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Original Article
ARTICLE IN PRESS
doi:
10.25259/CJHS_15_2023

Knowledge, acceptance, and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome among undergraduates of a public university in Southwestern Nigeria

Department of Nursing Science, Obafemi Awolowo University, Ile-Ife, Nigeria
Corresponding author: Sunday Joseph Ayamolowo, Department of Nursing Science, Obafemi Awolowo University, Ile-Ife, Nigeria. olowoyamolowo@yahoo.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ayamolowo SJ, Ayodele DO. Knowledge, acceptance, and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome among undergraduates of a public university in Southwestern Nigeria. Calabar J Health Sci, doi: 10.25259/CJHS_15_2023

Abstract

Objectives:

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global public health problem, and Nigeria has about 1.9 million people living with the virus. HIV testing and counseling services serve as a very important entry point to HIV/AIDS care and treatment. Voluntary counseling and testing (VCT) is one of the interventions developed to tackle the HIV/AIDS epidemic in Africa. This study determined the knowledge, acceptance, and utilization of VCT for HIV/AIDS among undergraduates in a public University in Southwestern Nigeria.

Material and Methods:

The study adopted a descriptive cross-sectional design, using the multistage sampling technique to select 425 respondents. A self-administered questionnaire was used for data collection. Data analysis was done using Statistical package for the social sciences (SPSS), version 25. Descriptive statistics were presented in tables and figures, and inferential statistics were analyzed at a level of significance of 0.05.

Results:

Over half of the respondents, 226 (53.2%) were within the age range of 18–25 years. The majority were female, 345 (81.2%), single 403 (94.8%), and had never had sexual intercourse 300 (70.6%). Over half of the respondents’ 240 (57%), had above average knowledge of VCT for HIV/AIDs, had above average levels of acceptance 254 (59%), and the majority 326 (76.2%) of the respondents had very low level of utilization of VCT for HIV/AIDS. There was a significant association between respondents’ age (χ2 = 55.599a, P = 0.000), gender (χ2 = 19.094a, P = 0.000), religion (χ2 = 8.990a, P = 0,038), marital status (χ2 = 8.411a, P = 0.038), age at first sex (χ2 = 61.847a, P = 0.000), knowledge of VCT (χ2 = 5.297a, P = 0.021), acceptance of VCT (χ2 = 80.235a, P = 0.000), and their uptake of VCT for HIV/AIDs. Furthermore, selected socio-demographic characteristics, knowledge, and acceptance of VCT significantly predicted the uptake of VCT among respondents (F [8,416] = 20.163, P < 0.05).

Conclusion:

The study concluded that respondents had an above average knowledge and acceptance of VCT but a low level of utilization. To increase the utilization of VCT for HIV/AIDS among undergraduates, public health programs should focus on educating undergraduates and significant others on the importance of VCT in the context of HIV prevention, care, and treatment.

Keywords

Knowledge
Acceptance
Uptake
Voluntary counseling and testing
Human immunodeficiency virus/ acquired immunodeficiency syndrome
Undergraduates

INTRODUCTION

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have persisted as a disease of public health importance around the world. It is known globally as one of the most important public health crises, with about 39 million people living with HIV/ AIDS globally in 2022.[1] According to UNAIDS (the joint United Nations program on HIV and AIDS), about 630,000 people died from AIDS-related illnesses at the end of 2022, and an estimated 1.3 million people have been newly infected with HIV.[1] Nigeria has one of the highest rates of new infection in Sub-Saharan Africa at an estimated 130,000, and about 1.9 million live with the virus in Nigeria.[2]

Young people within the ages of 15 and 24 are at the highest risk for HIV/AIDS epidemic in Nigeria.[2] They are vulnerable to HIV because of the strong influence of peer pressure and the development of their sexual and social identities. In West and Central Africa, this age group has an estimated HIV prevalence of 3.5% among other countries.[3] The epidemic is driven by this age group in the matrix of low-risk perception, risky sexual behavior, low condom use, lack of knowledge, and access to appropriate reproductive health services.[4] In Nigeria, HIV/AIDS is further aggravated by inadequate sexual health education, inadequate voluntary HIV testing and counseling, unhealthy cultural practices, and poor health care systems, especially in secondary and tertiary institutions.[5]

Voluntary counseling and testing (VCT) is one of the preventive measures put in place to prevent the transmission of HIV/AIDS. VCT is important in HIV prevention, care, and treatment since early detection of the virus reduces transmission and mortality. It is the process by which an individual, couple, or family receives HIV testing and confidential dialogue on HIV prevention, treatment, care, and support.[6]

