AN APPRAISAL OF HIV COUNSELLING AND TESTING SERVICES PROVIDED FOR PREGNANT WOMEN IN SELECTED GOVERNMENT HOSPITALS IN IBADAN METROPOLIS, NIGERIA

Abstract

The HIV Counseling and Testing (HCT) services constitute the gateway to the prevention of mother-to-child- Transmission (PMTCT) of HIV and the treatment of AIDS. Since the integration of HCT programme into Ante-natal Clinic (ANC) services in Nigeria not much has been done to evaluate it. Therefore, the standard procedures and basis requirements of HCT services provided for pregnant women at the ANCs of Jericho Nursing Home, General Hospital, Jericho and Adeoyo Maternity Hospital, Ibadan were appraised. Purposive sampling method was used to select 40 pregnant women (2 primigravida and 19multigravida) and 25 health workers (Doctors, Nurses, Counselors and Laboratory Scientists) from the hospitals. Six Focus Group Discussions (FGDs) were concluded among the pregnant women, while 25 In-depth interviews (IDIs) were conducted with the Health Workers (HWs) using pre-tested FGD and IDI guides. Observation and inventory checklists were to collect data on procedures and basic requirement of HCT. Data were analyzed using the thematic approach. Mean age of the pregnant women was 27.4 + 4.2 years with 32.5% having secondary school education. The FGD revealed that majority of the multigravida were unable to differentiate between HIV and AIDS but both primigravida and multigravida could correctly mention transmission routes and preventive practices. Majority in both groups also stated that they were neither counseled nor given opportunity to voluntarily participate in HCT services and that HIV testing was made compulsory for them before accessing ANC. Both groups at the Jericho hospital revealed that there was no counselor and HCT procedure was poor as they were directed to do the test and to come for result a week later. Most discussions revealed that results were handed over to them directly without post-test counseling. Discussants in the two groups from the selected hospitals enumerate the benefits of HCT as follows: opportunity to know ones sero – status, PMTCT and protection of the unborn child. In –depth interviews among the Health Workers (HWs) showed that majority in all categories were not specially trained on the basic skills for providing HCT. The HWs expressed divergent opinions on the policy establishing HCT services. While majority stated that it was meant to be mandatory for all pregnant women accessing ANC, few doctors said it was voluntary and that tacit coercion (opt-out method) was used to make the women undertake the test. Observations of HCT procedures showed that guidelines for counseling were not satisfy adhered to especially at the Jericho hospital, and HIV test was mandatory in all study sites. Inventory of facilities, staff and materials revealed inadequate staffing and lack of a dedicated counseling room, while lack of antiretroviral drugs and inadequate test-kits were found at the hospital in Jericho. The current HIV counseling and testing services provided for pregnant women in the selected hospitals have procedural inadequate health workers’ skills, facilities, staffing and materials. Training and provision of resources for conducting HIV counseling and testing are needed to address the situation.