Factors associated with male involvement in antenatal HIV counseling and testing in Kitgum District, Uganda

Abstract

Background: Male involvement in antenatal HIV counseling and testing increases the use of PMTCT interventions in resource limited settings. Male involvement is also associated with reduced mother to child transmission of HIV and reduced infant mortality. However, more male focused studies have to be conducted to explore men factors that have a bearing on their involvement in antenatal HIV counseling and testing in Kitgum district. Objective: To assess factors associated with male involvement in antenatal HIV counseling and testing in Kitgum district. Methods: This was a descriptive cross-sectional study employing both qualitative and quantitative methods of data collection. Multistage sampling was used to randomly select and enroll 362 eligible men for administration of the questionnaire. and in the qualitative component, two male and four female focus group discussions (FGDs) and four key informants (KIs) interviews were conducted.Quantitative data was analyzed using STATA versions 12 computer package. Frequency distribution tables and descriptive statistics were used to present the analysis of each variable while test for association was done using chi-square statistics at bivariable level and logistic regression model done at multivariable level. Correlation analysis was also conducted to assess the relationship between men involvement and the different factors, to measure the level of influence of each. In addition, logistic regression was conducted to assess the level of influence of the different factors on male involvement. For qualitative data, the raw field notes from focus group discussion and key informants were transformed into well organized notes. The responses were catergorized in themes which was then transcribed and coded such that the data is ordered in relation to the objectives of the study. The data was then analysed using the manifest-content analysis. Results: Knowledge and awareness of antenatal HIV counseling and testing was the strongest factor positively associated with male involvement at r=0.5 and p = 0.000. Health facility and socio- cultural factors were shown to have weak positive association in influencing male involvement in antenatal HIV counseling and testing measured at r=0.2478 and p = 0.0012; and r=0.2566 and p = 0.001 respectively. A statiscally significant variation in male involvement was observed among unemployed (AOR 0.33, 95% CI= 0.136-0.781). Men who had attained secondary education were more likely to be involved in antenatal HIV counseling and testing (AOR 2.33, 95% CI= 1.131-4.812). Findings from qualitative analysis indicated that perceived traditional norms and beliefs such as only women should go for ANC clinic services were barriers to men involvement in antenatal HIV counseling and testing. Further, beliefs of bewitched when a man accompaines the wife to antenatal negatively influenced their involvement. Some health facility factors were also cited as hindrance to male involvement in antenatal HIV counseling and testing such as men not able to accompany their spouse at scheduled antenatal visits since they work most of the day time when the ANC clinics are open. Conclusion: Overall, factors such as knowledge and awareness, health facility and socio-cultural assessed in this study positively influenced male involvement in antenatal HIV counseling and testing. Therefore, there is need to support the existing strategies that promote male participation in antenatal HIV counseling and testing in order to improve and sustain programmes aiming at male