title: HIV testing service awareness and service uptake among female heads of household in rural Mozambique: results from a province-wide survey.
abstract: BACKGROUND
  HIV voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, particularly in remote rural settings. We sought to identify factors associated with service awareness and service uptake of VCT among female heads of household in rural Zambézia Province of north-central Mozambique which is characterized by high HIV prevalence (12.6%), poverty, and suboptimal health service access and utilization.
  
  
  METHODS
  Our population-based survey of female heads of household was administered to a representative two-stage cluster sample using a sampling frame created for use on all national surveys and based on census results. The data served as a baseline measure for the Ogumaniha project initiated in 2009. Survey domains included poverty, health, education, income, HIV stigma, health service access, and empowerment. Descriptive statistics and logistic regression were used to describe service awareness and service uptake of VCT.
  
  
  RESULTS
  Of 3708 women surveyed, 2546 (69%) were unaware of available VCT services. Among 1162 women who were aware of VCT, 673 (58%) reported no prior testing. In the VCT aware group, VCT awareness was associated with higher education (aOR = 2.88; 95% CI = 1.61, 5.16), higher income (aOR = 1.41, 95% CI = 1.06, 1.86), higher numeracy (aOR = 1.05, CI 1.03, 1.08), more children < age 5 in the home (aOR = 1.53; 95% CI = 1.07, 2.18), closer proximity to a health facility (aOR = 1.05; 95% CI = 1.03, 1.07), and mobile phone ownership (aOR = 1.37; 95% CI = 1.03, 1.84) (all p-values < 0.04). Having a higher HIV-associated stigma score was the factor most strongly associated with being less likely to test. (aOR = 0.41; 95% CI = 0.23, 0.71; p<0.001).
  
  
  CONCLUSIONS
  Most women were unaware of available VCT services. Even women who were aware of services were unlikely to have been tested. Expanded VCT and social marketing of VCT are needed in rural Mozambique with special attention to issues of community-level stigma reduction.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA. hnpaulin@gmail.com.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Paulin
authors.affiliation: Department of Biostatistics, Nashville, TN, USA. meridith.blevins@Vanderbilt.Edu.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. meridith.blevins@Vanderbilt.Edu.
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA. john.r.koethe@Vanderbilt.Edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Koethe
authors.affiliation: Department of Biostatistics, Nashville, TN, USA. nicole.l.hinton@Vanderbilt.Edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hinton
authors.affiliation: Department of Preventive Medicine, Nashville, TN, USA. lmevaz@gmail.com.|Friends in Global Health (FGH), Maputo, Mozambique. lmevaz@gmail.com.|Save the Children, Washington, D.C., USA. lmevaz@gmail.com.
authors.forename: Lara M E
authors.initials: LM
authors.lastname: Vaz
authors.affiliation: Department of Preventive Medicine, Nashville, TN, USA. avedoce@gmail.com.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. avedoce@gmail.com.
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Vergara
authors.affiliation: Department of Preventive Medicine, Nashville, TN, USA. abraham.mukolo@Vanderbilt.Edu.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. abraham.mukolo@Vanderbilt.Edu.
authors.forename: Abraham
authors.initials: A
authors.lastname: Mukolo
authors.affiliation: Friends in Global Health (FGH), Maputo, Mozambique. Elisee.Ndatimana@fgh.org.mz.
authors.forename: Elisée
authors.initials: E
authors.lastname: Ndatimana
authors.affiliation: Department of Pediatrics, Nashville, TN, USA. troy.moon@Vanderbilt.Edu.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. troy.moon@Vanderbilt.Edu.|Friends in Global Health (FGH), Maputo, Mozambique. troy.moon@Vanderbilt.Edu.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Moon
authors.affiliation: Department of Pediatrics, Nashville, TN, USA. sten.vermund@Vanderbilt.Edu.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. sten.vermund@Vanderbilt.Edu.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA. william.wester@Vanderbilt.Edu.|Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. william.wester@Vanderbilt.Edu.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009073:Mozambique; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D012424:Rural Population; D057545:Social Stigma; D012959:Socioeconomic Factors; D055815:Young Adult