Acceptability Of Counseling Research Articles

Exploring the acceptability of a decision aid for rural women with a history of prior cesarean birth regarding subsequent mode of birth in Coatepeque, Guatemala.

Decisions regarding mode of delivery in the context of a prior cesarean birth is complicated because both trial of labor after cesarean and elective repeat cesarean birth have risks and benefits. The objective of this study was to understand the perspective of women and obstetricians in Coatepeque, Guatemala, to guide the development of a decision aid about mode of birth for women with a history of prior cesarean. We conducted in-depth semi-structured interviews with obstetricians at Coatepeque Hospital and women at the Center for Human Development in the southwest Trifinio region of Guatemala in February 2020. Using qualitative content analysis, we recorded, transcribed, translated, and analyzed qualitative data for the meaning of themes and concepts exploring the acceptability of counseling with a decision aid regarding mode of delivery. A total of 30 qualitative interviews were conducted with women and physicians. Three themes emerged from the qualitative interviews: Having a decision aid for women with a prior cesarean birth will be useful and helpful. Content of the decision aid should include benefits and risks for women and babies as well as figures. Women described the need of tailoring the content surrounding family's role in their decisions. They felt that a trusted provider from the healthcare system should facilitate the use of the decision aid for counseling. These findings emphasize the support and need for innovative approaches to patient education around mode of delivery after a prior cesarean in the southwest region in Guatemala. There is a need to improve the educational information given to women regarding their mode of delivery after a cesarean birth. Finally, an effective decision aid needs to be tailored to not only the women's needs but also the engagement of the family unit for its successful implementation.

What matters for sustainable psychosocial interventions and who decides? Critical ethnography of a lay counselling program in Nepal

Lay counselling, or the delivery of talk-based therapeutic support by people without a clinical degree, is gaining popularity as a way of addressing global shortages of mental health professionals. In Nepal, lay counselors have made significant contributions to mental health and psychosocial care over the last two decades, particularly in the aftermath of major emergencies. However, research on the longer-term integration and sustainability of lay counselling interventions remains limited. This ethnographic study explored the meaning and importance of sustainability to different stakeholders in a lay counselling program implemented following Nepal’s 2015 earthquake. We conducted participant observation in the everyday lives of five counsellors as well as four focus group discussions and 51 semi-structured interviews with counsellors and other key stakeholders. Our analysis revealed significant discrepancies in perceptions of sustainability; while organizations involved in implementing the program described it as a sustainability success due to continued government financing, counsellors emphasized their own and the government’s failure to sustain high-quality service delivery in practice. Program-level barriers included inadequate budget and remuneration, lack of clinical supervision, and poor integration within existing systems. We also identified wider sociopolitical influences on sustainability, including the social positioning of counsellors, low understanding and acceptability of counselling, and a rapidly changing political landscape. These findings reveal the need for a critical approach to sustainability in global mental health, warning against superficial engagement that prioritizes continuity of government financing over quality of care and workers’ rights. Advocating for an ecological orientation within sustainability research, we also discuss the importance of looking beyond program design factors to consider how local and national sociopolitical dynamics influence frontline service provision.

Coping Mechanism, Psychological Distress and Counselling Acceptance among Victims of Domestic Violence in Malaysia

Coping Mechanism, Psychological Distress and Counselling Acceptance among Victims of Domestic Violence in Malaysia

Counseling Acceptance Skills School Counselor In Individual Counseling

The purpose of this study is that researchers want to look at counselee acceptance skills in individual counseling by guidance and counseling teachers in MTsN 10 Agam. This type of research is descriptive qualitative field research. The key informants of this study were 1 guidance and counseling teacher plus a supporting informant of 7 students who had participated in individual counseling using the snowball method, which is a method for identifying, selecting and taking samples in a network or continuous chain of relationships. The information obtained will be developed to the point of saturation so that the longer the more information obtained. Based on the results of research and discussion it can be concluded that as a strategy for counselee acceptance skills by counseling teachers in individual counseling, counseling teachers assume counselee is the closest person, can accept counselees openly, guiding sincerely or voluntarily, sincerity, and loving, keep secrets counselee, not discriminating counselee, and love counseling.

