Acceptability Of The Opt-Out Counselling And Test For Pregnant Womenin The Wa Municipality; A Facility Based Study.

ABSTRACT

Background/Objectives: Mother-to-child transmission (MTCT) of HIV is a major contributor of paediatric HIV infection. HIV counselling and testing during pregnancy constitutes an important step in prevention. Acceptability of HIV test among women who voluntarily request to know their HIV status (opt-in) has been found to be rather low and yet the number of pregnant women with HIV in the Wa Municipality has almost doubled, from 3.2 per cent in 2006 to 5.8 per cent in 2007. To address this problem, HIV counselling and testing is routinely offered to all pregnant women who seek antenatal care, with an option to opt-out if they don‟t want to test. This study was conducted to determine the acceptability of the opt-out test as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Methods: The study was a facility based cross-sectional study involving 270 pregnant women from two health facilities. Pregnant women were randomly selected through a balloting process and a questionnaire administered to consenting individuals. Results: More than half, 58.5 per cent (158) of the study sample tested for HIV in the current pregnancy. Interestingly, of those who had not tested for HIV, 61 per cent (68) did not test because the test was not offered to them at antenatal care (ANC). Of these 82.4 per cent (56) expressed willingness to get tested if offered an HIV test. More than half of the respondents 58.6 per cent (157) expressed fears that the opt-out test could prevent women from seeking antenatal care; however 88.1 per cent (37) of the women who refused HIV testing were still willing to attend ANC. Awareness of the opt-out policy was high among the respondents 81.9 per cent (221) and majority of the women 90.7 per cent (245) were in favour of the opt-out policy. Despite the high knowledge of respondents on MTCT of HIV through pregnancy 79.4 per cent (177), knowledge of HIV transmission during labour 24.2 per cent (54) and breastfeeding 19.3 per cent (43) was poor. A large proportion of the respondents were however aware of the existence of a special drug to prevent MTCT 75.6 per cent (115).

Conclusion: The opt-out testing policy is acceptable to pregnant women in the Wa Municipality and awareness on the policy is high. Pregnant women in the Municipality are still willing to attend ANC even if they know they would be offered

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an HIV test. An increase in the number of trained counsellors would ensure that every pregnant woman who visits the facility is offered the test.