Socio‐economic determinants of HIV testing and counselling: a comparative study in four African countries
Research indicates that individuals tested for HIV have higher socio‐economic status than those not tested, but less is known about how socio‐economic status is associated with modes of testing. We compared individuals tested through provider‐initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested.
Cross‐sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi‐country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio‐economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand‐alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother‐to‐child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses.
Higher socio‐economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio‐economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested.
Provider‐initiated modes of testing make testing accessible to individuals from lower socio‐economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio‐economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.
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Document Type: Research Article
Publication date: September 1, 2013