Individual, household and community factors associated with HIV test refusal in rural Malawi.


Kranzer, K; McGrath, N; Saul, J; Crampin, AC; Jahn, A; Malema, S; Mulawa, D; Fine, PE; Zaba, B; Glynn, JR; (2008) Individual, household and community factors associated with HIV test refusal in rural Malawi. Tropical medicine & international health , 13 (11). pp. 1341-50. ISSN 1360-2276 DOI: 10.1111/j.1365-3156.2008.02148.x

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Abstract

OBJECTIVE: To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi. METHODS: HIV counselling and testing was offered to individuals aged 18-59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables. RESULTS: Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think. CONCLUSION: Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: ?? XALP ??
Centre for Maternal, Reproductive and Child Health (MARCH)
Population Studies Group
MEIRU
PubMed ID: 18983282
Web of Science ID: 261085800003
URI: http://researchonline.lshtm.ac.uk/id/eprint/6727

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