| Background. Due to low uptake of antenatal HIV testing under a voluntary opt-in approach, a new model of antenatal HIV testing known as the provider-initiated opt-out approach has been proposed. This study examined HIV testing experiences and rates of HIV serostatus disclosure among pregnant women attending clinics providing both opt-in and opt-out approaches to HIV testing. Moreover, the study sought to identify men's attitudes towards antenatal HIV testing and to identify challenges that providers face in implementing the PMTCT program.;Methods. 600 pregnant women recruited from 10 antenatal clinics throughout southern Uganda were interviewed using a survey questionnaire. Additionally, 40 men, 66 antenatal clinic attendees, and 30 antenatal HIV testing providers were interviewed using an in-depth interview guide. Structured observations of HIV counseling sessions were also conducted.;Results. Overall, 95% of women tested for HIV and 74% disclosed their HIV status to their current sex partner. Factors associated with uptake of antenatal HIV testing included: discussed testing with partner (OR:3.1, 95%CI:1.2,8.1), receipt of pre-test counseling session (OR:5.8, 95%CI:2.0,16.7), and quality of counseling (OR:5.9, 95%CI:1.6,21.6). Factors associated with HIV serostatus disclosure included being HIV-negative (OR:20.0, 95%CI:11.1-33.3), having under four lifetime sex partners (OR:2.04, 95%CI:1.25-3.23), and prior communication with partner about testing (OR:8.82, 95%CI:5.10-15.2). Most men believed women should consult with their husbands prior to testing. However, when women were testing as part of routine antenatal care, the need to obtain permission was less important as HIV testing in this setting was related to the baby's health. Providers identified a number of challenges related to the PMTCT program including low male involvement, low rates of HIV serostatus disclosure, inadequate training for counseling discordant couples, and frequent stock-outs of HIV test kits.;Conclusion. These findings emphasize the important role of pre-test counseling in antenatal HIV testing programs. Findings also lend support to the practice of routine HIV testing within the antenatal setting as it seems an acceptable place for women to test independently of their partner. However, strategies are urgently needed to increase male involvement and HIV serostatus disclosure as these continue to be impediments to the successful implementation of PMTCT programs. |
