Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-23T11:46:59.970Z Has data issue: false hasContentIssue false
  • English
  • Français

INDIVIDUAL- AND COMMUNITY-LEVEL DETERMINANTS OF ANTENATAL HIV TESTING IN ZIMBABWE

Published online by Cambridge University Press:  06 March 2018

Martin Marufu Gazimbi  and
Monica Akinyi Magadi
Martin Marufu Gazimbi*
Affiliation:
School of Education and Social Sciences, University of Hull, UK
Monica Akinyi Magadi
Affiliation:
School of Education and Social Sciences, University of Hull, UK
*
1Corresponding author. Email: m.gazimbi@2013.hull.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

This study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women’s economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.

Type
Research Article
Information
Journal of Biosocial Science , Volume 51 , Issue 2 , March 2019 , pp. 203 - 224
Copyright
Copyright © Cambridge University Press, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmed, S., Creanga, A. A., Gillespie, D. G. & Tsui, A. O. (2010) Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One 5, 6.Google Scholar
Alam, N., Hajizadeh, M., Dumont, A. & Fournier, P. (2015) Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis. PLoS One 10, 4.Google Scholar
Andersen, R. M. (1995) Revisiting the behavioural model and access to medical care: does it matter? Journal of Health and Social Behaviour 36, 1–10.Google Scholar
Angotti, N., Bula, A., Gaydosh, L., Kimch, E. Z., Thornton, R. L. & Yeatman, S. E. (2009) Increasing the acceptability of HIV counselling and testing with three C’s: Convenience, Confidentiality and Credibility. Social Science & Medicine 68(12), 2263–2270.Google Scholar
Aremu, O., Lawoko, S. & Dalal, K. (2011) Neighbourhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Women’s Health 3, 167–174.Google Scholar
Asefa, A. & Beyene, H. (2013) Awareness and knowledge on timing of mother-to-child transmission of HIV among antenatal care attending women in southern Ethiopia: a cross sectional study. Reproductive Health 10, 66.Google Scholar
Babalola, S. & Fatusi, A. (2009) Determinants of use of maternal health services in Nigeria – looking beyond individual and household factors. BMC Pregnancy and Childbirth 9, 43–103.Google Scholar
Birhane, T., Tessema., G., Alene, A. & Dadi, A. (2015) Knowledge of pregnant women on mother-to-child transmission of HIV in Meket District, northeast Ethiopia. Journal of Pregnancy 4, 1–6.Google Scholar
Buzdugan, R., McCoy, S. I., Webb, K., Mushavi, A., Mahomva, A., Padian, N. S. & Cowan, F. M. (2015) Facility-based delivery in the context of Zimbabwe’s HIV epidemic – missed opportunities for improving engagement with care: a community-based serosurvey. BMC Pregnancy and Childbirth 15, 338.Google Scholar
Byamugisha, R., Tumwine, J., Ndeezi, G., Karamagi, C. & Tylleska, T. (2010) Attitudes to routine HIV counselling and testing, and knowledge about prevention of mother to child transmission of HIV in eastern Uganda: a cross-sectional survey among antenatal attendees. Journal of the International AIDS Society 13, 52.Google Scholar
Catania, J., Kegeles, S. & Coates, T. (1990) Towards an understanding of risk behavior: an AIDS Risk Reduction Model (ARRM). Health Education Quarterly 17(1), 53–72.Google Scholar
Chandisarewa, W., Chibanda, L. S., Chirapa, E., Miller, A., Simoyi, M., Mahomva, A. et al. (2007) Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Publication: Bulletin of the World Health Organization, 06-035188; doi: 10.2471/BLT.06.035188.Google Scholar
Chevo, T. & Bhatasara, S. (2012) HIV and AIDS programmes in Zimbabwe: implications for the health system. Journal of Perinatology 30(11), 763.Google Scholar
Chitalu, M. C. C. & Koch, S. F. (2015) Utilisation of focused ANC in Zambia: examining individual and community level factors using a multilevel analysis. Health Policy and Planning 30(10), 78–87.Google Scholar