University undergraduates in Nigeria are mostly adolescents and youths within the ages of 15 and 24, which is the high-risk population for HIV/AIDS. University students are at risk because they tend to be sexually adventurous, often with multiple partners, and do not consistently use condoms.[7] Although studies show that there is increased knowledge of HIV/AIDS among young people, uptake and utilization of HIV testing and counseling services among them has been reportedly low.[7] It is therefore important that a youth-friendly counseling service such as the VCT be provided in universities in the fight against the epidemic in this high-risk population. The previous studies show that this study population is more knowledgeable on HIV/AIDS issues compared to the general population. There is, therefore, a need to investigate their knowledge and acceptance of VCT for HIV/AIDS, as well as their level of uptake of VCT services.[7] This will enable appropriate and accessible VCT services to be provided on university campuses, thereby increasing the uptake of the service among the undergraduate population.

MATERIAL AND METHODS

The study adopted a descriptive cross-sectional study design. Multistage sampling technique was used to select 425 undergraduates in the Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Stage one involved random sampling of 8 faculties among the 13 faculties in the university.[8] These faculties selected were basic medical sciences, agricultural science, technology, law, arts, dentistry, pharmacy, and social science. In the second stage, a proportionate sampling technique was used to identify the total number of students to be selected from each of the faculties. Stage three involved random sampling of 425 undergraduates from their various faculties.

Data collection was done with a self-administered questionnaire. The questionnaire had five stages: Stage I collected information on the socio-demographic data of respondents, stage II assessed respondents’ knowledge about VCT for HIV, stage III assessed respondent’s acceptance of VCT for HIV, stage IV assessed respondent’s utilization of VCT for HIV, while stage V assessed the factors influencing the utilization of VCT among respondents.

The data were checked for completeness and entered, cleared, and exported in SPSS version 25 for analysis. Descriptive statistical techniques, which include percentages, frequencies, mean, and standard deviation were used to give a clear picture of background variables such as age, sex, and other variables. Inferential statistics were also used to test the relationship between variables of the study.

An ethical clearance letter was obtained from the Human Research Ethical Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife (IPHOAU/12/2192). Verbal consent was also obtained from the students, and confidentiality of all information provided and anonymity of the respondents were maintained.

RESULTS

Four hundred and twenty-five questionnaires were administered to the respondents. The mean age of the respondents was 19 ± 2.6 years [Table 1]. Over half, 226 (53.2%) of the respondents were within the age range of 18–25 years and were majorly female 345 (81.2%). Furthermore, the majority of the respondents were Christians 374 (88%), single 403 (94.8%), and had never had sex 300 (70.6%), and over half 240 (57%) of the respondents had good knowledge of VCT. Results showed a high level of VCT acceptance among more than half, 254 (59%) of the respondents. The majority, 326 (76.2%) of the respondents had a low level of utilization of VCT [Figure 1].

Table 1: Respondents socio-demographic characteristics.
Variable Frequency (n=425) Percentage
Age
Mean=19±2.6 years
  Less than 20 years 121 28.5
  20–25 years 226 53.2
  Above 25 years 10 2.3
Sex
  Male 80 18.8
  Female 345 81.2
Faculty
  Agriculture 23 5.4
  Arts 90 21.1
  Administration 20 4.7
  Basic medical sciences 118 27.8
  EDM 30 7.1
  Education 23 5.4
  Pharmacy 24 5.6
  Social science 50 11.8
  Law 20 4.7
  Science 27 6.4
Level
  100 150 35.3
  200 57 13.4
  300 86 20.2
  400 85 20.0
  500 45 10.6
  600 02 0.5
Living arrangement
  On-campus 167 39.3
  Off-campus 258 60.7
Religion
  Christian 374 88
  Muslim 49 11.5
  Others 02 0.5
Ethnicity
  Igbo 42 9.9
  Yoruba 359 84.5
  Hausa 03 0.7
  Others 21 4.9
Marital status
  Married 08 1.9
  Single 403 94.8
  Cohabiting 05 1.2
  Others 09 2.1
Age at first sex
  Never had sex 300 70.6
  Less than 20 years 68 16
  20–24 years 56 13.2
  25 years and above 01 0.2
Average monthly allowance (in Naira)
  Below 30,000 276 64.9
  30,000–50,000 113 26.6
  51,000–100,000 24 5.7
  Above 100,000 12 2.8

EDM: Environmental design and management

Figure 1:
Knowledge, acceptance and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome.

