Lemu Yohannes Kebede, Koricha Zewdie Birhanu, Gebretsadik Lakew Abebe, Roro Ameyu Godesso
Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
HIV AIDS (Auckl). 2012;4:103-15. doi: 10.2147/HIV.S33122. Epub 2012 Aug 2.
Currently, provider-initiated human immunodeficiency virus (HIV) testing (PIHT) in health facilities is one of the strategies to advance HIV testing and related services. However, many HIV infected clients are missing the opportunities. This study intends to identify predictors of refusal of PIHT among clients visiting adult outpatient departments (OPDs) in Jimma town.
An unmatched case control study was conducted among 296 clients: 149 cases refusing HIV testing and 147 controls accepting HIV testing. The study recruited clients from OPDs of four public health facilities between March 6 and April 8, 2011 using consecutive sampling. The study instrument was adapted mainly considering health belief model (HBM). Jimma University ethical committee reviewed the study protocol. Data were collected by face-to-face interview and analyzed using SPSS Statistics (IBM Corporation, Somers, NY) software, version 16.0. Data were subjected to factor and reliability analysis. For prediction analysis, the study used logistic regression and odds ratio (OR) with 95% confidence interval (CI). To see the effects among HBM constructs, the study used standardized beta (β) coefficients at P < 0.05.
The study findings showed adjusted protective effects on refusal of PIHT for residence outside study town [adjusted OR (AOR) (95% CI) = 0.41 (0.22-0.79)] and higher scores of perceived benefit of early testing [AOR (95% CI)] = 0.86 (0.69-0.99)], self efficacy to live with HIV [AOR (95% CI) = 0.79 (0.66-0.93)], nondisclosure agreement [AOR (95% CI) = 0.74 (0.58-0.93)], perceived explicitness of opt-out right during initiation [AOR (95% CI) = 0.74 (0.56-0.98)] and clients' perceptions of selective initiation of HIV suspected [AOR (95% CI) = 0.54 (0.41-0.73)]. On the other hand, report of recent testing [AOR (95% CI) = 3.82 (1.71-8.55)] and perceived unpreparedness for testing [AOR (95% CI) = 1.86 (1.57-2.21)] aggravated refusal of PIHT. Exposure to cues to testing significantly reduced perceived barriers [β (P) = -0.05 (0.037)].
Clients' perceived barriers: feeling of unpreparedness for testing strongly aggravated refusal of test. Enhanced self-efficacy to live with HIV and presence of cues to HIV testing would reduce unpreparedness and protect from refusing PIHT.
目前，医疗机构中由医护人员主动提供的人类免疫缺陷病毒（HIV）检测（PIHT）是推进HIV检测及相关服务的策略之一。然而，许多HIV感染患者错失了这些机会。本研究旨在确定吉姆马镇成人门诊部就诊患者中拒绝PIHT的预测因素。
对296名患者进行了一项非匹配病例对照研究：149例拒绝HIV检测的患者为病例组，147例接受HIV检测的患者为对照组。该研究于2011年3月6日至4月8日采用连续抽样的方法，从四家公共卫生机构的门诊部招募患者。研究工具主要根据健康信念模型（HBM）进行调整。吉姆马大学伦理委员会审查了研究方案。通过面对面访谈收集数据，并使用SPSS Statistics（IBM公司，纽约州萨默斯）软件16.0版进行分析。对数据进行了因子分析和信度分析。在预测分析中，该研究使用了逻辑回归和95%置信区间（CI）的比值比（OR）。为了观察HBM各构成因素之间的影响，该研究使用了P<0.05时的标准化β系数。
研究结果显示，对于居住地不在研究镇的患者，PIHT拒绝率有调整后的保护作用[调整后OR（AOR）（95%CI）=0.41（0.22-0.79）]，早期检测的感知益处得分较高[AOR（95%CI）]=0.86（0.69-0.99）]，感染HIV后生活的自我效能感[AOR（95%CI）=0.79（0.66-0.93）]，保密协议[AOR（95%CI）=0.74（0.58-0.93）]，开始检测时选择退出权的感知明确性[AOR（95%CI）=0.74（0.56-0.98）]以及患者对疑似HIV检测选择性启动的看法[AOR（95%CI）=0.54（0.41-0.73）]。另一方面，近期检测报告[AOR（95%CI）=3.82（1.71-8.55）]和检测准备不足的感知[AOR（95%CI）=1.86（1.57-2.21）]加剧了对PIHT的拒绝。接触检测提示显著降低了感知障碍[β（P）=-0.05（0.037）]。
患者的感知障碍：检测准备不足的感觉强烈加剧了拒绝检测的情况。提高感染HIV后生活的自我效能感以及存在HIV检测提示将减少准备不足的情况，并防止拒绝PIHT。
