Of the total of 438 clients requested for interview, 427 clients (97.5% respondent rate) aged between 15 to 64 years were interviewed. The mean age of the study participants was 28.84 years with a standard deviation of ±10.29. Among all clients participated, 31.1% (133) were males and 68.9% (294) were females. (Table )
Socio demographic characteristics of clients treated at Dessie health facilities, North East Ethiopia, December/2008(N = 427)
The majority, 34% (145/427), of clients' reason for visit was for medical treatment. Clients demanding family planning and gynecological care comprised 29.6% (126/427) of the visitors. Clients who needed emergency treatment were 13.3% (57/427) and who came for follow-up were 9.1% (39/427). Clients who came for ANC were 9.1% (39/427).
From all clients who came to the health facilities, only 24.4% (104/427) were asked by service providers whether they had previously made HIV test or not. Moreover, the clients' risk for HIV infection was inquired by service providers for 23.2% (99/427) clients. Initiation for HIV test through questioning willingness of clients for HIV test was not conducted by service providers for 76.1% (325/427) of clients. Among 23.9% (102/427) clients who were asked for their willingness by service providers, 67.6% (69/102) were willing to have the HIV test. Among non-willing clients, the major reason, 56.2% (18/32), for not willing was that they have no risk or they know they would be HIV negative. The other important reason, 31.3% (10/32), was that they were not ready for the test and they wanted more time to discuss with their partners.
In order to assess the past lost opportunities for HIV testing, clients' previous one year visit to any health facilities was asked. Most clients 73.3% (313/427) visited health facilities at least once in the previous one year where they could get counseling and testing for HIV. During this time, the large segment of clients, 46.9% (147/313), visited the health facilities four times or above. From the total clients who at least visited health facilities once in the past one year, 75.2% (228/303) were not initiated for HIV testing. However, a good number of them, 22.1% (67/303), suspected themselves of HIV infection when they felt ill.
Levels of self risk perception of clients for HIV infection were investigated in order to explore clients' insights against their actual risk behaviors for HIV infection. Accordingly, the greater part of clients, 72.8% (311/427), perceived themselves as having no risk for HIV infection. The majority, 73.6% (229/311), thought so because they were living in one to one relationship with their partners while 4.2% (13/311) thought so because of their use of condom. Of the total clients, 23.7% (101/427) perceived themselves as having high risk or some risk for HIV infection.
When previous HIV test status of clients was assessed, a great part of clients, 42.2% (180/427), had never tested for HIV in their life and 29.0% (124/427) had only tested once. Out of all the tested clients, the majority, 50.2% (124/247), had only tested once. The greater part, 73.8% (180/244), of clients had made their tests within the last one year. The mean last HIV test duration was found to be 12.95 months with standard deviation of ±17.04 months. Among the clients who ever tested for HIV, only 28.7% (70/244) were tested through opt out approach. While the greater part, 88.1% (215/244), were tested through VCT approach. A large number of clients, 42.2% (95/225), who started sexual intercourse and ever tested for HIV had never tested with their partners. All clients were asked by interviewer for their willingness for HIV test at the time of interview and 76.3% (326/427) were willing to have HIV test. Among 326 clients who showed willingness for HIV test at the time of interview, 37.7% (123/326) were ready to have the HIV test on the same day. However, HIV test was actually offered at the time of interview for 91.1% (112/123) clients who accepted the test. The major, 54.4% (155/285), reason of clients who were not willing for HIV test at the time of interview was either they were not ready or they wanted to discuss with their partner.
Among the clients tested for HIV by data collecting trained counselors at the time of interview, 86.6% (97/112) were HIV negatives while 13.4% (15/112) were HIV positives. Of HIV positive clients, 40.0% (6/15) were not willing to disclose their results to their partners. Moreover, half of the clients, 50.0% (3/6), who were not willing to tell to their partners were also refused to disclose their results to no other person.
Investigating the missed opportunities for earlier HIV testing and diagnosis were the main objectives of why this study was conducted. (Figure ). Among all clients coming to health facilities, the majority, 76.1% (325/427), missed the opportunities for HIV testing level 1. Of all not initiated clients by service providers, 80.0% (260/325) became willing when initiated by interviewers. The majority, 60.9% (260/427), of clients who were not initiated by service provider were willing to have HIV test when initiated by interviewers; which was the second level of missed opportunities for HIV testing. Among clients who became willing, 43.0% (112/260) actually tested for HIV. This made the third level of missed opportunities for HIV testing 26.2% (112/427). The sever degree of lost opportunities for earlier HIV testing occurred for 13.4% (15/112) of the tested clients; when clients failed to be initiated by service provider, but later initiated by interviewer, tested and found to be HIV positive. The fourth level of missed opportunities for earlier HIV testing occurred in 3.5% (15/427) of clients coming to the health facilities. Out of all clients, health professionals were able to diagnose 3.2% (14/427) HIV positive clients missing the diagnosis of 3.5% (15/427). As a result, the greater part of HIV positive clients, 51.7% (15/29), lost the opportunities of being diagnosed their sero status by service providers. (Table )
Schematic drawing showing the proportion of missed opportunities for HIV testing in different levels.
Missed opportunities for earlier HIV testing and diagnosis of clients treated at Dessie health facilities, North East Ethiopia, Dec 2008(N = 427)
The association of missed opportunities for HIV testing level 1 with socio demographic variables was assessed using bi-variate and multivariate analysis. Accordingly, sex, marital status, and religion of clients had no association with the lost opportunities for HIV testing. Family monthly income had association with the lost opportunities for HIV test in bivariate analysis, whereas educational status and occupation of clients had association in both bivariate and multivariate analysis. Individuals with educational status between 11-12 grade lost the opportunities for HIV testing 3.02 times more likely compared to the clients with no formal education. OR 3.02(1.130-8.084) (P = 0.028). However, government employee had 0.227 times less likely of missing the opportunities for HIV testing compared to the students. OR 0.227(.064 - .806) (P = .022) (Table )
Missed opportunities for HIV testing vs. socio economic characteristics of clients attending health facilities at Dessie town, North East Ethiopia, December 2008