Findings on the association between the socio-demographic characteristics of respondents and uptake of VCT showed that respondents’ age (χ2 = 55.599a, P = 0.000), gender (χ2 = 19.094a, P = 0.000), religion (χ2 = 8.990a, P = 0,038), marital status (χ2 = 8.411a, P = 0.038), and their age at first sex (χ2 = 61.847a, P = 0.000) were significantly associated with uptake of VCT. There was also a significant association between the uptake of VCT and respondents knowledge (P = 0.021) and acceptance (P = 0.000) of VCT for HIV/AIDS [Table 2].

Table 2: Association between selected socio-demographic of respondents, knowledge of VCT, acceptance of VCT, and the uptake of VCT.
Selected socio-demographic characteristics Level of uptake Total
High level (%) Low level (%)
Age
  Less than 20 years 07 (5.8) 114 (94.2) 121 χ2=55.599a
  20–25 years 87 (38.5) 139 (61.5) 226 df=13
  Above 25 years 07 (70) 03 (30) 10 P=0.000
Sex
  Male 34 (42.5) 46 (57.5) 80 χ2=19.094a
  Female 57 (20.5) 278 (79.5) 345 df=1
P=0.000
Religion
  Christianity 92 (24.6) 282 (75.4) 374 χ2=8.990a
  Islam 07 (14.3) 42 (85.7) 49 df=2
  Others 02 (100) 00 (0) 02 P=0.011
Ethnicity
  Yoruba 82 (36.8) 277 (63.2) 359 χ2=3.621a
  Igbo 11 (21.2) 31 (50) 42 df=3
  Hausa 02 (66.7) 01 (33.3) 03 P=0.305
  Others 06 (28.6) 15 (71.4) 21
Marital status
  Single 91 (22.6) 312 (77.4) 403 χ2=8.411a
  Married 04 (50) 04 (50) 08 df=3
  Cohabiting 01 (20) 04 (80) 05 P=0.038
  Others 05 (55.5) 04 (44.5) 09
Age at first sex
  Never had sex 46 (58.3) 254 (41.7) 300 χ2=61.847a
  Less than 20 years 30 (47.1) 38 (52.9) 68 df=13
  20–24 years 35 (66) 21 (37) 56 P=0.000
  25 years and above 0 (0) 01 (100) 01
Level of knowledge
  Good 48 (19.7) 196 (80.3) 244 χ2=5.297a
  Poor 53 (29.3) 128 (70.7) 181 df=1
P=0.021
Level of acceptance
  High 80 (45.9) 94 (54.1) 174 χ2=80.235a
  Low 21 (8.4) 230 (91.6) 251 df=1
P=0.000

VCT: Voluntary counseling and testing, aP<0.05

The dependent variable (uptake of VCT) was regressed on predicting independent variables of selected socio-demographic characteristics, knowledge, and acceptance of VCT. The independent variable significantly predicts the uptake of VCT (F [8,416] = 20.163, P < 0.05), which indicates that the three factors under study have a significant impact on the uptake of VCT. Moreover, R2 = 0.279 depicts that the model explains 27.9% of the variance in uptake of VCT.

In addition, in Table 3, the coefficient was further assessed to ascertain the influence of each factor on the criterion variable (uptake of VCT). Hypothesis 1 evaluates whether there is a significant association between selected socio-demographic characteristics and respondents’ level of VCT utilization. The results revealed that respondents’ age (0.002), sex (0.013), and age at first sex (0.014) had a significant association with their level of knowledge. Hypothesis 2 evaluates the association between respondents’ level of knowledge of VCT and their utilization of VCT services. The results showed a significant negative association between respondents’ level of knowledge and their utilization of VCT (B = −0.117, t = −3.236, P = 0.001). Furthermore, hypothesis 3 evaluates the association between respondents’ level of acceptance of VCT and their utilization of VCT. The results showed a significant association between the level of acceptance and utilization of VCT (B = 0.323, t = −8.575, P = 0.000).

