Acceptance Rate of Index Case Human Immunodeficiency Virus Testing and its Associated Factors Among Patients Receiving Anti-retroviral Therapy in a Public Health Facilities in Arba Minch Town,Southern Ethiopia

Abstract

Introduction

Index case human immunodeficiency virus (HIV) testing is a key strategy to identify those most at risk of acquiring HIV, with a high yield of positive cases.

Objective

To assess the acceptance rate of index case HIV testing and its associated factors among patients receiving anti-retroviral therapy in a public health facility in Arba Minch town, Southern Ethiopia, 2024.

Methods

A facility-based, retrospective study was conducted from July 1 to 15, 2024. The total sample size was 379, and a simple random sampling technique was used to select clients’ cards. Data were entered into Epi Data version 3.1 and then exported to statistical package for social science version 25 statistical software for analysis. Binary logistic regression analysis was used to check the association. Finally, significant independent associations were identified with a p-value less than 0.05 and a 95% confidence interval (CI).

Result

The acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up was 72.8% with a 95% CI (68.6–77.4). Gender [adjusted odds ratio (AOR): 2.69, 95%CI: 1.46–5.37], place of residence [AOR: 2.35, 95%CI: 1.26–4.39], WHO clinical stage I [AOR: 0.07, 95%CI: 0.01–0.59], WHO clinical stage II [AOR: 0.09, 95%CI: 0.01–0.89], duration on ART [AOR: 2.61, 95%CI: 1.23–5.55], disclosure status [AOR: 5.53, 95%CI: 2.87–10.65], and educational status of the partner [AOR: 0.12, 95%CI: 0.04–0.44] were associated.

Conclusion

Seven in 10 patients on anti-retroviral therapy follow-up accept index case HIV testing. Gender, place of residence, WHO clinical stage, duration of anti-retroviral therapy, exposure status, and spouse education were associated with HIV testing acceptance. Thus, gender identity, urbanization of the index case location, description of the index case at the WHO clinic level, reporting of cases to household members, and improving spouse education would increase acceptance

Keywords

Acceptance index case HIV testing associated factors clients on anti-retroviral therapy public health facilities

Introduction

Human immunodeficiency virus (HIV) infection continues to be a global health problem with approximately 38 million people living with HIV/AIDS worldwide, and more than 16% of them are unaware of their status. More than two-thirds of the 68% of people living with HIV live in Sub-Saharan Africa (Mwango et al., 2020; UNAIDS, 2021). Vulnerable groups face multiple challenges to accessing services, including language barriers, limited access to healthcare services, stigma, discrimination, poverty, and limited information about HIV infection (Tilahun & Mohamed, 2015). Screening tests involve asking the person who has had an HIV test to contact family members (children, spouse, sexual partner, siblings, and parents) on their initiative or with the assistance of a healthcare provider (WHO, 2015). Screening tests increase the use of HIV tests and identify partners with undiagnosed infections. This approach is an important intervention for screening people living with HIV/AIDS and for monitoring and managing their treatment and care (Harries et al., 2016).

Index case HIV testing is a key strategy to identify those most at risk of acquiring HIV with a high yield of positive cases (Tamir et al., 2015). Purpose of Index HIV Testing is a measure of HIV transmission and is a good source of information to reduce future transmission (Ministry of Health, 2022). Index case HIV testing supports partners and children of people living with HIV to access HIV testing services, thereby increasing ART adherence and promoting prevention. HIV. It also allows HIV-positive partners and children to access HIV treatment to reduce HIV infection and mortality, a positive finding (Ministry of Health, 2018).

The Ethiopian National Guidelines for Comprehensive HIV Prevention, Care, and Treatment state that client concerns should be addressed to improve the provision of services and testing for HIV-infected spouses (married and unmarried) and children (Ahmed et al., 2017; Haileyesus, 2013).