Recommendation and Acceptance of Counselling for Familial Cancer Risk in Newly Diagnosed Breast Cancer Cases

Background: In clinical routine, not every patient who is offered genetic counselling and diagnostics in order to investigate a familial cancer risk predisposition opts for it. Little is known about acceptance of counselling and testing in newly diagnosed breast cancer cases in Germany. Methods: All primary breast cancer cases and patients with DCIS (ductal carcinoma in situ) treated at the University Hospital of Dresden between 2016 and 2019 were included. The number of tumor board recommendations for genetic counselling on the basis of the GC-HBOC risk criteria was recorded. Acceptance was analyzed by number of cases with counselling in the GC-HBOC-Center Dresden. Results: Of 996 primary breast cancer and DCIS cases, 262 (26.3%) were eligible for genetic counselling. Recommendation for genetic counselling was accepted by 64.1% (168/262). Of these 90.5% (152/168) opted for molecular genetic analysis. The acceptance rate for counselling increased between 2016 and 2019 from 58.3 to 72.6%. Altogether, 20.4% (31/152) patients were found to carry a pathogenic variant in the breast cancer genes BRCA1 or BRCA2. Conclusion: Acceptance of recommendation is increasing as clinical consequences augment. Optimization in providing information about hereditary cancer risk and in accessibility of counselling and testing is required to further improve acceptance of recommendation.

Frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance.

To assess the frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance we undertook a cross-sectional study conducted from July to December 2018. Women aged 20-45years, who were pregnant and planned to deliver at the facility, were included. Women were counseled and offered about Human Immunodeficiency virus (HIV) screening. A total of 718 women were included in the study. The screening was accepted by 32.3% of women. Six women tested positive in the study giving a seroprevalence of 0.8% in the population studied. Acceptance of counseling and screening varied significantly with age range, educational status, socioeconomic status, and employment status. Women aged 30years and above (p = 0.023) and women with higher education (p < 0.001) were more likely to refuse counselling. Similarly, employed women (p = 0.041) and women of higher socioeconomic class (p = 0.039) refused counselling. However, when logistic regression was conducted, only educational status (p < 0.001) and occupational status (p = 0.039) were significantly associated with acceptance of counseling and screening. The acceptance of counselling and testing for HIV in antenatal care attendees was low. Women of higher educational status and having some employment refused counselling and testing more commonly.

Educação alimentar e nutricional para o controle de comorbidades em pessoas com doenças infecciosas

Objective: To report the experience of implementing Food and Nutrition Education (FNE) Practices in group, for improvement of nutrition counseling acceptance among patients with infectious diseases. Data synthesis: This is an experience report of food and nutrition education activity carried out from April to November 2015 at the Evandro Chagas National Institute of Infectology (INI/Fiocruz). Twelve individuals carrying infectious and parasitic diseases, of both genders, diagnosed with overweight and metabolic syndrome, took part in seven monthly thematic workshops. Themes of relevance to the treatment of metabolic syndrome and overweight were approached by means of group chats and dynamics, and explanatory brochure distribution. During the workshops, eating behaviors were clearly identified, which were not in conformity with the nutrition counseling provided in previous individual appointments and hampered the control of the clinical conditions experienced in metabolic syndrome and overweight. In the workshops, the participants consolidated the knowledge of healthy eating habits and, by exchanging experiences, they felt more confident and motivated to overcome the difficulties during nutrition treatment. Conclusion: It was observed that the participants consolidated their knowledge and autonomy for healthy food choices and, with the exchange of experience, they felt more confident and motivated to overcome the difficulties during the nutrition treatment. Therefore, the implementation of FNE in group was effective in improving nutrition counselling acceptance, which brings forward new reports of healthy eating practices.

