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EFFECT OF HEALTH EDUCATION ON HIV COUNSELLING AND TESTING (HCT) FOR ANTENATAL CLIENTS IN ABEOKUTA SOUTH LOCAL GOVERNMENT AREA OF OGUN STATE, NIGERIA BY DR. OLURANTI. O. SOFOWORA BSC, MBBS, MPH, MPA. A DISSERTATION SUBMITTED TO THE NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT FOR THE AWARD OF PART II (FINAL) FELLOWSHIP IN THE FACULTY OF PUBLIC HEALTH (FMCPH) NOVEMBER 2009 CERTIFICATION We hereby certify that this research work titled: “Effect of health education on HIV Counselling and Testing (HCT) for HIV/AIDS among antenatal clients in 1 Abeokuta South Local Government Area of Ogun State, Nigeria” was carried out by Dr. Oluranti O. Sofowora of the Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu under our supervision. Professor O.K. Alausa, FMCPH, FMCPath Supervisor Dr. F.A. Oluwole, FWACP Head of Department DECLARATION It is hereby declared that this work “Effect of health education on HIV counselling and testing (HCT) for HIV/AIDS among antenatal clients in Abeokuta South Local Government 2 Area of Ogun state, Nigeria” is original unless otherwise acknowledge. The work has not been presented to any other College, body or institution for a Fellowship or for any other publications or purposes. -------------------------------------------------- DR. OLURANTI .O. SOFOWORA DEDICATION To my Father, Almighty Father, He is King of Kings, 3 He is Lord of Lords. ACKNOWLEDGEMENTS Firstly, I wish to thank my Almighty Father in Heaven and the Lord Jesus Christ for being with me and granting me the grace, guidance and strength throughout my studies. I am greatly indebted to Prof. O.K. Alausa, my supervisor, for his encouragement, support and patience at all the stages of this study. 4 My sincere appreciation goes to many people who have supported me in this work, these people include Dr. F.A. Oluwole, Dr. K. Sekoni and Dr. Sam Wobo. My gratitude goes to members of the primary health care department of Abeokuta South Local Government and Sagamu Local Government for permitting me to conduct the research in the two local government areas. I wish to thank members of Ogun State Action Committee on AIDS for their assistance throughout this study. Finally, my thanks go to members of my family who gave me a hand when I most needed it and wished me all the best in my ventures. 5 ABSTRACT The study was carried out to determine the effect of health education on HIV counseling and testing (HCT) for antenatal clients in Abeokuta South LGA, Ogun State. Context: Voluntary counseling and testing service is not making appreciable progress as shown by the low turnout of people who did not know their HIV status and also those who wished to know their HIV status. HCT remains an important entry point into other services provided for HIV/AIDS including care, support, antiretroviral treatment, reduction of infection mother to child transmission and clinical management of HIV related illness e.g. tuberculosis. Method: The study took place in Abeokuta South and Sagamu Local Government Areas of Ogun State. The respondents were antenatal clinic attendees in primary health care centres of both local government areas. The study was in three stages. The first stage was a baseline (pre - intervention) study of antenatal clinic attendees in Abeokuta South Local Government Area and Sagamu Local Government Area. The research instrument was a questionnaire. During the second stage, antenatal clinic attendees in Abeokuta South Local Government only were given health education on HIV/AIDS, HCT, ART and PMTCT. The ANC attendees in Sagamu LGA were given health education on malaria in pregnancy. The third stage was an immediate post comparative study of the respondents in both Local Government Areas. The same questionnaire was used for comparability. A three months post – study was also carried out on antenatal clinic attendees in both the intervention group and the control groups, using the same questionnaire. 6 Results: The women in the control and experimental groups were comparable because there was no statistically significant difference in their demographic characteristics at baseline. Analysis of the pre – intervention responses of the two groups showed that there was no statistically significant difference in the baseline awareness of HIV and AIDS and pregnancy between the two groups. Only 88.3% of respondents in the study group had heard of HCT at baseline compared to 80.3% in the control group. Only 45.8% of respondents in the study group had gone for HCT at baseline compared to 35.0% in the control group. This improved with intervention to 88.3% in the study group. This also is statistically significant p = 0.000. The result showed a high number of respondents who knew that a pregnant woman could have HIV infection in both the control and the intervention group (95.5% and 93.3% respectively). In the intervention group there was increase in the number of respondents who had heard of PMTCT services 44.2% to 97.5% after intervention compared