Teklehaimanot Hailay D, Teklehaimanot Awash, Yohannes Mekonnen, Biratu Dawit
Center for National Health Development in Ethiopia, Columbia University, Kebele 06, H No 447, PO Box 664 code 1250, Bole Sub City, Addis Ababa, Ethiopia.
The Earth Institute, Columbia University, 475 Riverside Drive, Suite 401, New York, NY, 10025, USA.
BMC Public Health. 2016 Mar 8;16:239. doi: 10.1186/s12889-016-2918-z.
Voluntary counseling and testing (VCT) has been one of the key policy responses to the HIV/AIDS epidemic in Ethiopia. However, the utilization of VCT has been low in the rural areas of the country. Understanding factors influencing the utilization of VCT provides information for the design of context based appropriate strategies that aim to improve utilization. This study examined the effects of socio-demographic and behavioral factors, and health service characteristics on the uptake of VCT among rural adults in Ethiopian.
METHODS/DESIGN: This study was designed as a cross sectional study. Data from 11,919 adults (6278 women aged 15-49 years and 5641 men aged 15-59 years) residing in rural areas of Ethiopia who participated in a national health extension program evaluation were used for this study. The participants were selected from ten administrative regions using stratified multi-stage cluster sampling. Multivariate logistic regression analysis was performed accounting for factors associated with the use of VCT service.
Overall, men (28 %) were relatively more likely to get tested for HIV than women (23.7 %) through VCT. Rural men and women who were young and better educated, who perceived having small risk of HIV infection, who had comprehensive knowledge, no stigmatization attitude and discussed about HIV/AIDS with their partner, and model-family were more likely to undergone VCT. Regional state was also strongly associated with VCT utilization in both men and women. Rural women who belonged to households with higher socio-economic status, non-farming occupation, female-headed household and located near health facility, and who visited health extension workers and participated in community conversation were more likely to use VCT. Among men, agrarian lifestyle was associated with VCT use.
Utilization of VCT in the rural communities is low, and socio-economic, behavioral and health service factors influence its utilization. For increasing the utilization of VCT service in rural areas, there is a need to target the less educated, women, poor and farming families with a focus on improving knowledge and reducing HIV/AIDS related stigma. Strategy should include promoting partner and community conversations, accelerating model-family training, and using alternative modes of testing.
自愿咨询检测（VCT）一直是埃塞俄比亚应对艾滋病毒/艾滋病疫情的关键政策措施之一。然而，该国农村地区VCT的利用率一直很低。了解影响VCT利用率的因素可为旨在提高利用率的基于具体情况的适当策略设计提供信息。本研究调查了社会人口学和行为因素以及卫生服务特征对埃塞俄比亚农村成年人接受VCT的影响。
方法/设计：本研究设计为横断面研究。本研究使用了参与国家卫生推广计划评估的11919名居住在埃塞俄比亚农村地区的成年人（6278名15至49岁的女性和5641名15至59岁的男性）的数据。参与者是通过分层多阶段整群抽样从十个行政区中选取的。进行多变量逻辑回归分析以考虑与使用VCT服务相关的因素。
总体而言，通过VCT进行艾滋病毒检测的男性（28%）比女性（23.7%）相对更有可能接受检测。年轻且受教育程度较高、认为感染艾滋病毒风险较小、拥有全面知识、没有污名化态度且与伴侣讨论过艾滋病毒/艾滋病的农村男性和女性，以及模范家庭更有可能接受VCT。地区州也与男性和女性的VCT利用率密切相关。属于社会经济地位较高家庭、非农业职业、女性为户主的家庭且位于卫生设施附近、拜访过卫生推广工作者并参与社区对话的农村女性更有可能使用VCT。在男性中，农业生活方式与VCT使用相关。
农村社区VCT的利用率较低，社会经济、行为和卫生服务因素影响其利用率。为提高农村地区VCT服务的利用率，有必要针对受教育程度较低者、女性、贫困家庭和务农家庭，重点是提高知识水平和减少与艾滋病毒/艾滋病相关的污名化。策略应包括促进与伴侣和社区的对话、加快模范家庭培训以及使用替代检测方式。