P1.01-019 Integration of Tobacco Cessation Counseling in a Lung Screening Program

In the lung screening population, the prevalence of lung cancer is typically a small percentage (2.3% (10/440) in our institution’s program). A much more common, treatable, and potentially overlooked condition in the lung screened patient population is nicotine addiction. The National Lung Screening Trial contained 49% current smokers. A review of our lung cancer screening program showed 70.2% (309/440) of patients were active smokers at the time of lung screening. Our lung screening program is designed so that all scheduling would be done by a coordinator who is a Nurse Practitioner and a Certified Tobacco Treatment Specialist. A telephone call to schedule the scan was done by the coordinator and basic tobacco cessation intervention was integrated into every call. Further follow up as face-to-face counseling was offered. We reviewed institutional data to determine what proportion of active smokers would agree to individualized counseling when it would be conveniently offered at the point of the scan, by the person coordinating the program. Over a consecutive 26 month period, 440 patients underwent lung screening. The majority of patients (70.2%, 309/440) were actively smoking. Telephone intervention reached 100% (309/309). The telephone intervention consisted of an Ask, Advise, Refer strategy which offered further resources including: a quitline referral, a weekly group counseling session referral, and an in depth personal counseling session which would be provided at the time and place of the screening scan. The same tobacco treatment specialist who provided telephone intervention, met face-to-face with 80.6% (249/309) of active smokers for in depth counseling and development of a cessation plan. Our lung screening program detected lung cancer in a minority of participants (2.3%, 10/440) but encountered nicotine addiction in the majority of participants (70.2%, 309/440). Positioning Certified Tobacco Treatment Specialists as coordinators of lung screening programs ensure that all participants receive at minimum a telephone intervention. The initial telephone intervention coinciding with scheduling the screening scan allowed a relationship to develop between the patient and the coordinator (who is tobacco cessation specialist). Most participants who were smoking (80.6%, 249/309) agreed to in depth counseling which was conveniently provided at the point of service with the screening scan. Without integration of the resources, few patients would have sought out cessation counseling. As lung screening will recur annually, this will provide longitudinal support. Further data about acceptance of counseling and data about long term cessation in a lung screening program will be gathered.

Initial gatekeeping role by surgeon about BRCA mutation early detection among advanced ovarian carcinoma.

e13022Background: Obstacles may arise for offering genetic counseling and acceptance according to disease severity of ovarian carcinoma about BRCA mutation.BRCA testing and genetic counseling was highly recommended for women who had strong family history among ovarian cancer. We undertook this study to investigate whether advanced staging can be a barrier in BRCA testing and genetic counseling. Methods: Two groups of early (I-II) and advanced (III-IV) ovary carcinoma patients were divided regarding BRCA mutation and genetic counseling acceptance. Total 34 patients were evenly divided between them. After complete surgical staging and pathology result, single gynecologic oncologist offered genetic counseling about risk assessment based on pathology, family history and immunohistochemistry. BRCA1/2 gene sequencing was done. Results: Among 34 patients, we evenly divide early stage (n = 17) and advanced stage (n = 17) respectively. Advanced stage group was older than early stage group, median age of 52.53(19~7...

271PD Clinical significance of BRCA gene testing among ovarian carcinoma: can advanced staging be an obstacle for acceptance of counseling?

271PD Clinical significance of BRCA gene testing among ovarian carcinoma: can advanced staging be an obstacle for acceptance of counseling?