to the baseline. Knowledge of awareness of HIV and AIDS in pregnancy rose from 91.7% to 100.0%. There was also a statistical significance difference in the baseline comparison of awareness of whether an HIV positive woman can transmit HIV to her unborn child at baseline p = 0.592 compared to immediate post intervention result which showed p = 0.006 in the study group, this was statistically significant. Conclusion: Education on HCT and most especially PMTCT can improve knowledge, which will ultimately translate to use of these services and further reduce the transmission of the virus from mother to child; thereby preventing HIV/AIDS in future generations. Table of Content 7 Title Page Page Certification i Declaration ii Dedication iii Acknowledgement iv Abstract v - vi Table of content vii - ix List of table x List of figures xi List of Acronyms and Terms xii CHAPTER 1: INTRODUCTION PAGE 1.1 Background 1 – 2 1.2 Statement of the research problem and the impact of the HIV problem 2 – 4 1.3 Rationale for study 4 – 5 1.4 General objectives 5 1.4.1 Specific objectives 5 1.5 Study hypothesis 6 CHAPTER 2: LITERATURE REVIEW 8 2.0 Preamble 7 2.1 The Impact of HIV Problem 7 – 9 2.2 Modes of HIV Transmission 9 – 13 2.3 Natural History and Clinical Spectrum of HIV Disease 14 2.4 Clinical Course of HIV Disease 14 – 15 2.5 Diagnosis of HIV Disease 15 – 17 2.6 Rationale for the Care of HIV Infected Persons 17 – 18 2.7 Drug Treatment of HIV Disease 18 2.8 Classification of Anti-Retroviral Drugs 18 2.9 HIV Prevention 19 2.10 Prevention of Prenatal Transmission of HIV 19 – 20 2.11 HIV Voluntary Counseling and Testing 20 – 21 2.12 Evolution of HCT Practice 22 – 23 9 2.13 The HCT Service in Nigeria 23 – 24 2.14 Health education strategies In HIV/AIDS and HCT 24 – 28 CHAPTER 3: MATERIALS AND METHOD 3.1 Background information on study area 29 – 30 3.2 Study Population 30 – 31 3.3 Study Design and instrument of data collection 31 – 33 3.4 Sampling Method 34 3.5 Sample Size 34 – 35 3.6 Data Analysis 35 3.7 Ethical Consideration 35 – 36 3.8 Limitation to study 36 CHAPTER 4: RESULTS PAGES Baseline comparison on demographic characteristics of the respondents 10 in terms of age educational level marital status and religion 37 – 38 Baseline comparison on demographic characteristics of the respondents in terms of ethnicity, occupation, parity and gestational period 39 – 40 Baseline comparison on of pregnant respondents who are aware of HIV/AIDS and pregnancy 41 – 42 Respondents baseline awareness of HCT and HCT Uptake 43 – 44 Respondents awareness of HIV/AIDS and pregnancy pre and post Intervention 45 – 46 Baseline comparison on awareness of HCT and HCT uptake in the study and control groups 47 – 48 Use of HCT services 49 CHAPTER 5: DISCUSSION, CONCLUSION AND RECOMMENDATIONS Discussion 53 – 59 Conclusion 59 – 60 Recommendations 60 REFERENCES 61 – 75 Appendix 11 a- Approval from OOUTH, Sagamu Ethical Review Committee 76 b-1 Consent Form 77 b-2 Voluntary Counselling and Testing Consent Form 78 c- Health education schedule and content of Health Education Lesson 79 – 82 d Questionnaire 83 – 90 List of Tables Tables Page Table 1 Distribution of respondents according to Age, Educational level 38 and Marital Status and Religion Table 2 Distribution of respondents according to Ethnicity, Occupation, 39 – 40 Parity and Gestational age Table 3 Respondents baseline awareness of HIV/AIDS and 41 – 42 Pregnancy Table 4 Respondents baseline awareness of HCT and HCT uptake 43 – 44 12 Table 5 Respondents awareness of HIV / AIDS and pregnancy post Intervention 45 – 46 Table 6 Respondents awareness of HCT and HCT uptake pre and post intervention 47 - 48 Table 7 Use of HCT services 49 LIST OF FIGURES Figures Figure 1: The proportions of respondents at baseline with knowledge of the 50 modes of HIV transmission by study group and control group. Figure 2: The proportions of respondents at baseline with knowledge of 51 mode of prevention of HIV by study group and control group. Figure 3: The proportions of respondents at baseline with knowledge of infections 52 seen in AIDS patients by study group and control group. 13 LIST OF ACRONYMS AND TERMS ART: Anti – Retroviral Therapy ARV: Anti – Retroviral HIV: Human immunodeficiency Virus HIV Positive: Presence of HIV Infection HIV Negative: Absence of HIV Infection IEC: Information, Education and Communication LACA: Local Action Committee on AIDS LGA: Local Government Area NACA: National Agency for the Control of AIDS NGO: Non – Governmental Organisation PHC: Primary Health Care PMTCT: Prevention of Mother – To – Child Transmission 14 SACA: State Action Committee on AIDS STI: Sexual Transmitted Infection HCT: HIV Counseling and Testing (for HIV) WHO: World Health Organisation OOUTH: Olabisi Onabanjo University Teaching Hospital CHAPTER ONE: INTRODUCTION 1.1 BACKGROUND The HIV/AIDS pandemic is one of the greatest health problems threatening the human race in our time, the burden is greatest in Sub-Saharan Africa (1, 2).

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