The Ethiopian National Consolidated Guidelines for Comprehensive HIV Prevention, Care and Treatment guideline recommends targeted HIV testing and the list of eligible clients for targeted HIV testing included all pregnant, laboring and post-partum women with unknown HIV status, and partners of HIV-positive pregnant/post-partum women and partners of high risk HIV negative pregnant and post-partum women, commercial sex workers and their clients, all TB patients with unknown HIV status and presumptive TB cases, all sexually transmitted infections patients with unknown HIV status, their partners and sexual networks, discordant couples, children orphaned by AIDS and vulnerable children, children with malnutrition, patients with clinical signs and symptoms of HIV/AIDS visiting health facilities, long-distance truck drivers, mobile workers and daily laborers, widowed, divorced & remarried individuals, vulnerable adolescents / youth clients (15–24 years), all under five children visiting health facilities, refugees and inmates and family planning clients with identified risk (history of having multiple sexual partner) inconsistent condom use and their partners (Ministry of Health, 2018).

Review of Literature

The nature of HIV testing and counseling regarding testing issues varies by location and client. Studies indicate that marital status, year on Ante Retroviral Theraph, adherence status, discussion about HIV testing, disclosure status to family, voluntary counseling and testing, occupational status, marital status, and knowledge about HIV transmission (Asmare et al., 2024; Edosa et al., 2022; Wegu et al., 2022). Due to the hot temperature of the environment and the place of the tourism center, the HIV status is highly dynamic. Therefore, this study assessed the acceptance rate of index case HIV testing and its associated factors among patients receiving anti-retroviral therapy in a public health facilities in Arba Minch town, Southern Ethiopia.

Methods and Materials

Study Area and Period

The study was conducted in Albaminch town. Arbaminch town is the capital of the Gamo Region. It is located 505 km south of Addis Ababa and 115 km from Wolaita Sodo, the capital of the Southern Province of Ethiopia. The city is one of the lowlands of Ethiopia and has a hot climate with an average temperature of 29'0c and an average annual rainfall of 900 mm. The estimated total population of Albaminch District in 2019/20 was 118,040. Arbaminchi Town has one general hospital, one primary hospital, and two health centers. There are currently 2,480 patients receiving anti-retroviral therapy in the study area. The study was conducted from July 1 to July 15, 2024.

Study Design

A facility-based based retrospective study design was conducted.

Source Population

All people living with HIV clients` cards were elicited for HIV index case testing at public health facilities in Arba Minch town.

Study Population

People living with HIV clients who were recruited for HIV testing in public health facilities in Arbanich town.

Eligibility Criteria

People living with HIV that had at least one index partner were included. However, clients whose information was not recorded and clients under the age of 18 were excluded.

Sample Size Determination

The sample size is calculated based on the assumption that the percentage of the population with HIV index case test acceptance is 0.377% (Tesfaye et al., 2018), a percentage reported in previous studies. It comes with a 95% confidence level and a 5% margin of error, as shown below.

n = \frac{{(\frac{z @}{2})}^{2} x p (1 - p)}{d^{2}} = \frac{{(1.96)}^{2} x 0.377 (1 - 0.377)}{({0.5}^{2}} = 360.5 \approx 361

Considering the 5% non-response rate, the total sample size is 379.

Sampling Procedure

The three public health facilities in the town were included in the study. Then, the number of ART clients enrolled in each health facility was determined as 1837 clients in Arba Minch General Hospital, 423 clients in Dilfana Primary Hospital, and 71 clients in Secha Health Center. Next, the determined number was proportionally allocated according to the total sample size, which was 305 clients from Arba Minch General Hospital, 65 clients from Dilfana Primary Hospital, and 9 clients from Secha Health Center. Finally, the client's card in each facility was selected by using a simple random sampling technique using the number on the registration book as a sampling frame (Figure 1).

Figure 1.

Sapling procedure for the acceptance rate of index case HIV testing and its associated factors among patients receiving anti-retroviral therapy in a public health facilities in Arba Minch town, Southern Ethiopia, 2024. HIV, human immunodeficiency virus.

Study Variables

Dependent Variable

Acceptance rate of the index case HIV testing.

