|Year : 2012 | Volume
| Issue : 1 | Page : 6-10
HIV counseling and testing in a tertiary health facility in Lafia, Nigeria
Audu Esther Solomon1, Madawa Absalom Amos1, Mohaammed Hajara Laraba1, Iyigulu Alice Alaska1, Yakubu Ahmed Ashuku2, Olaiya Olanrewaju Oluwadare3, Bako Ishaku Ara4
1 Department of Medicine (Special Treatment Clinic), Dalhatu Araf Specialist Hospital, Lafia, Nigeria
2 Department of Surgery, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
3 Department of Surgery, Institute of Human Virology, Nigeria
4 Nasarawa State AIDS Control Agency, Nasarawa State, Nigeria
|Date of Web Publication||10-Oct-2012|
Audu Esther Solomon
Consultant Medical Microbiologist, Special Treatment Clinic, Dalhatu Araf Specialist Hospital, P.M.B 007, Lafia, Nasarawa State
Source of Support: None, Conflict of Interest: None
Objectives : This study was carried out with the aim of determining the seroprevalence of HIV among clients accessing human immunodeficiency virus (HIV) counseling and testing (HCT) services in Dalhatu Araf Specialist Hospital, Lafia, North Central Nigeria. The study also determined the personal profile of these clients and their reasons for accessing the HCT services. The findings of the research would be useful in assisting the state government and policy makers to plan for treatment, care, and prevention for those at risk. Materials and Methods : A retrospective review of records of clients who accessed services at the HCT unit of the Dalhatu Araf Specialist Hospital Lafia over a 2-year period was carried out. Results : A total of 4,292 (50.1%) out of the 8,554 who were tested for HIV were seropositive. 65.7% (2,818) of those who were HIV-seropositive were females while 44% (1,474) were males. Majority (84.7%) of those who were HIV-seropositive were between the ages of 16 to 35 years, and 64.9% of those who were positive were married. Those who came for HCT because of medical reasons had higher seroprevalence than those who came on their own to know their HIV status Conclusion: There is need to encourage activities that promote HCT and especially health provider initiated HCT in all health facilities. This will increase the diagnosis of new HIV cases, thus leading to an early commencement of treatment and initiation of strategies for prevention of transmission from the HIV-infected persons to their partners. Preventive strategies should be tailored towards high-risk groups including those who are married and the young adults to reduce new infections through heterosexual transmission.
Keywords: HIV, HIV counseling and testing, Lafia
|How to cite this article:|
Solomon AE, Amos MA, Laraba MH, Alaska IA, Ashuku YA, Oluwadare OO, Ara BI. HIV counseling and testing in a tertiary health facility in Lafia, Nigeria. Niger J Basic Clin Sci 2012;9:6-10
|How to cite this URL:|
Solomon AE, Amos MA, Laraba MH, Alaska IA, Ashuku YA, Oluwadare OO, Ara BI. HIV counseling and testing in a tertiary health facility in Lafia, Nigeria. Niger J Basic Clin Sci [serial online] 2012 [cited 2019 Mar 20];9:6-10. Available from: http://www.njbcs.net/text.asp?2012/9/1/6/102102
| Introduction|| |
The human immunodeficiency virus (HIV) epidemic is in its third decade with the UNAIDS reporting that the epidemic has leveled in 2009. About 33.3 million people are reported to be living with HIV worldwide, 22.5 (67.8%) million of them in sub-Saharan Africa. 
The seroprevalence of HIV in Nigeria has witnessed a slight decline from 4.4% in 2008 to 4.1% in 2010.  Nigeria has an estimated 3.1 million people living with HIV/AIDS (PLWHA). The country has the second highest number of people living with HIV/AIDS (PLWHAs) in Africa.  Nasarawa State has a prevalence of 7.5%, which is higher than the average national prevalence of 4.1%. 
