Background
Voluntary counseling and Testing in PMTCT has an important role to play Namibia’s
response to the HIV epidemic among women of childbearing age. In fact, the
cornerstone of a successful PMTCT program is a high rate of HIV testing among
pregnant women in order to identify who are positive and at risk of transmitting the
virus to their babies. For effective PMTCT, there is a need to integrate VCT into
antenatal care (ANC) and maternity care, rather than providing it through a separate
VCT unit. There is also a need to understand that counseling and HIV testing must be
confidential and voluntary, and the quality of these services have a high impact on the
uptake of VCT services
Aim
The aim of this study was to assess VCT and factors that contribute to its low uptake
among pregnant women affecting ANC clinics in the public sector. The study
determined the quality of the counseling and testing provided; assessed the
knowledge, attitude and practice (KAP) of women regarding the VCT/PMTCT
services and identified barriers that prevent pregnant women from utilizing VCT
services.
Method
A cross-sectional descriptive study design was used in which data was collected using
a structured questionnaire administered in a face to face interviews. The study was
conducted in Tsumeb district, Namibia at three clinics; Tsumeb, Lombard and
Oshivelo clinics between 12th April and 15th June 2006 and the study sample
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comprised of one hundred and fifty (150) pregnant women aged <15- 49+ years.
Informed consent was obtained from each participant prior to commencing the
interview. Closed-ended questions were analyzed using nominal scales into mutually
exclusive categories and frequencies. Open-ended questions responses were analyzed
using post-coding prior to entering data.
Results
In contrast to the expected results, the uptake of Voluntary Counseling and HIV
Testing in PMTCT by pregnant women was found to be high across all three study
sites.
It was evident from the findings that the pregnant women were aware of HIV
transmission and protection and they knew about the VCT/HIV services available at
the clinics, as well as treatment and care provided in PMTCT program. The clinics
are accessible and available to these particular women utilizing the services.
Participants said they appreciated the benefit of enrolling in PMTCT although they
identified factors that influence VCT/PMTCT uptake to include; fear of stigma,
discrimination and rejection from families and community members. Fear for
confidentiality about test results or status, attitudes of health workers or community
counselors were also raised as well as concerns about lack of rapid test at some
clinics.
Conclusions
Increased uptake of VCT services by pregnant women may be attributed to the
development of counseling services and increased availability of rapid tests at the
study clinics by the Namibian Health and Social Services. A high knowledge and
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understanding of HIV and VCT services by pregnant women also probably
contributed.
Recommendations
Recommendations include continuing development of HIV and VCT services and
roll-out to all sites in Namibia, and community-focused and culturally appropriate
awareness raising about HIV, in order to address significant issues around stigma and
discrimination.