Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study

Mari Nythun Utheim; Petros Isaakidis; Rafael Van den Bergh; Bantas Bata Ghislain Géraud; Rodrigue Biguioh Mabvouna; Tone Kristin Omsland; Espen Heen; Cecilie Dahl

doi:10.1186/s13031-023-00505-0

Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study

Confl Health. 2023 Mar 27;17(1):14. doi: 10.1186/s13031-023-00505-0.

Authors

Mari Nythun Utheim¹, Petros Isaakidis^{2

3}, Rafael Van den Bergh⁴, Bantas Bata Ghislain Géraud⁵, Rodrigue Biguioh Mabvouna⁶, Tone Kristin Omsland⁷, Espen Heen⁷, Cecilie Dahl⁷

Affiliations

¹ Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway. marinythun@protonmail.com.
² Médecins Sans Frontières - Southern African Medical Unit, Marshalltown, South Africa.
³ Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
⁴ Médecins Sans Frontières - Operational Centre Brussels, Operational Research Unit (LuxOR), Brussels, Belgium.
⁵ Directeur de Ressources, Ministère de La Santé, Bangui, Central African Republic.
⁶ Department of Biology, University of Roma Tor Vergata, Rome, Italy.
⁷ Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.

Abstract

Introduction: In the Central African Republic (CAR), HIV/AIDS is the main cause of death in women aged 15-49 years. Increased testing coverage is essential in prevention of HIV/AIDS, especially in areas where conflict hinders access to health care. Socio-economic status (SES) has been shown to be associated with HIV testing uptake. We investigated whether "Provider-initiated HIV testing and counselling" (PITC) could be implemented in a family planning clinic in an active conflict zone in the Central African Republic to reach women of reproductive age and assessed whether socioeconomic status was associated with testing uptake.

Methods: Women aged 15-49 years were recruited from a free family planning clinic run by Médecins Sans Frontières in the capital Bangui. An asset-based measurement tool was created based on analysis of qualitative in-depth interviews. Measures of socioeconomic status were constructed from the tool, also by using factor analysis. Logistic regression was used to quantify the association between SES and HIV testing uptake (yes/no), while controlling for potential confounders: age, marital status, number of children, education level and head of household.

Results: A total of 1419 women were recruited during the study period, where 87.7% consented to HIV testing, and 95.5% consented to contraception use. A total of 11.9% had never been tested for HIV previously. Factors negatively associated with HIV testing uptake were: being married (OR = 0.4, 95% CI 0.3-0.5); living in a household headed by the husband as opposed to by another person (OR = 0.4, 95% CI 0.3-0.6), and lower age (OR = 0.96, 95% CI 0.93-0.99). Higher level of education (OR = 1.0, 95% CI 0.97-1.1) and having more children aged under 15 (OR = 0.92, 95% CI 0.81-1.1) was not associated with testing uptake. In multivariable regression, testing uptake was lower in the higher SES groups, but the differences were not significant (OR = 0.80, 95% CI 0.55-1.18).

Conclusions: The findings show that PITC can be successfully implemented in the patient flow in a family planning clinic, without compromising contraception uptake. Within the PITC framework in a conflict setting, socioeconomic status was not found to be associated with testing uptake in women of reproductive age.

Keywords: Central African Republic; Conflict; Family planning; HIV testing uptake; HIV/AIDS; PITC; Socio-economic status.