PREDICTING INTENTION TO TEST FOR HIV AND ACTUAL HIV TESTING IN ANTENATAL CARE SETTINGS USING THE THEORY OF PLANNED BEHAVIOUR: A COHORT STUDY

Introduction

HIV counselling and testing behaviour in antenatal settings is one of the least researched areas using the Theory of Planned Behaviour (TPB). Focusing a cohort of pregnant women attending antenatal care for the first time, this study assessed predictors of intentions and actual HIV testing.

Method

The study was conducted from Jan to Feb, 2009 in 12 public and three private health facilities in Addis Ababa, in three phases. First phase, salient control factors were assessed in three focus group discussions with 27 pregnant women. Second phase, a survey was conducted among pregnant women using standard pre-tested questionnaire. Third phase, the actual HIV testing was obtained from log books. A total of 3033 pregnant women participated in the study and 95.2% completed their follow up to HIV testing.

Result

Women attending public health facilities were significantly different from women attending private health facilities with respect to socio-demographic characteristics (p<0.01). Intentions were significantly correlated with all the cognitive variables and previous HIV testing experience among women attending public health facilities, whereas only attitude (r=0,24), subjective norm (r=0,41), descriptive norm (r=0,26) and knowledge (r=0,17) were significantly correlated with intentions among women attending private health facilities. The cognitive variables and previous HIV testing experience explained 12% and 19% of the variance in intentions among women attending public and private health facilities respectively. Subjective norm was the strongest predictor of intentions followed by attitude in both groups when the effect of other variables was controlled. Intentions (OR=0.41 (0.25, 0.67)), type of pre-test counseling (OR=0.57 (0.35, 0 .92)) and education were independent significant predictors of actual HIV testing. Among the low intenders, women who received individual pre-test counseling were 65% (OR=0,35 (0,20, 0,62)) less likely to test for HIV compared to women who received group pre-test counseling.

Conclusion

This study demonstrates the applicability of the TPB to understand HIV testing behavior among pregnant women. The total explained variance in intentions appeared modest compared to other studies. Many women seem to have difficulty to actively opt-out HIV testing and ended up tasting out of their intentions. Further considerations are needed in the implantation of the opt-out approach.