Demissie, A., Deribew, A. & Abera, A. (2009) Determinants of acceptance of voluntary HIV testing among antenatal clinic attendees at Dil Chora Hospital, Dire Dawa, East Ethiopia. Ethiopian Journal for Health Development 23(2), 141–147.Google Scholar
Denison, J. A., McCauley, A. P., Dunnett-Dagg, W. A., Lungu, N. & Sweat, M. D. (2008) The HIV testing experiences of adolescents in Ndola, Zambia: do families and friends matter? AIDS Care 20(1), 101–105.Google Scholar
Fotso, J. C., Ezeh, A., Madise, N., Ziraba, A. & Ogollah, R. (2009) What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Maternal Child Health Journal 13(1), 130–137.Google Scholar
Goldstein, H. (2003) Multilevel Statistical Models, 3rd edition. Arnold, London.Google Scholar
Granich, R., Gupta, S, Hersh, B. et al. (2015) Trends in AIDS deaths, new infections and ART coverage in the top 30 countries with the highest AIDS mortality burden; 1990–2013. PLoS One 10, e0131353.Google Scholar
Gustav, A. S. P., Odberg Pettersson, K., Sandberg, J., Kabakyenga, J. & Agardh, A. (2014) Associations between mass media exposure and birth preparedness among women in southwestern Uganda: a community-based survey. Global Health Action 7(9), 1–9.Google Scholar
Hardon, A., Vernooij, E., Bongololo-Mbera, G., Cherutich, P., Desclaux, A., Kyaddondo, D. et al. (2012) Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries. BMC Public Health 12, 26.Google Scholar
Heemelaar, S., Habets, N., Makukuka, Z. & Van Den Akker, T. (2014) Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia. Tropical Medicine & International Health 20(3), 277–283.Google Scholar
Houweling, T. A., Ronsmans, C. & Campbell, O. (2007) Huge poor rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization 85, 745–754.Google Scholar
Iriyana, S., Nakahara, S., Jimba, M. et al. (2007) AIDS health beliefs and intention for sexual severity and susceptibility. Science Direct 121(1), 64–72.Google Scholar
Jayleen, K. L. G., Asaolu, I. O., Center, E. K., Gibson, S. C., Wightman, P., Echezona, E. & Ehiri, J. E. (2016) Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study. Journal of the International AIDS Society 19, 20605.Google Scholar
Jesmin, S. S., Chaudhuri, S. & Abdullah, S. (2013) Educating women for HIV prevention: does exposure to mass media make them more knowledgeable? Health Care Women International 34, 30331.Google Scholar
Kayeyi, N., Sanday, I. F. & Fykesnes, K. (2009) Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia. BMC Public Health 9, 310.Google Scholar
Keogh, S. C., Urassa, M., Kumogola, Y., Mngara, J. & Zaba, B. (2009) Reproductive behaviour and HIV status of antenatal clients in northern Tanzania: opportunities for family planning and preventing mother-to-child transmission integration. AIDS 23, S27–S35.Google Scholar
Kevany, S., Murimo, O., Singh, B. et al. (2012) Socio-economic status and health care utilisation in rural Zimbabwe: findings from Project Accept (HPTN 043). Journal of Public Health in Africa 3(1), e13.Google Scholar
Killam, W. P., Tambatamba, B. C., Chintu, N., Rouse, D., Stringer, E., Bweupe, M. et al. (2010) Antiretroviral therapy in antenatal care to increase treatment initiation in HIV-infected pregnant women: a stepped-wedge evaluation. AIDS 24(1), 85–91.Google Scholar
Koech, E., Teasdeale, C. A., Wang, C. et al. (2014) Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya. AIDS 28, 2729–2738.Google Scholar
Lepine, A., Terris-Prestholt, F. T. & Vickerman, P. (2014) Determinants of HIV testing among Nigerian couples: a multilevel modelling approach. Health Policy and Planning 30(5), 579–592.Google Scholar
Magadi, M. A., Agwanda, A. O. & Obare, F. O. (2007) A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS). Social Science & Medicine 64(6), 1311–1325.Google Scholar
Magadi, M. & Desta, M. (2011) A multilevel analysis of determinants and cross-national variations of HIV sero positivity in sub-Saharan Africa: evidence from the DHS. Health and Place 17, 1067–1083.Google Scholar
Makate, M. & Makate, C. (2017) The evolution of socioeconomic-related inequalities in maternal healthcare utilization: evidence from Zimbabwe, 1994–2011. Global Health Research and Policy 2, 1.Google Scholar