Independent Variables

Sociodemographic Characteristics

age, sex, educational status, marital status, occupational status, and residence.

Clinically Related Factors

WHO clinical stage of the disease, duration on ART, and adherence status.

HIV-Related Characteristics of Index Case Relatives

HIV status disclosure, sex of the partner, age of the partner, educational status of the partner, linkage of the HIV-positive partner to care and treatment, index case who had children <19 years, number of children < 19 years tested for HIV, test result of children < 19 years, and linkage of the HIV-positive children < 19 years to care and treatment.

Operational Definition

Acceptance of Index Case HIV Testing

The Index case accepts family or partners for testing, and the index case accepts the positive test result. It was measured by identifying the statements written on the card and dividing them into two groups: not accepted (if written not accepted) or accepted (if written accepted) (Edosa et al., 2022).

Gender Identity

The individual`s personal perception and sense of what his or her gender is.

Data Collection Tool and Procedure

A data collection checklist (tool) was prepared by investigators from different references and assessed the ART follow-up cards and registration book (Ahmed et al., 2017; Edosa et al., 2022; Ministry of Health, 2022). The data collection from the card was done by three clinical nurses and supervised by an experienced epidemiologist.

Data Quality Assurance

Data collectors and supervisors were trained for 1 day on the objectives of the study, how to select the client card, how to maintain the confidentiality of information, how to fill out the checklist, and data quality management by the investigators. The supervisor conducted follow-ups every other day during the whole period of data collection. Every day, after data collection, each checklist was reviewed and checked for completeness by the investigators. The necessary feedback was given to the data collectors for the next day. Again, the investigators evaluated the submitted data before entering it into the software. To determine the internal validity, a Cronbach`s alpha test was conducted, and it was 0.861

Data Processing and Analysis

The data was entered into EpiData Version 3.1 and exported to the statistical package for social science version 25.0 for analysis. Descriptive statistics were computed for all variables according to the type of variable. Categorical variables were assessed by computing frequencies and proportions. A binary logistic regression model was used to determine the significant association between dependent and independent variables. First, bivariate logistic regression analysis was conducted between each independent variable and the dependent variable. A crude odds ratio along with a 95% confidence interval (CI) was used to present the results of the bivariate analysis. All variables with association in bivariable analysis at p-value ≤ 0.25 were entered into a multivariable logistic regression model to assess the adjusted association between dependent and independent variables. An enter method was used to fit a multivariable logistic regression model to identify factors remaining in the model. The adjusted odds ratio (AOR), along with a 95% CI and p-value < 0.05, was used to determine the strength of the association and to declare statistical significance in the final model. Multi-collinearity between independent variables was checked for all candidate variables by considering the variable inflation factor and tolerance. The Hosmer–Lemeshow goodness of fit test was used to check model fitness and was satisfied (p-value > 0.05). Finally, the finding was presented using texts, tables, and figures.

Result

Sociodemographic Characteristics

Three hundred seventy-nine patients` cards were reviewed, and that made the overall response rate 100%. The mean age of the patients was 35.06 with SD ± 6.438 years. Nearly half, 193(50.9%), were in the age group 35–44 years old, and the gender of 268(70.7%) were males. The residence of more than half, 235(62.0%), of the patients was urban, and 246(64.9%) were followers of the protestant religion. The marital status of 185(48.8%) was married, the educational status of 195(51.5%) was primary level, and the occupation of 127(33.5%) was employed (Table 1).

Table 1.

Sociodemographic Characteristics of the Acceptance Rate of Index Case HIV Testing Among Patients Receiving Anti-retroviral Therapy in a Public Health Facilities in Arba Minch Town, Southern Ethiopia, 2024.