Clinicopathologic factors predictive of concurrent endometrial carcinoma in women with a preoperative diagnosis of endometrial hyperplasia

Objectives: To evaluate the effect of a universal screening protocol for all newly diagnosed endometrial cancers for Lynch syndrome (LS) using immunohistochemistry staining (IHC) for mismatch repair (MMR) enzyme expression on subsequent genetic counseling and genetic testing referral and acceptance rates. Methods: We performed a retrospective cohort study of all womenwho underwent a hysterectomy for endometrial cancer at Barnes Jewish Hospital in St. Louis, MO, between January 1, 2011 and December 31, 2013, (n= 637). A universal screening protocol was initiated on December 17, 2012, and used IHC for MMR enzymes MLH1, MSH2, MSH6, and PMS2. Caseswith absentMLH1 stainingwere reflexed toMLH1 promoter methylation testing. The first cohort (Pre Em-USP) consisted of women who presented prior to initiation of the screening protocol and were selectively screened (n= 395). In the second cohort (Em-USP), women presented after initiation of this protocol and were all screened for LS (n= 242). Genetic counseling and genetic testing referrals in both cohortswere based on risk factors (family or personal history) and/or IHC results. Categorical variables were compared using the Fisher's exact tests and continuous variables were compared using the Kruskal–Wallis test. Results: Overall, a greater proportion of individuals in the Em-USP cohort underwent genetic testing than in Pre Em-USP (9.1% vs. 4.8%, P b 0.05). Of the individuals with an IHC screening result suggestive of LS, those in the Em-USP cohort were significantly more likely to accept genetic counseling compared to those in the Pre-Em-USP cohort (95% vs. 64%, P= 0.02). Within the Em-USP cohort specifically, patients referred for genetic counseling due to a concerning IHC screening result compared with those who had a normal MMR enzyme staining pattern and were referred based on other risk factors had a higher counseling acceptance rate (95% vs. 61%, P=0.03) and underwent genetic testing more readily (76% vs. 30%, P b 0.001). Conclusions: Implementation of a universal screening protocol utilizing IHC for LS in endometrial cancer leads to higher acceptance of genetic counseling and higher rates of genetic testing compared to referral based on family or personal history alone.

Universal screening for Lynch syndrome in endometrial cancer results in increased acceptance of genetic counseling and testing

Objectives: To evaluate the effect of a universal screening protocol for all newly diagnosed endometrial cancers for Lynch syndrome (LS) using immunohistochemistry staining (IHC) for mismatch repair (MMR) enzyme expression on subsequent genetic counseling and genetic testing referral and acceptance rates. Methods: We performed a retrospective cohort study of all womenwho underwent a hysterectomy for endometrial cancer at Barnes Jewish Hospital in St. Louis, MO, between January 1, 2011 and December 31, 2013, (n= 637). A universal screening protocol was initiated on December 17, 2012, and used IHC for MMR enzymes MLH1, MSH2, MSH6, and PMS2. Caseswith absentMLH1 stainingwere reflexed toMLH1 promoter methylation testing. The first cohort (Pre Em-USP) consisted of women who presented prior to initiation of the screening protocol and were selectively screened (n= 395). In the second cohort (Em-USP), women presented after initiation of this protocol and were all screened for LS (n= 242). Genetic counseling and genetic testing referrals in both cohortswere based on risk factors (family or personal history) and/or IHC results. Categorical variables were compared using the Fisher's exact tests and continuous variables were compared using the Kruskal–Wallis test. Results: Overall, a greater proportion of individuals in the Em-USP cohort underwent genetic testing than in Pre Em-USP (9.1% vs. 4.8%, P b 0.05). Of the individuals with an IHC screening result suggestive of LS, those in the Em-USP cohort were significantly more likely to accept genetic counseling compared to those in the Pre-Em-USP cohort (95% vs. 64%, P= 0.02). Within the Em-USP cohort specifically, patients referred for genetic counseling due to a concerning IHC screening result compared with those who had a normal MMR enzyme staining pattern and were referred based on other risk factors had a higher counseling acceptance rate (95% vs. 61%, P=0.03) and underwent genetic testing more readily (76% vs. 30%, P b 0.001). Conclusions: Implementation of a universal screening protocol utilizing IHC for LS in endometrial cancer leads to higher acceptance of genetic counseling and higher rates of genetic testing compared to referral based on family or personal history alone.