Mapuranga, B., Rugonye, S. & Pombi, S. (2015) Women’s perception on HIV/AIDS testing during pregnancy a case of Mopani District in Nkowankowa Tzaneen South Africa. Journal of Health, Medicine and Nursing 19, 102–111.Google Scholar
Martin-Herz, S. P., Shetty, A. K., Bassett, M. T., Ley, C., Mhazo, M., Moyo, S. et al. (2006) Perceived risks and benefits of HIV test and predictors of acceptance of HIV counselling and testing among pregnant women in Zimbabwe. International Journal of STDS and AIDS 17(12), 835–841.Google Scholar
Maruva, M., Gwavuya, S., Marume, M., Musarandega, R. & Madzingira, N. (2014) Knowledge of HIV status at ANC and utilisation of maternal health services in the 2010–11 Zimbabwe Demographic and Health Survey. Zimbabwe Working Papers No. 8. ICF International, Rockville, MD, USA.Google Scholar
Mashuba, S. & Hemalata, K. (2015) HIV status disclosure among HIV positive women in Zimbabwe. International Asian Research Journal 3(1), 44–50.Google Scholar
Matthews, C., Guttmacher, S., Fisher, A., Mtshizana, Y., Nelson, T., McCarthy, J. & Daries, V. (2009) The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference? Journal of Adolescent Health 44, 188–190.Google Scholar
Moindi, R. O., Mbakaya, C., Nyambati, V. & Habtu, M. (2015) Qualitative study of factors associated with home deliveries and practices in Kilifi County, Kenya. International Journal of Health Sciences and Research 5(12), 369–376.Google Scholar
Mtumbuka, E., Maluwa, A., Pindani, A. & Bultemeier, K. (2012) Factors influencing pregnant women to undergo HIV testing and counselling during antenatal clinic in Malawi. Journal of Research in Nursing and Midwifery 1(4), 56–61.Google Scholar
Muchabaiwa, L., Muzambani, D., Chigusiwa., L., Bindu, S. & Mudavanhu, V. (2012) Determinants of maternal healthcare utilisation in Zimbabwe. International Journal of Economic Science and Applied Research 5(2), 145–162.Google Scholar
Mucheto, P., Chadambuka, A., Shambira, G. et al. (2011) Determinants of nondisclosure of HIV status among women attending the prevention of mother to child transmission programme, Makonde district, Zimbabwe. Pan African Medical Journal 8, 51.Google Scholar
Munjoma, M. W., Mhlanga, F. G., Mapingure, M. P., Kurewa, E. N., Mashavave, G. et al. (2010) The incidence of HIV among women recruited during late pregnancy and followed up for six years after childbirth in Zimbabwe. BMC Public Health 10, 668.Google Scholar
Murire, M. N., Campbell, C. & Gregson, C. (2014) Community group membership and stigmatising attitudes towards people living with HIV in Eastern Zimbabwe. Journal of Community Health 39(1), 72–78.Google Scholar
Musarandega, R., Machekano, R., Chideme, M., Muchuchuti, C., Mushavi, A., Mahomva, A. & Guay, L. (2017) PMTCT service uptake among adolescents and adult women attending antenatal care in selected health facilities in Zimbabwe. Journal of Acquired Immune Deficiency Syndromes 75, 148–155.Google Scholar
Ngome, E. & Odimegwu, C. (2014) The social context of adolescent women’s use of modern contraceptives in Zimbabwe: a multilevel analysis. Reproductive Health Journal 11, 64.Google Scholar
Obure, A. D., Jacobs, R., Guinness, L., Mayhew, S. & Vassall, A. (2016) Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures. Social Science & Medicine 151, 147–156.Google Scholar
Ochako, R. & Gichuh, W. (2016) Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya. Reproductive Health 13(1), 51.Google Scholar
O’Meara, W. P., Platt, A., Naanyu, V. & Ndege, S. (2013) Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya. International Journal of Health Geographics 12, 55.Google Scholar
Renju, J., Andrew, B., Kishamawe, C., Kato, C., Changalucha, J. & Obasi, A. (2010) A process evaluation of the scale up of a youth friendly health services initiative in northern Tanzania. Journal of the International AIDS Society 13, 32–10.Google Scholar
Rutaremwa, G. & Kabagenyi, A. (2016) Utilization of integrated HIV and sexual and reproductive health services among women in Uganda. BMC Health Services Research 20(16), 494.Google Scholar