Variable (379)	Response	Frequency	Percent
Age group	18–24	17	4.5
	25–34	127	33.5
	35–44	193	50.9
	45–49	42	11.1
Gender	Male	268	70.7
Gender	Female	111	29.3
Residence	Urban	235	62.0
Residence	Rural	144	38.0
Religion	Protestant	246	64.9
	Orthodox	90	23.7
	Muslim	27	7.1
	Others (Catholic, Adventist)	16	4.2
Marital status of the index client	Married	185	48.8
	Divorced	102	26.9
	Widowed	73	19.3
	Single	19	5.0
Educational status	No formal education	21	5.5
	Primary education	195	51.5
	Secondary education	126	33.2
	Diploma and above	37	9.8
Occupational status of the index client	Employed	127	33.5
	Farmer/housewife	112	29.6
	Merchant	74	19.5
	Others (daily labor, housewife, student)	66	17.4

HIV, human immunodeficiency virus.

Clinically Related Factors

Of the WHO clinical stage of less than half, 134(35.4%) were in the clinical stage of II, and the duration of ART treatment of 293(77.3%) was 12 months and above. The status of adherence for more than half, 235(62.0%), was good (Table 2).

Table 2.

Clinical-Related Factors of Acceptance Rate of Index Case HIV Testing Among Patients Receiving Anti-retroviral Therapy in a Public Health Facilities in Arba Minch Town, Southern Ethiopia, 2024.

Variable (379)	Response	Frequency	Percent
WHO clinical stage	Stage I	130	34.3
	Stage II	134	35.4
	Stage III	86	22.7
	Stage IV	29	7.7
Duration on ART	Less than 12 months	86	22.7
Duration on ART	12 months and above	293	77.3
Status of adherence	Good	235	62.0
	Fair	83	21.9
	Poor	61	16.1

HIV, human immunodeficiency virus.

HIV-Related Characteristics of index Case Relatives

Out of 379 index cases, the majority, 313(82.6%), disclosed their HIV status to their families, and the gender of 258(68.1%) was female. About 151(39.8%) of the partners were in the age group of 25–34 years old, and similarly, the educational status of 158(41.7%) partners was secondary level. Most, 346(91.3%) partners were linked to care and treatment, and More than half, 259(68.3%) index cases had children < 19 years old (Table 3).

Table 3.

HIV-Related Characteristics of Acceptance Rate of Index Case HIV Testing Among Patients Receiving Anti-retroviral Therapy in a Public Health Facilities in Arba Minch Town, Southern Ethiopia, 2024.

Variable (n = 379)	Response	Frequency	Percent
HIV status disclosure to family	Disclosed	313	82.6
HIV status disclosure to family	Not disclosed	66	17.4
Gender of the partner	Male	121	31.9
Gender of the partner	Female	258	68.1
Age of the partner	18–24 years	107	28.2
	25–34 years	151	39.8
	35–44 years	96	25.3
	45–49 years	25	6.6
Educational status of the partner	No formal education	21	5.5
	Primary level	139	36.7
	Secondary level	158	41.7
	College and above	61	16.1
The partner is linked to care and treatment	Yes	346	91.3
The partner is linked to care and treatment	No	33	8.7
The index case who had children under <19years old	Yes	259	68.3
The index case who had children under <19years old	No	120	31.7
Number of children <19 years old the index client had (n = 259)	One to three	145	56.0
	More than three	114	44.0
Number of children < 19 years tested for HIV (n = 259)	Yes	259	100.0
Number of children < 19 years tested for HIV (n = 259)	No	0	0.0
Test result of children <19 tested for HIV (n = 259)	Positive	46	17.8
Test result of children <19 tested for HIV (n = 259)	Negative	213	82.2
Linkage of the HIV-positive children to care and treatment (n = 46)	Yes	46	100.0
	No	0	0.0

HIV, human immunodeficiency virus.

Acceptance of the index Case Human Immunodeficiency Virus Testing

Out of the 379 index cases, 276(72.8%) accepted HIV testing. On the other hand, 103(27.2%) did not accept index case HIV testing (Figure 2).

Figure 2.

Acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up in public health facilities of Arba Minch town, South Ethiopia, 2024. HIV, human immunodeficiency virus

Acceptance of the index Case Human Immunodeficiency Virus Testing Regarding the WHO Clinical Stage

Out of the 379 index case patients` cards reviewed, the result indicates that 58(56.3%) of WHO clinical stage I, 34(33.0%) of WHO clinical stage II, 10(9.7%) of WHO clinical stage III, and 1(1.0%) of WHO clinical stage IV did not accept the index case HIV testing. On the other hand, 72(26.1%) of WHO clinical stage I, 100(36.2%) of WHO clinical stage II, 76(27.5%) of WHO clinical stage III, and 28(10.1%) of WHO clinical stage IV were accepted the index case HIV testing (Figure 3).

Figure 3.

Acceptance of index case HIV testing regarding WHO clinical stage among patients on anti-retroviral therapy follow-up in public health facilities of Arba Minch town, South Ethiopia, 2024. HIV, human immunodeficiency virus.

Factors Associated with the Acceptance of the index Case Human Immunodeficiency Virus Testing

In bivariable logistic regression analysis, gender, residence, WHO clinical stage, duration on ART, disclosure status, gender of partner, and educational status of the partner were associated with acceptance of the index case's HIV testing. Whereas, in multivariable logistic regression analysis; gender [AOR: 2.69, 95%CI: 1.46–5.37], residence [AOR: 2.35, 95%CI: 1.26–4.39], WHO clinical stage I [AOR: 0.07, 95%CI: 0.01–0.59], WHO clinical stage II [AOR: 0.09, 95%CI: 0.01–0.89], duration on ART [AOR: 2.61, 95%CI: 1.23–5.55], disclosure status [AOR: 5.53, 95%CI: 2.87–10.65], and educational status of the partner [AOR: 0.12, 95%CI: 0.04–0.44] were associated with acceptance of index case HIV testing (Table 4).

Table 4.

Bivariable and Multivariable Logistic Regression Analysis of Acceptance Rate of Index Case HIV Testing Among Patients Receiving Anti-retroviral Therapy in a Public Health Facilities in Arba Minch Town, Southern Ethiopia, 2024.

Variables (n = 379)	Category	Acceptance rate of index case HIV testing		COR(95%CI)	AOR(95%CI)	P-value
Variables (n = 379)	Category	Not accepted	Accepted	COR(95%CI)	AOR(95%CI)	P-value
Gender	Male	53(14.0%)	215(56.7%)	3.33(2.06–5.37)	2.69(1.46–4.95)	0.002*
Gender	Female	50(13.2%)	61(16.1%)	1	1
Residence	Urban	59(15.6%)	233(61.5%)	4.04(2.43–6.72)	2.35(1.26–4.39)	0.007*
Residence	Rural	44(11.6%)	43(11.3%)	1	1
WHO clinical stage	Stage I	58(15.3%)	72(19.0%)	1	1
	Stage II	34(9.0%)	100(26.4%)	0.04(0.01–0.34)	0.07(0.01–0.59)	0.016*
	Stage III	10(2.6%)	76(20.1%)	0.11(0.01–0.80)	0.09(0.01–0.89)	0.039*
	Stage IV	1(0.3%)	28(7.4%)	0.27(0.03–2.22)	0.22(0.02–2.15)	0.194
Duration on ART	< 12 months	13(3.4%)	73(19.3%)	1	1
Duration on ART	≥ 12 months	90(23.7%)	203(53.6%)	2.49(1.31–4.72)	2.61(1.23–5.55)	0.013*
Disclosure status	Disclosed	63(16.6%)	250(66.0%)	6.11(3.47–10.75)	5.53(2.87–10.65)	0.000*
Disclosure status	Not disclosed	40(10.6%)	26(6.9%)	1	1
Gender of partner	Male	45(11.9%)	76(20.1%)	2.04(1.28–3.27)	1.45(0.80–2.63)	0.218
Gender of partner	Female	58(15.3%)	200(52.8%)	1	1
Educational status of the partner	No formal education	13(3.4%)	8(2.1%)	1	1
	Primary level	46(12.1%)	93(24.5%)	0.20(0.07–0.58)	0.12(0.04–0.44)	0.001*
	Secondary level	29(7.7%)	129(34.0%)	0.66(0.33–1.30)	0.71(0.30–1.66)	0.431
	College and above	15(4.0%)	46(12.1%)	1.45(0.71–2.95)	1.05(0.45–2.44)	0.912

Hint: “*"= statistically significant at a p-value less than 0.05, “1”= reference group.