The availability of and accessibility to anti-retroviral drugs in Nigeria has led to a high number of people seeking to know their HIV serostatus through HIV counseling and testing (HCT). The HCT services are being provided by many organizations including health care facilities, non-governmental organizations (NGOs), and faith-based organizations (FBOs). This is both the entry point to comprehensive HIV care and treatment as well as its prevention, hence awareness and acceptance of HCT services is vital if the HIV/AIDS epidemic is to be controlled.
Various HIV seroprevalence studies have been carried out among women attending antenatal clinics but not much has been reported in other categories of people. , This study seeks to describe the prevalence of HIV and characteristics of those who seek HCT services in the HCT unit of a tertiary health center. The study will also look at reasons why these clients are seeking HCT services. Findings obtained will be used to advise policy makers and government on adequate planning for care and treatment of those infected with HIV and preventive strategies for those at risk.
| Materials and Methods|| |
The study was carried out at the Dalhatu Araf Specialist Hospital (DASH, Lafia). This is a 200-bed capacity tertiary health facility located in Lafia, Nasarawa State in North Central Nigeria. It is a government-owned hospital and serves a large population from both within the state and neighboring states including Benue, Plateau, Taraba, Kaduna, and the Federal Capital Territory (FCT). Even though the facility is a tertiary health center, it provides both secondary and tertiary health services due to lack of a secondary health facility in the state capital.
A retrospective collation of data from available records of all clients who attended the HIV counseling and testing (HCT) unit of the hospital between October 2006 and September 2008 was carried out. The HCT unit captures their data in registers and logbooks. Data accessed in the records included age, sex, marital status, and reasons for attending the HCT unit.
All clients had relevant pretest counseling, and written consent was sought before an HIV testing was carried out. HIV testing was done using Stat Pak dipstick Assay (Chembio Diagnostic System, USA), and all those who tested positive had a second rapid test using Determine test (Abbott Laboratories, USA). All testing and interpretations of results followed the Nigerian National HIV testing Algorithm. Discordant results were decided using a third rapid test using Stat pak. HIV results were reported as positive or negative. Those who tested positive were given post-test counseling and were enrolled into HIV care and treatment services of the hospital while those who tested negative were also given post-test counseling. In addition, clients who were HIV-negative were given relevant information on prevention of HIV to reduce risk and to reinforce positive risk reduction measures. Information about window period and the need to re-test after two months was also given.
All data collected were analyzed using SPSS Version 20 Software.
| Results|| |
A total of 8,565 clients accessed HCT services at the HCT unit in the facility between October 2006 and September 2008. Only nine (9) clients declined testing, making the uptake of HCT 99.9%.
Out of the 8,556 who attended the center for HCT, 4,938 (57.7%) were women while men constituted 3,618 (42.3%).
A total of 4,292 (50.2%) of those who were tested were HIV-positive while 4,264 (49.8%) were HIV-negative. Out of the 3,618 males who were tested 1,474 (40.7%) were positive while 2,818 (56.1%) females out of 4,938 were positive [Table 1].
The difference in HIV prevalence between males and female was statistically significant (P < 0.05).
The HIV status based on age revealed that 84.7% of those who were HIV-positive were between the ages of 16 and 35 years while 49.7% were between the ages of 21 to 30 years [Table 2].
This study also found that 59.9% of those who were tested were married. About 64.9% of those who were HIV-positive were married while 15.8% were single.
Findings also showed that there was a high rate of HIV seropositivity among those who were separated, divorced, or widowed. Out of the 496 clients who were widowed, 410 (82 %) were HIV-positive; of the 275 who were separated, 222 (80%) were HIV-positive while 73% (49 out of 67) of those who were divorced tested positive. The relationship between HIV prevalence and marital status was statistically significant (P < 0.05) [Table 3].
This study showed that 48% (4,108 out of 8,556) of those accessing the HCT services came for medical reasons while 49.7% (4,250) were self-referred. 2.3% (198) of those who came to HCT had other reasons [Table 4]. The other reasons for accessing HCT services in this study include: Children that were brought by their HIV-infected parents to ascertain their HIV status and orphans who were brought by their guardians for an HIV testing.