Table 3: Regression analysis on association between selected socio-demographic characteristics of respondents, knowledge, acceptance of VCT, and VCT uptake.
Variables Level of utilization f (%) Unstandardized coefficient (B) Standardized coefficient (β) e 95% CI P-value
High Low
Age
  Less than 20 years 07 (5.8) 114 (94.2) 1.0 −0.288 0.759–1.020 0.000
  20–25 years 87 (38.5) 139 (61.5) −0.23
  Above 25 years 07 (70) 03 (30) −0.53
Sex
  Male 34 (42.5) 46 (57.5) 1.0 0.212 1.326–4.303 0.000
  Female 57 (20.5) 278 (79.5) 0.231
Religion
  Christianity 92 (24.6) 282 (75.4) 1.0 0.057 0.789–3.605 0.011
  Islam 07 (14.3) 42 (85.7) 0.44
  Others 02 (100) 00 (0) 0.78
Ethnicity
  Yoruba 82 (36.8) 277 (63.2) 1.0 0.035 0.617–1.406 0.305
  Igbo 11 (21.2) 31 (50) −0.011
  Hausa 02 (66.7) 01 (33.3) −0.015
  Others 06 (28.6) 15 (71.4) −0.022
Marital status
  Single 91 (22.6) 312 (77.4) 1.0 0.059 0.429–1.592 0.038
  Married 04 (50) 04 (50) −0.011
  Cohabiting 01 (20) 04 (80) −0.025
  Others 05 (55.5) 04 (44.5) −0.041
Age at first sex
  Never had sex 46 (58.3) 254 (41.7) 1.0 0.002 0.933–0.986 0.000
  <20 years 30 (47.1) 38 (52.9) −0.003
  20–24 years 35 (66) 21 (37) −0.006
  25 years and above 0 (0) 01 (100) −0.009
Level of knowledge
  Good 48 (19.7) 196 (80.3) 1.0 −0.142 0.254–0.716 0.001
  Poor 53 (29.3) 128 (70.7) −0.122
Level of acceptance
  High 80 (45.9) 94 (54.1) 1.0 0.444 6.081–18.525 0.000
  Low 21 (8.4) 230 (91.6) 0.385

Model summary: (F [8,416]=20.163, P<0.05, R2=0.279); VCT: Voluntary counseling and testing, CI: Confidence interval.

DISCUSSION

Findings from this study revealed that over half of the respondents had good knowledge of VCT for HIV/AIDs. This is similar to the findings of studies conducted in Nigeria, where most undergraduates had adequate knowledge of VCT.[5,6] Although the literature on the knowledge of VCT for HIV/AIDs among undergraduates in Sub-Saharan Africa is not conclusive, several studies have reported good knowledge of VCT for HIV/AIDs in the region. In a study on the knowledge of VCT among university students, the majority (93.4%) of the students were knowledgeable about VCT, which is also similar to the findings of this study.[9] A study conducted in Uganda also showed that most participants had adequate VCT knowledge of what, why, how, where, and when VCT services were conducted.[10]

In this study, there was a high level of VCT acceptance for HIV/AIDs among a majority of the respondents. However, the majority of the respondents have never gone for HIV VCT and have not visited their schools’ facilities for VCT service. These are similar to the findings of Kalimbo, where most of the respondents have never gone for an HIV VCT.[11] The previous studies have highlighted that the majority of undergraduates will not willingly accept to be tested for HIV at their school VCT facility. Several factors may attributed to this, such as not being satisfied with the facilities and manner of personnel conduct of the counseling and testing services, as also stated by over half of the respondents in this study.

These are contrary to the findings of a study conducted in Ghana, where most of the undergraduates in the study were willing to test for HIV/AIDs. However, this willingness was influenced by respondents’ gender, history of sexual intercourse, good background knowledge of HIV/AIDs and its transmission, and parental influence.[12]

The utilization of VCT in this study appears to be notably low, mirroring the findings of a similar investigation in Abia state, Nigeria, which reported a high prevalence of nonuptake of VCT among participants.[5] This study’s results indicate a significant association between respondents’ age, sex, and age at first sexual activity with the uptake of VCT. These trends align with a study conducted in Sudan, where VCT uptake was similarly low among university students and associated with factors such as age and risk perception.[13] In addition, a recent study in a southwestern state in Nigeria concurs with the current findings, highlighting a widespread low level of VCT utilization.[14] Notably, a majority of the respondents in this study have never undergone HIV/AIDS testing using VCT, and none have engaged in VCT within the past 12 months. This echoes the results of a study by Ogbonna et al., wherein the vast majority of participants had not utilized VCT in the preceding 12 months.[15] The consistency of these findings is further emphasized by a study among undergraduates in Osun state, revealing that only a small proportion of respondents had utilized the VCT centers within the school for VCT uptake. Probable reasons for the low VCT utilization may include insufficient awareness, social stigmas associated with HIV/AIDS testing, and a lack of perceived risk among the target population.[8,14] Further, research may delve into these factors to inform strategies aimed at improving VCT uptake in the context of HIV prevention, care, and treatment among university undergraduates.

CONCLUSION

In this study, the adequate knowledge and high acceptance of VCT among the majority of the respondents did not translate to the uptake of VCT for HIV/AIDS. There is a need to create more awareness of the need and benefits of VCT and innovatively encourage the use of VCT for HIV/AIDs among the undergraduate population in the study area.

Ethical approval

Ethical approval for the study was obtained from the Human Research Ethical Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife (IPHOAU/12/2192).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.

Financial support and sponsorship

Nil.

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