HIV, human immunodeficiency virus; COR, crude odds ratio; CI, confidence interval; AOR, adjusted odds ratio.

Discussion

The magnitude of acceptance rate of index case HIV testing among patients on anti-retroviral therapy follow-up was 72.8% with 95% CI (68.6–77.4). It is in line with studies conducted in Lesotho, 75% (Jubilee et al., 2019), Cameroon, 71.5% (Sanga et al., 2015), Addis Ababa, Ethiopia, 73% (Haileyesus, 2013), in Felege Hiwot referral hospital, BahirDar, Ethiopia, 74.2% (Aluisio et al., 2016). The findings may be explained by similar procedures and health policies for HIV testing, consistent with the national HIV index case testing strategy (Armstrong-Mensah et al., 2022; Jubilee et al., 2019) and the complex nature of HIV interventions, where there are many ways and dimensions to measure the effectiveness of the intervention.

However, it was lower than studies conducted in Tanzania in which 96.1% (Kahabuka et al., 2017), Zimbabwe 95% (Mahachi et al., 2019), and West Ethiopia 85.2% (Edosa et al., 2022). This difference may be due to differences in economic conditions between the study populations, differences in the size and scope of the program as it was developed in each country, and differences in the size and scope of the study setting.

On the other hand, it was higher than studies conducted at the University of Gondar hospital, Ethiopia, 39.21% (Asmare et al., 2024), at Kule Refugee Camp in Gambela region, Ethiopia, 49.3% (Wegu et al., 2022), in Addis Ababa, Ethiopia, 53% (Netsanet & Dessie, 2013), in South Africa, 62% (Joseph Davey et al., 2019). The possible explanation for this variation might be due to data in the literature, data collection methods, economic diversity in the study population, and time of initiation and learning.

In this study, gender was significantly associated with acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up. Index case patients whose gender was male were 2.69 times more likely to accept index case HIV testing compared to index case patients whose gender was female. This might be related to gender identity and sociocultural considerations in the community.

This study showed that residence was significantly associated with acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up. Index case patients whose residence was urban were 2.35 times more likely to accept index case HIV testing compared to index case patients whose residence was rural. This might be related to the living setting and the way of living, as those who live in urban areas have better exposure to information regarding the effect of early initiation of treatment and negotiating situations.

This study revealed that the WHO clinical stage was significantly associated with the acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up. Index case patients whose WHO clinical stage was stage II were 93% less likely to accept index case HIV testing compared to index case patients whose WHO clinical stage was stage I. Similarly, index case patients whose WHO clinical stage was stage III were 91% less likely to accept index case HIV testing compared to index case patients whose WHO clinical stage was stage I. This might be because fear of social stigma and poor psychological response to the disease. Also, due to the lack of awareness of the natural disease course of HIV infection to base management decisions.

This study revealed that the duration of ART was significantly associated with the acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up. Index case patients whose duration on ART was greater than or equal to 12 months were 2.61 times more likely to accept index case HIV testing compared to index case patients whose duration on ART was less than 12 months. This finding is consistent with a study done at Jimma, Ethiopia in which clients who stayed on ART for more than 2 years disclosed their HIV status were two times more likely when compared to those who stayed on ART for less than 2 years (Tesfaye et al., 2018), in the East Gojjam, North Ethiopia showed that clients on ART for less than 1 year were less likely to disclose their HIV status (Tamir et al., 2015) and in Nekemte town, West Ethiopia showed that clients on ART for greater than 1 year were 4.78 times more likely to accept index case HIV testing compared to the opponent groups (Edosa et al., 2022). This might be related to various day-to-day life activity situations encountered during the entire HIV care duration.

