Determinants For Refusal Of Provider Initiated HIV Testing And Counseling Among Adult Opd Clients In Kachabira District Health Centers, South Ethiopia: Institution Based Unmatched Case Control Study

Abstract

Background: Provider initiated HIV testing and counseling serve as a gateway to HIV prevention, early access to treatment, Care and Support interventions. However, PITC refusal rate tends to be high in OPD setting compared to other clinical service delivery areas. The objective of this study was to assess determinants for refusal of PITC among clients attending adult OPD services in Kachabira District Health Centers, 2015. Method: Institution based unmatched case control study design was conducted from Mar 25 to Apr 24/2015. A total of 503 OPD clients (116 cases and 387 controls) were enrolled from five health centers. Cases were OPD clients who refused PITC and controls were OPD clients who accepted PITC. Data were collected by using face to face interview and entered by EPi info version 6 and transported to SPSS version 20 for analysis. Backward Stepwise LR method was used to analyze the data and Strength of the association was assessed using odds ratio with 95% CI. Results: only 25.3% of clients were ever tested through health care provider initiation approach. Sex, poor access to PITC information from health workers, lack of comprehensive knowledge and self-risk perception to HIV infection were found to be statistically significant predictors for refusal of PITC with AOR (95%CI) of 3.1(1.55-6.32), 3.2(1.59-6.58), 2.2(1.16-4.50) and 3.5(1.46-8.26) respectively. Moreover, thinking self not at risk for HIV infection (77.6%), lack of interest and unpreparedness (67%), ever tested before (66.4%) and no sure of confidentiality (16.4%) were the main reasons for refusal of PITC. Conclusion: Generally, the number of clients ever tested by provider initiation was low. Lack of comprehensive knowledge and risk perception to HIV infection, poor access to PITC information from health workers are main factors for refusal of PITC service.