title: Individual-level predictors for HIV testing among antenatal attendees in Lusaka, Zambia.
abstract: Despite the availability of antiretroviral prophylaxis, roughly one-fifth of public-sector antenatal patients decline HIV testing in Lusaka, Zambia. We administered a survey to determine individual-level predictors of HIV testing. Of 1064 antenatal attendees approached after pretest counseling, 1060 (>99%) participated. Of these, 686 (65%) agreed to HIV testing. On bivariate analysis controlling for clinic of attendance, women younger than 20 years old (adjusted RR [ARR] = 1.14), unmarried (ARR = 1.14), pregnant for the first time (ARR = 1.14), with lower educational attainment (ARR = 1.15), and with lower income (ARR = 1.14) were all more likely to undergo testing. When HIV risk was considered, women with low self-perceived risk were most likely to undergo HIV testing. As risk perception increased, likelihood for testing decreased (P for trend < 0.001). Although not statistically predictive, we identified prevalent community beliefs that may act as barriers to testing. Because individual-level characteristics were only weakly predictive of HIV testing, future work should concentrate on community-level factors.
authors.affiliation: University of California School of Medicine, San Francisco, California, USA. sara.thierman@ucsf.edu
authors.forename: Sara
authors.initials: S
authors.lastname: Thierman
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Jens W
authors.initials: JW
authors.lastname: Levy
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
mesh_terms: D000293:Adolescent; D000328:Adult; D003151:Community Health Centers; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D012306:Risk; D012959:Socioeconomic Factors; D015024:Zambia