Abstract
BackgroundHIV voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, particularly in remote rural settings. We sought to identify factors associated with service awareness and service uptake of VCT among female heads of household in rural Zambézia Province of north-central Mozambique which is characterized by high HIV prevalence (12.6%), poverty, and suboptimal health service access and utilization.MethodsOur population-based survey of female heads of household was administered to a representative two-stage cluster sample using a sampling frame created for use on all national surveys and based on census results. The data served as a baseline measure for the Ogumaniha project initiated in 2009. Survey domains included poverty, health, education, income, HIV stigma, health service access, and empowerment. Descriptive statistics and logistic regression were used to describe service awareness and service uptake of VCT.ResultsOf 3708 women surveyed, 2546 (69%) were unaware of available VCT services. Among 1162 women who were aware of VCT, 673 (58%) reported no prior testing. In the VCT aware group, VCT awareness was associated with higher education (aOR = 2.88; 95% CI = 1.61, 5.16), higher income (aOR = 1.41, 95% CI = 1.06, 1.86), higher numeracy (aOR = 1.05, CI 1.03, 1.08), more children < age 5 in the home (aOR = 1.53; 95% CI = 1.07, 2.18), closer proximity to a health facility (aOR = 1.05; 95% CI = 1.03, 1.07), and mobile phone ownership (aOR = 1.37; 95% CI = 1.03, 1.84) (all p-values < 0.04). Having a higher HIV-associated stigma score was the factor most strongly associated with being less likely to test. (aOR = 0.41; 95% CI = 0.23, 0.71; p<0.001).ConclusionsMost women were unaware of available VCT services. Even women who were aware of services were unlikely to have been tested. Expanded VCT and social marketing of VCT are needed in rural Mozambique with special attention to issues of community-level stigma reduction.
Highlights
human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, in remote rural settings
Despite global efforts to scale up human immunodeficiency virus (HIV) prevention measures and voluntary counseling and testing (VCT) for HIV, testing coverage remains low in many sub-Saharan African countries, in rural areas [1,2,3,4]
As of 2010, it was estimated that approximately 32% of adults in Mozambique with advanced HIV disease are receiving antiretroviral treatment (ART), but coverage remains highest in urban areas [16,18,25]
Summary
HIV voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, in remote rural settings. Despite global efforts to scale up human immunodeficiency virus (HIV) prevention measures and voluntary counseling and testing (VCT) for HIV, testing coverage remains low in many sub-Saharan African countries, in rural areas [1,2,3,4]. Programmatic analyses of VCT and treatment initiatives supported by the United States government-funded President's Emergency Plan for AIDS Relief (PEPFAR) have focused primarily on urban and peri-urban populations. As of 2010, it was estimated that approximately 32% of adults in Mozambique with advanced HIV disease are receiving ART, but coverage remains highest in urban areas [16,18,25]
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