Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries.
OBJECTIVE
Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested.


METHODS
Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses.


RESULTS
Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested.


CONCLUSIONS
Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Carla Makhlouf
CM
Obermeyer
Institute for Global Health, University College London, London, UK.
Melissa
M
Neuman
University of Amsterdam, Amsterdam, The Netherlands.
Anita
A
Hardon
Institut de Recherches pour le Développement, Dakar, Senegal.
Alice
A
Desclaux
Makerere University School of Public Health, Kampala, Uganda.
Rhoda
R
Wanyenze
Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso.
Odette
O
Ky-Zerbo
National AIDS Control Program, Nairobi, Kenya.
Peter
P
Cherutich
Reach Trust, Lilongwe, Malawi.
Ireen
I
Namakhoma
D015492:AIDS Serodiagnosis / Q000191:economics / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002050:Burkina Faso; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007630:Kenya; D008295:Malawi; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D012923:Social Class; D014454:Uganda; D055815:Young Adult
HIV; access; provider-initiated testing and counselling; socio-economic; sub-Saharan Africa; testing; voluntary counselling and testing