Impact of an immunohistochemistry-based universal screening protocol for Lynch syndrome in endometrial cancer on genetic counseling and testing

ObjectiveEvaluate effects of a Lynch syndrome universal screening protocol in newly diagnosed endometrial cancers on subsequent genetic counseling (GC) and germline testing (GT) referral and acceptance rates. MethodsWe performed a retrospective cohort study of women who underwent a hysterectomy for endometrial cancer at Barnes Jewish Hospital in St. Louis, MO between 1/1/2011 and 12/31/2013 (n=637). An immunohistochemistry-based (IHC) universal screening protocol for Lynch syndrome was initiated on 12/17/2012. The cohorts consisted of women presenting prior to (Pre-Em-USP; n=395) and those presenting following (Em-USP; n=242) initiation of the universal screening protocol. GC and GT referrals were based on risk factors and/or IHC results. Comparisons were made using the Fisher's exact test and the Kruskal–Wallis test. ResultsA greater proportion of individuals in the Em-USP cohort underwent GT than in Pre-Em-USP (9.1% vs 4.8%, p<0.05). Of individuals with an IHC screening result suggestive of LS, those within the Em-USP cohort were significantly more likely to accept GC compared to those in the Pre-Em-USP cohort (95% vs 64%, p=0.02). Specifically within the Em-USP cohort, patients referred to GC due to a concerning IHC screening result, versus those who were referred based on other risk factors, had a higher counseling acceptance rate (95% vs 61%, p=0.03) and underwent genetic testing more readily (76% vs 30%, p<0.001). ConclusionsImplementation of an IHC-based universal screening protocol for LS in endometrial cancer leads to higher acceptance of genetic counseling and higher rates of genetic testing compared to referral based on risk factors alone.

Strong effects of home-based voluntary HIV counselling and testing on acceptance and equity: A cluster randomised trial in Zambia

Home-based voluntary HIV counselling and testing (HB-VCT) has been reported to have a high uptake, but it has not been rigorously evaluated. We designed a model for HB-VCT appropriate for wider scale-up, and investigated the acceptance of home-based counselling and testing, equity in uptake and negative life events with a cluster-randomized trial. Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and randomly assigned to the intervention or the control arm. Both arms had access to standard HIV testing services. Adults in the intervention clusters were offered HB-VCT by local lay counsellors. Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis. The study was registered with www.controlled-trials.com, number ISRCTN53353725. A total of 836 and 858 adults were assigned to the intervention and control clusters, respectively. In the intervention arm, counselling was accepted by 85% and 66% were tested (n = 686). Among counselled respondents who were cohabiting with the partner, 62% were counselled together with the partner. At follow-up eight months later, the proportion of adults reporting to have been tested the year prior to follow-up was 82% in the intervention arm and 52% in the control arm (Relative Risk (RR) 1.6, 95% CI 1.4–1.8), whereas the RR was 1.7 (1.4–2.0) according to the intention-to-treat analysis. At baseline the likelihood of being tested was higher for women vs. men and for more educated people. At follow-up these differences were found only in the control communities. Measured negative life events following HIV testing were similar in both groups. In conclusion, this HB-VCT model was found to be feasible, with a very high acceptance and to have important equity effects. The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential.

P2-16-11: Role of Proper Patient Counselling in Combination with Effect of Socioeconomic Deprivation on the Rate of Immediate Breast Reconstruction after Mastectomy.