About 63.3% (2,715 of the 4,108) of those who came for HCT because of medical reasons were HIV-positive compared to only 36% (1,536 out of 4,250) of those who were self-referred, while 20% (41 out of 198) of those who came for other reasons were HIV-positive. The difference in HIV prevalence between those who had medical reasons and those who were self-referred or had other reasons was statistically significant (P < 0.05).
| Discussion|| |
The uptake of an HIV counseling and testing in this study was 99.9%. This is similar to other reports in Nigeria. ,, This high uptake of HCT may be due to different factors including a high level of awareness and the desire of the clients to access medical care in the facility. The availability of free anti-retroviral therapy has resulted in improvement in the quality of life of persons living with HIV and thus a gradual shift in peoples' perception that HIV/AIDS is a death sentence.
The HIV seroprevalence of 50.2% in this study is slightly higher than findings from some previous studies. In a report from a tertiary health facility in Jos, North Central Nigeria, Imade et al found that 40.6% of those who accessed voluntary counseling and testing (VCT) for HIV were HIV-positive.  A similar study found 38% in Uganda.  However, another study reported that the median HIV prevalence in West Africa was 3-5%.  Similarly, a study from Kwara State in North West Nigeria reported that 5.4% of patients who reported in 16 health facilities for VCT were HIV seropositive. 
This high HIV prevalence among HCT clients observed in our study may be due to the proximity of Lafia to the Federal capital territory and to Benue State, both of which are among the states with HIV prevalence (over 8%) in Nigeria and were areas where some of the HCT clients came from.  Nasarawa state with a prevalence of 7.5% is one of the states in Nigeria with an HIV prevalence above the average National HIV prevalence of 4.1%.  The relatively high prevalence among the general population may have contributed to this finding. In addition, the high prevalence in this study can also be attributed to the fact that most high-risk clients and those previously tested in other institutions prefer to come to DASH Lafia to have an easy access to anti-retroviral therapy. Furthermore, majority of persons who had HIV testing done in smaller health facilities in and around Lafia are usually referred to this tertiary health facility for confirmation. This finding is similar to the findings from Ugandan hospitals where there is a high prevalence in the reference hospitals where patients prefer to go either for confirmation of HIV tests already carried out elsewhere or because of an easy access to care. 
This study found a significantly higher rate of HIV among those who were married, had separated from their partners, or were widowed. Other studies have reported similar findings. , About 64.8% of all who were HIV seropositive in this study were married. Heterosexual transmission has been reported as being responsible for most of the HIV infections in Africa. , The high prevalence of HIV in those who were married is similar to the findings from other studies from Nigeria and Uganda. ,
The high prevalence of HIV among those who were divorced, separated, or widowed has very significant implications for efforts towards prevention of new infections. Most African cultures frown at people who are not married. This puts pressure on those who are divorced, separated, or widowed to re-marry, thus placing their uninfected partners at risk of an HIV infection through unprotected sex. Unprotected heterosexual sex has been found to be responsible for most cases of HIV transmission.  Persistence of stigma and discrimination also makes disclosure of a positive HIV status difficult, thus leading to marriages where HIV transmission takes place. 
Interventions aimed at prevention must be stepped up with an increasing need to promote HIV testing for couples planning to marry or even in marriage. When intending couples know their HIV status before marriage, the information empowers them to take positive steps towards prevention of transmission, reduction of high-risk behavior, and decisions that will help in planning for pregnancy and prevention of mother to child transmission, especially where the woman is the infected partner.
The study shows that promoting provider-initiated HCT in all health facilities will increase detection of undiagnosed HIV cases, thus leading to an early initiation of treatment. The significantly higher prevalence in those who came for medical reasons, to know their HIV status, supports this stand. This is similar to findings by researchers in Uganda. 
Early diagnosis of HIV cases is key to prevention of HIV transmission, especially when issues of HIV serodiscordance in relationships are considered.  With a large number of HIV-positive clients in marital relationships, it is obvious that early identification of cases will help in reducing new infections through prompt initiation of treatment with anti-retroviral drugs and promotion of condom use in heterosexual relationships as well as promotion of HCT for family members and partners of those who are HIV-infected.