Sahlu, I., Howe, C. J., Clark, M. A. & Marshall, B. D. L. (2014) HIV status, knowledge of mother-to-child transmission of HIV and antenatal care use among Ethiopian women. Journal of Epidemiology and Global Health 4, 144–184.Google Scholar
Sama, C-B., Feteh, V. F., Tindong, M., Tanyi, J. T. & Bihle, N. M. (2017) Prevalence of maternal HIV infection and knowledge on mother-to-child transmission of HIV and its prevention among antenatal care attendees in a rural area in northwest Cameroon. PLoS One 12, 2.Google Scholar
Semali, I. A., Jeremia, D., Saronga, H. & Malamsha, D. (2014) Factors associated with HIV testing and receiving results during antenatal care in Tanzania. African Population Studies 28, 2.Google Scholar
Sharma, M., Barnabas, R. V. & Celum, C. (2017) Community-based strategies to strengthen men’s engagement in the HIV care cascade in sub-Saharan Africa. PLoS Medicine 14, 4.Google Scholar
Shetty, A. K., Chandisarewa, W., Mahomva, A. & Mushava, A. (2010) Preventing mother-to-child transmission of HIV in urban Zimbabwe. Journal of Perinatology 30(11), 763–764.Google Scholar
Takarinda, K. C., Madyira, L. K., Mhangara., M., Makaza, V., Maphosa-Mutsaka, M., Rusakaniko, S. et al. (2016) Factors associated with ever being HIV tested in Zimbabwe: an extended analysis of the Zimbabwe Demographic and Health Survey (2010–2011). PLoS One 11(1).Google Scholar
Tarekegn, M. S., Lieberman, L. S. & Giedraitis, V. (2014) Determinants of maternal health service utilisation in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy and Childbirth 14, 161.Google Scholar
Tenthan, L., Haas, H. D. & Egger, M. (2015) HIV testing among pregnant women who attend antenatal care in Malawi. Journal of Acquired Immune Deficiency Syndromes 69, 610–614.Google Scholar
Titaley, C. R., Hunter, C. L., Heywood, P. & Dibley, M. J. (2010) Why don’t some women attend antenatal and postnatal care services? A qualitative study of community members’ perspectives in Garut, Sukabumi and Ciamis districts of west Java province Indonesia. BMC Pregnancy and Child Birth 10, 61.Google Scholar
Turan, J. M., Miller, S, Bukusi, E. A., Sanded, J. & Cohen, C. R. (2008) HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labour and delivery services. AIDS Care 20(8), 938–945.Google Scholar
Tweya, H., Gugsa, S., Hosseinipour, M. et al. (2014) Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Tropical Medicine & International Health 19, 1360–1366.Google Scholar
Underwood, C. R. & Schwand, H. M. (2016) Assessing girls’ HIV vulnerability: evidence from Botswana, Malawi and Mozambique. Health Policy and Planning 31, 729–735.Google Scholar
Uthman, O. A. (2017) Does it really matter where you live? A multilevel analysis of social disorganisation and risky sexual behaviours in sub-Saharan Africa. 2010. Demographic and Health Research Working Paper No. 78. URL: https://dhsprogram.com/pubs/pdf/WP78/WP78.pdf (accessed 4th February 2018).Google Scholar
Washington, S., Owuor, K., Turan, J. M., Steinfeld, R. L., Onono, M., Shade, S. B. et al. (2015) The effect of integration of HIV care and treatment into antenatal care clinic son mother-to-child HIV transmission and maternal outcomes in Nyanza, Kenya: results from the SHAIP cluster randomized controlled trial. Journal of Acquired Immune Deficiency Syndromes 69, e16471.Google Scholar
WHO (2015) New HIV Testing Guidance to Help Reach the 90-90-90 Targets. URL: http://www.who.int/hiv/mediacentre/news/hiv-testing-90targets/en/ (accessed 15th August 2017).Google Scholar
Woldesenbet, S., Jackson, D., Lombard, C. et al. (2015) Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: uptake, determinants, and attributable risk. PLoS One 10, e0132425.Google Scholar
Zimbabwe National HIV and AIDS Strategic Plan [ZNASP II1] (2015–2018) Commitment Towards Fast Tracking 90.90.90 Targets by 2020 and Ending AIDS by 2030 and 75/90.90.90 Ambitious Targets by 2020. URL: http://www.nac.org.zw/ (accessed 3rd February 2018).Google Scholar