This study identified that disclosure status was significantly associated with acceptance of index case HIV testing among patients on anti-retroviral therapy follow-up. Index case patients who disclosed their status were 5.53 times more likely to accept index case HIV testing compared to index case patients who did not disclose their status. This finding is consistent with a study done in Addis Ababa, Ethiopia on disclosure of HIV status to family, which showed that partners who were aware were about two times more likely to accept HIV testing and counseling when compared to partners of the index clients who had not disclosed their status (Haileyesus, 2013) and also consistent with a study in Assosa town, Ethiopia in which the odds of acceptance of provider-initiated HIV testing was higher among those who planned to disclose their test results to their husbands than those who did not (Abtew et al., 2015). Similarly, it is consistent with a study done in Nekemte town, West Ethiopia, which showed that partners who disclosed were 9.74 times more likely to accept HIV testing when compared to partners of the index clients who had not disclosed their status (Edosa et al., 2022). This might be related to the pre-counseling individual awareness level and the counseling potential of the healthcare providers.

In this study, the educational status of the partner of the index case was significantly associated with acceptance of the index case's HIV testing among patients on anti-retroviral therapy follow-up. Index case patients who had no formal education were 88% less likely to accept index case HIV testing compared to index case patients whose educational status was college and above. This was supported by another study (Asmare et al., 2024). This is because, when educational status increases, client responsiveness on the index case testing service also increases. This may be because those who are attending higher education may have a variety of experiences.

Strengths and Limitations of the Study

The strength of this study includes using validated WHO standard checklist is for data collection and models for analysis. However, secondary data from the patient card was used in the study, which might cause subjective professional bias which could be the potential limitation of the study.

Implications for Nursing Practice

The study assessed and identified the important variables that can be clues for making nursing care strategies and health policies about the acceptance of index case HIV testing in nursing practice. Increasing the acceptance of index case HIV testing is the expectation and direction of the Ethiopian Ministry of Health and the World Health Organization. To have this, nurses play primary vital role for both the care and for the patient. The study identified the need for the right gender identity, the accessibility of safe residence, having clear knowledge about their own WHO clinical stage for index cases, the importance of disclosing their status to families, and the importance of education status as significant factors. In all these factors, nurses have direct contact with the patient primarily. Therefore, making nurse–patient-based strategies and implementing activities considering these identifying factors can increase the acceptance of index cases.

Conclusion

Seven in 10 patients on anti-retroviral therapy follow-up accept index case HIV testing. Gender, residence, WHO clinical stage, duration of ART, disclosure status, and educational status of the partner were significantly associated with acceptance of the index case's HIV testing. Thus, gender identity, urbanization of the index case location, description of the index case at the WHO clinic level, reporting of cases to household members, and improving spouse education would increase acceptance.

Footnotes

Acknowledgment

We would really like to thank the data collectors for scarification of their precious time.

ORCID iDs

Elias Ezo

Taye Mezgebu Ashine

Asnakech Zekiwos Heliso

Ethical Consideration

Institutional Research Ethical Review Committee of Paramed College, Arba Minch approved the proposal of this research (PC/AM/114/2016). A support letter was sent to health facilities.

Authors' Contribution

EE and MZ contributed to conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing—original draft, and writing—review & editing. TM and AZ contributed to conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing—original draft, and writing—review & editing. EE and AZ contributed to conceptualization, formal analysis, methodology, software, and writing—review & editing. EE, MZ, and AZ contributed to conceptualization, formal analysis, methodology, software, and writing—review & editing. TM and AZ contributed to conceptualization, formal analysis, methodology, software, and writing—review & editing. EE and MZ contributed to conceptualization, formal analysis, methodology, supervision, visualization, writing—original draft, and writing—review & editing. EE, MZ, TM, and AZ contributed to conceptualization, formal analysis, methodology, software, and writing—review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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