasibility in rural settings. This paper examines the acceptability and feasibility of providing VCT using data from two sub-studies: (1) client-initiated VCT provided in rural health centres (RHCs) and (2) researcher-initiated VCT provided in a non-clinic community setting. Nurses provided client-initiated VCT in 39 RHCs in three Zimbabwean provinces (2004-2007). Demographic data and HIV status were collected. Qualitative data were also collected to assess rural communities' impressions of services. In a second study in 2007, VCT was offered to participants in a population-based HIV prevalence survey. Quantitative data from clinic-based VCT show that of 3585 clients aged > or =18, 79.4% (95% CI: 78.0-80.7%) were female; young people (aged 18-24) comprised 21.1%. Overall, 32.9% (95% CI: 31.4-34.5%) tested HIV positive. Young people were less likely to be HIV positive 13.5% (95% CI: 11.1-16.1%) vs. 38.1% (95% CI: 36.3-39.9%). In the second study conducted in a non-clinic setting, 27.0% (n=1368/5052) of participants opted to test. Young people were as likely to test as adults (27.3% vs. 26.9%) and an equal proportion of men and women tested. Overall during the second survey, 18.8% (95% CI: 16.7-21.0%) of participants tested positive (youth = 8.4% (95% CI: 6.4-10.7%); adults = 29.1% (95% CI: 25.7-32.7%)). Qualitative data, unique to clinics only, suggested that adults identify RHCs as acceptable VCT sites, whereas young people expressed reservations around these venues. Males reported considering VCT only after becoming ill. While VCT offered through RHCs is acceptable to women, it seems that men and youth are less comfortable with this venue. When VCT was offered in a non-clinic setting, numbers of men and women testing were similar. These data suggest that it may be possible to improve testing uptake in rural communities using non-clinic settings.

A Multilevel Analysis of the Determinants of HIV Testing in Zimbabwe: Evidence from the Demographic and Health Surveys

“…People act upon what they see happening around them. 23 People may have been discouraged from being tested for HIV if they observed people living with HIV being discriminated against in their communities or families. In a study by the Government of Zimbabwe, 38 a significantly number of people living with HIV reported that they had been forced to change residency or denied accommodation.…”

“…10,14,16 This pattern is likely to relate to the fact that never married females perceive themselves to be at lower risk of HIV; thus see no need to test for HIV. 23,45 It may also be that those married or divorced may have had an opportunity for HIV testing during marriage and as partner involvement during ANC visit. 46 This study did not come to the same conclusion with other studies in regards to HIV testing for males based on marital status.…”

“…16 Another explanation could be that HIV testing promotion and programmes are failing to reach the most deprived populations. 23 Thirdly, the adverse living conditions associated with low socio-economic status may itself constitute a barrier to access to HIV testing, 5 and that the wealthier may have the opportunity to access health service easily and to choose a health service which they are comfortable with. The fact that household wealth is more important for males, while community wealth is more important for females may suggest that most of males are economically empowered and have more resources enabling them to access healthcare services than females, while females rely on public health care which is cheaper or free in Zimbabwe.…”

“…5,22 These interactions may lead to an increased risk perception of HIV infection which may in turn decrease the willingness to utilise health care services that are linked to HIV. 23 The risk perception of contracting HIV may either increases or decreases the likelihood of using health care services. 24 An example of this phenomenon could be that, since HIV prevalence is reported to be positively associated with higher socio-economic status and education, 25 individuals with higher educational attainment and those who are wealthier may perceive themselves to be at risk of HIV infection, and therefore have recourse for HIV testing, compared to those who are less well-off.…”

Factor Influencing HIV Care Continuum among People Living with HIV in Western Kenya

“…This may be due to poor linkage on HIV care and management in this region which stands at 29.1% except for those tested at VCTs where the linkage is at 99.6% [22]. More importantly, this is still below the UNAIDS global target of 90% of HIV positive patients being initiated on ART by 2020 [20].…”