Abstract Introduction: current guidelines in the United Kingdom suggest that the possibility of breast reconstruction should be discussed with all patients prior to mastectomy. However, the majority of patients are still treated with mastectomy alone and no reconstruction is carried out. It has also been suggested that women from more deprived areas are less likely to undergo immediate breast reconstruction (IBR). We investigated potential pitfalls in patient counselling and consequent decision making contributing to present IBR rate in combination with the effect of socioeconomic deprivation. Methods: data from 89 consecutive mastectomy patients was prospectively collected in a single centre in Glasgow between August 2010 and March 2011. Each patient was scored for deprivation based on The Scottish Index of Multiple Deprivation. The patients were then divided into two groups: high and low deprivation levels. Consultations about IR and patients’ acceptance of counselling were analysed. For statistical calculations Fischer's exact test was applied. Results: IBR was offered to 41 (46%) patients, but it was not to 42 (47%) (6 were excluded due to incomplete data). 25 patients accepted IBR, and of those 24 (27%) underwent IBR. 16 of 41 patients refused to undergo IBR due to lack of interest (10), not feeling ready for it (2), preference of delayed procedure (2) and fear of delaying adjuvant therapy (2). Of 42 patients whom IBR was not offered, only 10 were documented in the notes, while there was no reference for discussing reconstruction in 32 (36%) cases. Reasons for not even discussing reconstruction were the following: age (15), co-morbidities (18), locally advanced cancer (2), co-morbidities with age (5), and locally advanced cancer with age (2). As regards to socioeconomic deprivation; 44 (49%) patients were from deprived areas and 39 (44%) from affluent areas. 41 patients were offered IBR and of these 23 (26%) were from affluent areas compared to 18 (20%). Of the 42 patients who were not offered IR, 26 (29%) were from deprived while 16 (18%) from affluent areas (p&amp;lt;0.05). Of the 44 deprived patients, 18 were offered IBR but 26 were not. 15 of 25 patients, who accepted IBR, were from affluent areas. The 16 patients who refused IBR had equal distribution of deprivation. Conclusions: while none of the reasons for not offering IBR represent absolute contraindication to IBR, decisions about refusal are based mostly on patients’ subjective intuitions. Further, a greater proportion of the patients who were not offered IBR were from more deprived areas, and it seems that patients from affluent areas are more likely to be offered IBR compared to ones from deprived areas. However, confounding factors such as co-morbidities may contribute to the above. We believe, therefore, that detailed counselling about reconstruction of each patient requiring mastectomy is necessary, which is likely to further increase IBR rate. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-11.

Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting

BackgroundAs in other resource limited settings, the Ministry of Health in Zambia is challenged to make affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the introduction of context-specific interventions.MethodsInterventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September 2008. Data was checked for internal and external consistency using logic built into databases used for data management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and post- intervention.ResultsUptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and 99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29% to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care.ConclusionsUptake of PMTCT services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships with the government. These health system based approaches provide a sustainable improvement in the capacity and uptake of services.

Caring for the Caregivers: Models of HIV/AIDS Care and Treatment Provision for Health Care Workers in Southern Africa

Rollout of antiretroviral therapy (ART) has been successfully initiated in many countries, but concerns have been raised about the ability to meet treatment needs in areas where there is a high prevalence of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and where there are severe deficits in human-resource capacity. Many health care workers in resource-poor areas are experiencing burnout, struggling with external and internal stigma, failing to access HIV testing and treatment early, and subsequently becoming sick and dying of AIDS. Although the human-resource deficit is a well-recognized problem, little has been written about the programs that have been established to provide treatment for HIV-infected health care workers. In the present article, we describe staff care programs at McCord Hospital in Durban, South Africa; Mseleni Hospital in northern KwaZulu-Natal, South Africa; and the Tshedisa Institute in Gaborone, Botswana. These programs provide convenient, confidential, and holistic care for HIV-infected health care workers and health care workers affected by caring for HIV-infected patients. All 3 programs have noted that, among health care workers, there is increasing acceptance of counseling, testing, and treatment. We propose that there is an urgent need for the development of HIV/AIDS care and treatment programs for health care workers that remove barriers to access, provide confidentiality in testing, are conveniently located, and are integrated with tuberculosis programs and other treatment services.