Limitations of the study
This study was limited by incomplete documentation including missing information and unreadable records. The data used are facility-based and may not be a true representation of the community.
| Conclusions|| |
This study found that about half of all HCT clients in the facility were HIV-positive with significantly higher prevalence among those who came for medical reasons and those who were divorced, separated, or widowed. This study has brought to the forefront the issue of promoting HCT as it remains one of the most effective tools in the fight against the HIV/AIDS pandemic. Early identification of cases through health provider-initiated HCT will lead to early intervention in terms of treatment and ultimately prevention of new infections.
Current efforts at most government-owned health facilities are commendable. There is, however, need to expand comprehensive HIV care and treatment to secondary and primary health care facilities to cater for the large number of clients who are HIV-infected and need to be placed in care and treatment. There is also need to have adequately-trained personnel to offer the right care to people living with HIV. This is very necessary to remove stigma and encourage disclosure of HIV status as a necessary step towards reducing risk of transmission of HIV.
| Acknowledgements|| |
The comprehensive HIV Care and Treatment in Dalhatu Araf Specialist Hospital Lafia is being supported by the Institute of Human Virology Nigeria (IHVN) under the AIDS Care and Treatment in Nigeria (ACTION) Project. Their support is hereby acknowledged.
We also wish to acknowledge the support and contribution of all the staff of HIV counseling and testing unit of Dalhatu Araf Specialist Hospital, Lafia.
| References|| |
|1.||UNAIDS; UNAIDS report on the global AIDS epidemic-2010. Available from: http://www.unaids.org/globalreport/ [Last accessed on 2011 Sep 22]. |
|2.||Federal Ministry of Health, Technical Report 2010; National HIV seroprevalence survey among pregnant women attending Antenatal clinics in Nigeria; 2010:18. |
|3.||Ekanem EE, Gbadegesin A. Voluntary counseling and testing (VCT) for human immunodeficiency virus: A study of acceptability by Nigerian women attending antenatal clinics. African J Rep Hlth 2004;8:91-100. |
|4.|| Imade GE, Fallum D, Agbaji O, Pam S, Egah D, Sagay AS, et al. Outcome of free voluntry counseling and testing for HIV infection in Jos, North central Nigeria; 14 th International STDs and AIDS in Africa (ICASA) Abstracts No. MoPoAOO12; 2005. p. 99. |
|5.||Abdulazeez AA, Alo EO, Nassar AS. Harmonization of HIV testing in Nigeria; A missing step in HIV/AIDS control. Nig J Bio Edu Sci 2006;2 : 23-6. |
|6.||Wanyenze RK, Nawavvu C, Namale AS, Mayanja B, Bunnell R, Abang B, et al. Acceptability of Routine HIV seroprevalence in ugandan hospitals. Bull World Health Organ 2008;86:241-320. |
|7.||Asamoah-odei E, Garcia C, Boerma JT. HIV prevalence and trends in subsaharan Africa: No decline and large subregional differences. Lancet 2004;364:35-40. |
|8.||Akhigbe RE, Bamidele JO, Abodunrin OL. Seroprevalence of HIV infection in Kwara, Nigeria. Int J Virol 2010;6:158-63. |
|9.|| Desgrees-du-Lou A, Orne-Gilemann J. Couple centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters 2008;16:151-61. |
|10.||Hochgesang M, William K, John GA, Wellington L, Davis M, Newman D. HIV serodiscordance in couples seeking VCT services in Malawi. 2005. 14 th International conference on STDs and AIDS in Africa (ICASA) Abstracts No. frorB239: 89. 2005. |
|11.||Vyas N, Hooja S, Sinha P, Mathur A, Singhal A, Vyas L. Prevalence of HIV/AIDS and prediction of future trends in north-west region of India: A six-year ICTC-based study. Indian J Community Med [serial online] 2009;34:212-7. Available from: http://www.ijcm.org.in/text.asp?2009/34/3/212/55286. [Last cited on 2011 Nov 28]. |
[Table 1], [Table 2], [Table 3], [Table 4]