Background
Methods
Study design and setting
Study population and sample
Data collection and analysis
Quantitative
Qualitative
Ethical considerations
Results
Background characteristics of respondents
Variables | Frequency | Percentage (%) |
---|---|---|
Age (n = 300)
| ||
− < 25 | 82 | 27.3 |
− 25 – 34 | 178 | 59.3 |
− 35 – 44 | 38 | 12.7 |
− > 45 | 2 | 0.7 |
Marital status (n = 299)
| ||
− Married | 239 | 79.7 |
− Single | 60 | 20.3 |
Religion (n = 299)
| ||
− Christian | 251 | 83.9 |
− Moslem | 48 | 16.1 |
Education (n = 299)
| ||
− No formal | 34 | 11.4 |
− Primary | 20 | 6.7 |
− JSS/middle | 176 | 58.8 |
− Sen. Sec/Tech | 61 | 20.4 |
− Tertiary | 8 | 2.7 |
Employment status (n = 300)
| ||
− Employed | 193 | 64.3 |
− Not employed | 107 | 35.7 |
Family size (n = 300)
| ||
− <3 | 104 | 34.7 |
− 3 – 5 | 176 | 58.7 |
− > 5 | 20 | 6.6 |
Utilization of HIV testing and counseling
“As for this place they force us to do anything. When we came, the midwife told us ‘if you do not do HIV testing, you cannot deliver your baby here.’ And me too I like this place so I have to do it by force” (Pregnant women, Focus group discussion, health facility in Kumasi).
“I didn’t even know it was HIV testing. When I came they took my card and called me in to go for test. So I asked the one who took my blood sample what it was for, before I was told it was for HIV. […] I think this is not good” (Pregnant women, Focus group discussion, health facility in Kumasi).
“Some of the presenting pregnant women don’t want to come and test and they will manage to pass through to about 36 weeks of their gestation without testing. We spot some of them when they are about to deliver. We test them, admittedly, sometimes without their knowledge” (Midwife, Key informant, health facility in Kumasi).“Those who are adamant or so difficult are those who listen to other people and they discourage them from testing, so those are the people we try our possible best to encourage and if they insist they won’t do it, then we either use force or do it without their knowledge (Key informant interviews, , health facility in Kumasi).
Health facility related factors influencing HTC
Long waiting time
“When you come here you wait too long. Before I finish seeing the midwife it is too late and I am hungry so I postpone but the situation is always the same” (pregnant woman, FGD, health facility in Kumasi).“The problem here is the waiting time. Any day I come here I wait too long before being attended. So I am waiting till the day I will finish ANC early …. then I will go for the HIV test” (pregnant woman, FGD, health facility in Kumasi).
Relationship with health workers
“As for this place they don’t treat us well at all. The nurses, especially the younger ones are so rude and they will be shouting at us for any small mistake we make. This is why I have not tested, because I always want to go home and leave this place” (pregnant woman, FGD, health facility in Kumasi).
Privacy and confidentiality
“I decided not to take the test because it is too open to people. When we come the midwife calls the names and they sit around a table in the open where we are all waiting. When she finishes, she mentions some of the names and ask the rest to see her in the office and one can easily suspect something” (pregnant woman, FGD, health facility in Kumasi).
“Some refused the test because they say the room has not adequate privacy. They believe if they are positive, people will notice and they will be stigmatized” (midwife, key informant interview, health facility in Kumasi).“The place we are working is not very good. Some patients upon seeing people around the counseling room refuse to enter the room. ….. People even sometimes hear us telling patients they are positive, and that deter others from coming” (HIV counselor, key informant interview health facility in Kumasi).
Inadequate information
“Nobody has told me anything like that since I started coming here. I don’t know anything about HTC” (Pregnant woman, FDG, health facility in Kumasi).“Please, have not been told to do it and I don’t know anything about it (HTC). That is why I have not done it” (Pregnant woman, FDG, health facility in Kumasi).
“Well I have been told but I wasn’t told when to do it (HTC). I didn’t know I have to do it now, I thought I have to wait till maybe when my pregnancy has progressed to the later stage, so I am just waiting till that time, ….. maybe the eighth month” (Group 2).
“I normally do the counseling for them once; early in the morning when I come to the facility, then I go and sit down and wait for those who will come so I do the testing for them” (HIV counselor, key informant, health facility in Kumasi).
Challenges faced by health workers
“We are normally short of OraQuick, which we use as a confirmatory test. At times we ask patients to go and come because we have to send their blood samples to the reference laboratory at Komfo Anokye Teaching Hospital and many go and do not come back” (HIV counselor, key informant interview, health facility in Kumasi).“The place we are working is not good enough. It is too small and we can’t even accommodate two people here. We normally ask them to wait outside which they are not comfortable of. Some of them will leave when you ask them to sit outside” (health staff, key informant interview, health facility in Kumasi).
Influence of perceptions of quality of care and HTC
Variables | OR | AOR |
---|---|---|
I feel attended to at the facility
| ||
— Yes | 1 | 1 |
— No | 0.48 (0.30, 0.77)* | 0.65 (0.33, 1.28) |
Listened to
| ||
— Yes | 1 | 1 |
— No | 0.52 (0.30, 0.87)** | 1.36 (0.61, 3.05) |
You are treated with respect
| ||
— Yes | 1 | 1 |
— No | 0.56 (0.36, 0.85)** | 1.0 (0.56, 1.78) |
You can trust the health workers
| ||
— Yes | 1 | |
— No | 1.08 (0.93, 1.26) | - |
Privacy and confidentiality
| ||
— Yes | 1 | 1 |
— No | 0.43 (0.25, 0.73)** | 1.0 (0.52, 1.97) |
Do not wait long
| ||
— Yes | 1 | 1 |
— No | 0.49 (0.36, 0.66)*** | 0.50 (0.35, 0.72)*** |