title: Factors influencing the uptake of voluntary HIV counseling and testing in rural Ethiopia: a cross sectional study.
abstract: BACKGROUND
  Voluntary counseling and testing (VCT) has been one of the key policy responses to the HIV/AIDS epidemic in Ethiopia. However, the utilization of VCT has been low in the rural areas of the country. Understanding factors influencing the utilization of VCT provides information for the design of context based appropriate strategies that aim to improve utilization. This study examined the effects of socio-demographic and behavioral factors, and health service characteristics on the uptake of VCT among rural adults in Ethiopian.
  
  
  METHODS
  This study was designed as a cross sectional study. Data from 11,919 adults (6278 women aged 15-49 years and 5641 men aged 15-59 years) residing in rural areas of Ethiopia who participated in a national health extension program evaluation were used for this study. The participants were selected from ten administrative regions using stratified multi-stage cluster sampling. Multivariate logistic regression analysis was performed accounting for factors associated with the use of VCT service.
  
  
  RESULTS
  Overall, men (28 %) were relatively more likely to get tested for HIV than women (23.7 %) through VCT. Rural men and women who were young and better educated, who perceived having small risk of HIV infection, who had comprehensive knowledge, no stigmatization attitude and discussed about HIV/AIDS with their partner, and model-family were more likely to undergone VCT. Regional state was also strongly associated with VCT utilization in both men and women. Rural women who belonged to households with higher socio-economic status, non-farming occupation, female-headed household and located near health facility, and who visited health extension workers and participated in community conversation were more likely to use VCT. Among men, agrarian lifestyle was associated with VCT use.
  
  
  CONCLUSIONS
  Utilization of VCT in the rural communities is low, and socio-economic, behavioral and health service factors influence its utilization. For increasing the utilization of VCT service in rural areas, there is a need to target the less educated, women, poor and farming families with a focus on improving knowledge and reducing HIV/AIDS related stigma. Strategy should include promoting partner and community conversations, accelerating model-family training, and using alternative modes of testing.
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Kebele 06, H No 447, PO Box 664 code 1250, Bole Sub City, Addis Ababa, Ethiopia. hailaycnhde@ethionet.et.|The Earth Institute, Columbia University, 475 Riverside Drive, Suite 401, New York, NY, 10025, USA. hailaycnhde@ethionet.et.
authors.forename: Hailay D
authors.initials: HD
authors.lastname: Teklehaimanot
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Kebele 06, H No 447, PO Box 664 code 1250, Bole Sub City, Addis Ababa, Ethiopia. thawash@ei.columbia.edu.|The Earth Institute, Columbia University, 475 Riverside Drive, Suite 401, New York, NY, 10025, USA. thawash@ei.columbia.edu.
authors.forename: Awash
authors.initials: A
authors.lastname: Teklehaimanot
authors.affiliation: College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia. mekonnenyohannes@yahoo.co.uk.
authors.forename: Mekonnen
authors.initials: M
authors.lastname: Yohannes
authors.affiliation: Center for National Health Development in Ethiopia, Columbia University, Kebele 06, H No 447, PO Box 664 code 1250, Bole Sub City, Addis Ababa, Ethiopia. dawit2007@gmail.com.
authors.forename: Dawit
authors.initials: D
authors.lastname: Biratu
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012424:Rural Population; D057545:Social Stigma; D012959:Socioeconomic Factors; D035141:Voluntary Programs / Q000706:statistics & numerical data*; D055815:Young Adult