Predictors of repeat HIV testing among voluntary counseling and testing center clients in Uganda Restricted; Files Only

Hundley, Lee (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/qv33rx529?locale=en
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Abstract

Abstract

Predictors of repeat HIV testing among voluntary counseling and testing center clients in Uganda

By Lee Hundley

Background: Regular engagement in HIV testing and counseling (HCT) is known to lead to improved behavioral and physical health outcomes at the individual and population level. However, more research is needed to determine motivators of repeat testing for varied population subgroups in order to effectively target testing outreach efforts to link more people to testing and treatment.

Objective: The purpose of this analysis was to assess predictors of repeat HIV testing among clients of the Mildmay testing and counseling center in Kampala, Uganda.

Methods: Data was collected as part of routine procedures at the Mildmay HCT center between 2011 and 2013. Descriptive frequencies were assessed to compare demographic, behavioral, and other relevant factors among male and female repeat testers versus first-time testers. Bivariate and multivariate logistic regression analyses were conducted to examine the association between variables of interest and repeat HIV testing among males and females. Final multivariate models were selected using backwards elimination.

Results: Of the 12,233 participants, 7,571 (61.9%) had previously tested for HIV at the time of the survey. Among males, 39.2% of first-time were HIV-positive compared to 25.1% of repeat testers. Female first-time testers had an HIV prevalence of 54.5% compared to 39.6% of repeat testers. Bivariate analysis revealed that people reporting that they were "extremely likely" to become infected in the next year had the lowest likelihood of repeat testing (men: aPR 0.62, 95% CI 0.55-0.69; women: aPR 0.70, 95% CI 0.66-0.76). Among both men and women, predictors of repeat HIV testing included high education level, being married, and safe drinking behavior. Age was associated with HIV testing history among HIV-negative participants but not among HIV-positive among both men and women.

Conclusion: The analysis revealed that HIV testing behaviors may vary by several demographic and behavioral factors, as well as other individual characteristics and beliefs. This indicates the need for more individualized testing outreach efforts in order to reach groups least likely to test for HIV including at-risk young people, those who perceive themselves to be at high risk of infection, and individuals who do not know the HIV status of their last partner.

Table of Contents

Introduction....................................................................................................................... 1

Methods.............................................................................................................................. 4

Data collection setting and design.......................................................................... 4

Data collection procedures..................................................................................... 4

Variables and measures.......................................................................................... 5

Data analysis ......................................................................................................... 8

Results ............................................................................................................................. 12

Demographic characteristics................................................................................ 12

Risk factors, behaviors and perceptions............................................................... 13

Biomarkers............................................................................................................ 14

Bivariate analysis................................................................................................. 14

Multivariate analysis............................................................................................ 16

Discussion........................................................................................................................ 20

Limitations............................................................................................................ 25

Conclusions........................................................................................................... 26

References........................................................................................................................ 28

Tables............................................................................................................................... 33

Appendices....................................................................................................................... 57

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