Predictors of HIV-test utilization in PMTCT among antenatal care attendees in government health centers: institution-based cross-sectional study using health belief model in Addis Ababa, Ethiopia, 2013

BACKGROUND: Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is the most dramatic epidemic of the century that has claimed over two decades more than 3 million deaths. Sub-Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Mother-to-child transmission of HIV is responsible for 20% of all HIV transmissions. With no preventive interventions, 50% of HIV infections are transmitted from HIV-positive mothers to newborns. HIV-testing is central to prevent vertical transmission. Despite, awareness campaigns, prevention measures, and more recently, promotion of antiviral regimens, the prevalence of cases and deaths is still rising and the prevalence of prevention of mother-to-child transmission (PMTCT) voluntary counseling test (VCT) use remains low. This study identifies predictors and possible barriers of HIV-testing among antenatal care attendees based on the health belief model (HBM) in Addis Ababa, Ethiopia. METHODS: The study was an institution-based cross-sectional survey conducted from September 1 to September 30, 2013. A total of 308 individuals were interviewed using structured questionnaires adopted and modified from similar studies. Data were collected through face-to-face interviews. A logistic regression was used to identify factors associated with HIV-test use. RESULTS: In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection, wherein only 51.8% tested for HIV; among the married, only 84.1% and among the gestational age of third trimester, 34.1% mothers tested for HIV. Based on the HBM, failure to use PMTCT-HIV-test was related to its perceived lack of net benefit (adjusted odds ratio [AOR] =0.34, confidence interval [CI] [0.19–0.58], P<0.001), but interviewees with high perceived self-efficacy were 1.9 times more likely to use HIV-test (AOR =1.90, CI [1.09–3.33], P<0.05). CONCLUSION AND RECOMMENDATION: This study identifies perceived self-efficacy and perceived lack of net benefit as the main predictors of PMTCT-HIV-test use. Hence, prevention strategies based on increasing perceived risk, perceived severity, or adequate knowledge about HIV/AIDS may not be sufficient to induce PMTCT-HIV-test. These data will be useful in designing and improving HIV/AIDS prevention programs and focused health communication and counseling strategies in relation to PMTCT in Ethiopia.