Acceptance of counseling, voluntary HIV testing and use of prophylactic nevirapine in labour and immediate puerperium at Muhimbili national hospital, Tanzania

Background: Mother to child transmission contributes significantly to the incidence of HIV in our country. A PMTCT program exists in Muhimbili National Hospital (MNH) and some surrounding public hospitals since 2000. Inspite of this it has been observed that a substantial number of women delivering at MNH have not had VCT and therefore cannot benefit from the PMTCT intervention. Objective: To determine the acceptance of counseling, voluntary HIV testing and prophylactic use of Nevirapine among pregnant women during labour / immediate postpartum at Muhimbili National Hospital. Methodology: This descriptive Cross-sectional study was done in the labour ward of MNH. Data collection: Trained counselors invited all women who met inclusion criteria as they were admitted. Patients who had obstetric complications were excluded. Women who accepted counseling were taken to private rooms for discussion and those who consented were screened for HIV using rapid tests. Direct observed therapy with Nevirapine was done. Data was filled in a structured questionnaire and analysed by EPI Info 6 and SPSS software. Results: We recruited 885 women with unknown sero-status through convenient sampling. The overall acceptance of pre-test counseling in labour among women with unknown sero-status was 71.7% while acceptance of counseling and voluntary HIV testing was 56.6%. Among those who accepted pre-test counseling in labour, 78.9% accepted HIV testing and 8.6% of these were found to be HIV infected. Eighty-three percent of women diagnosed to be HIV infected accepted Nevirapine. Counselor's experience of more than 3 years had a significant impact on acceptance of counseling and testing of HIV in labour. Conclusion and recommendation: The results of this study show that HIV testing during labour and use of prophylactic ARV is acceptable in our setting. Women with unknown serostatus in labour should be offered counseling and testing in order to prevent MTCT of HIV. Keywords:Acceptance, HIV testing in labour. Tanzania Medical Journal Vol. 21 (1) 2006: pp. 1-5

Feasibility of counselling and HIV testing of pregnant women in Zimbabwe; is acceptability or acceptance rates the issue?

The article by Shetty et al. reported on a pilot study intended to assess the feasibility and acceptability of voluntary counselling and testing (VCT) among pregnant women… but the authors did not report as much on the acceptability of VCT. If anything while the authors suggested that VCT was acceptable to warrant scaling up on the other hand they are concerned with the 30% acceptance of HIV counselling suggesting that they were less than pleased about the acceptance of the process. This raises another question: what level of acceptance would we consider to be satisfactory? Shetty et al. reported 30% acceptance of counselling and Baruch et al. reported 44% acceptance and the former were pleased and displeased at the same time. (excerpt)

Perinatal HIV Counseling and Rapid Testing in Tijuana, Baja California, Mexico

To evaluate the acceptance of counseling and rapid HIV testing and to determine the associated risk factors for HIV infection in pregnant women in Baja California, Mexico. Pregnant women attending Tijuana General Hospital who consented to participate in the study had blood drawn for a rapid HIV test (Determine HIV-1/2; Abbott Diagnostics, North Chicago, IL). A confirmatory enzyme immunoassay and Western blot were performed and demographic and risk factor data were obtained. From March to November 2003, 1529 (92.5%) of 1653 women who sought prenatal care and 1068 (95.2%) of 1122 women in labor consented to participate. HIV seroprevalence was significantly higher among women screened during labor (12/1068, 1.12%) compared with those seeking prenatal care (5/1529, 0.33%). HIV-infected women were significantly more likely to use injection drugs (12% vs. 1%, P = 0.02), "other" drugs, including methamphetamine, marijuana, and cocaine (65% vs. 6%, P < 0.001), to have more sex partners (3.6 vs. 2.6, P = 0.0002), to not have received prenatal care (41% vs. 13%, P = 0.03), and to have a spouse/partner who used injection drugs (36% vs. 4%, P < 0.001) or "other" drugs (73% vs. 23%, P < 0.001). In multivariate regression analysis, use of methamphetamine (adjusted odds ratio, 17.8, 95% CI, 5.6-56) was independently associated with the risk of HIV infection. These findings indicate a wide acceptance of HIV counseling and testing and document a higher HIV seroprevalence among pregnant women delivering at Tijuana General Hospital than current established estimates in Mexico.