Factors associated with refusal to participate in HIV surveillance in rural KwaZulu Natal, South Africa

Mthethwa, Ncengani Abigail Celani (2014-04)

Thesis (MPhil)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Africa Centre for health and population studies (AC) their focal point on research is HIV surveillance, demography, and other contagious diseases such as Tuberculosis and sexually transmitted diseases. The Africa Centre collects demographic data from a population of 90 000 residing in bounded structure estimated at 12.000 in the Demographic Surveillance Area (DSA). In the HIV surveillance, individuals are anonymously tested for HIV at their homes by fieldworkers on annual basis through a finger prick and drop of blood is placed on filter paper. When participants are asked to give blood samples, some refuse to participate in the HIV surveillance. Knowing that is voluntary, participants are given right to refuse and records are kept in Africa Centre Demographic information System (ACDIS) so as to keep track of the number of individuals who have refused to participate in the surveillance. The objective of this study was to identify factors that make men and women of the Mpukunyoni community refuse to participate in the HIV and Health surveillance in order to devise strategies that could increase the HIV uptake so that the community members could be informed about the HIV prevalence to enable them to take special precautions about their wellbeing. Thirty (30) participants who had refused more than once between 2007 and 2012 were randomly selected from the ACDIS data base. Interviews were carried out at their homes and refusal questionnaire was used for data collection. For qualitative approach, thematic analysis was used to analyse the contextual meaning of the text while frequencies and percentages were used for participant’s demographic information. Almost 67% of participants did not show any understanding of the Africa Centre activities while 27% refused because they use their doctors for HIV testing. The study found 46% of participants refused to participate because after having been tested by Africa Centre Fieldworkers, they did not get their results Seventeen percent of the participants had never been asked to provide finger prick sample by AC field workers but they were found in the refusal list. Fear of the breach of confidentiality by Fieldworkers was reported by 18% of the participants. Another dimension which was found was 38% of participants reported that they have been asked and agreed to give their blood sample but they are recorded as refusals. Community education and awareness about health and HIV surveillance is essential to inform participants that even if they had signed informed consent for HIV testing, they would not get their HIV results and those results cannot be linked back to them as well as that the test is for measuring HIV prevalence estimates in the community. Moreover, Field workers need to be trained on the importance of accurate information when collecting data. Reviewing other strategies like incentives, need to be explored in order to increase uptake in the HIV surveillance.

AFRIKAANSE OPSOMMING: Die Africa Centre for Health and Population Studies (AC) se navorsingsfokus is op MIV-waarneming, demografie en ander aansteeklike siektes soos Tuberkulose en seksueel-oordraagbare siektes. Die Africa Centre versamel demografiese data van ‘n bevolking van 90 000. Hierdie bevolking bly in ongeveer 12 000 huishoudings in die Demografiese Waarnemings Area (DSA). As deel van die MIV-waarnemingsprojek, toets die veldwerkers jaarliks individue anoniem vir MIV. Hierdie toets word tuis gedoen deur ‘n vingerprik en ‘n druppel bloed van die deelnemer word op ‘n filtreerpapier geplaas. Hierdie opname is vrywillig en sommige deelnemers weier deelname aan die opname. Die Africa Centre hou ‘n rekord in die Africa Centre Demographic Information system (ACDIS) van deelnemers wat deelname geweier het. Die doel van die studie was die identifisering van faktore wat mans en vrouens van die Mpukunyoni gemeenskap deelname laat weier aan die MIV- en gesondheidswaarnemingsprojek, om sodoende ‘n strategie te beding wat kan help om die toestemming tot MIV-toetsing te verhoog. Nog ‘n rede is sodat die gemeenskapslede beter ingelig kan wees oor die voorkoms van MIV en die insidensie daarvan, sodat hulle beter voorsorg kan tref om na hulle eie gesondheid om te sien. Dertig deelnemers wat alreeds meer as een keer deelname geweier het tussen 2007 en 2012, is gekies van die ACDIS databasis. Onderhoude is gedoen deur die vrae op die weieringsvraelys aan die deelnemers te stel. Vir die kwalitatiewe analise is tematiese analise gebruik om die kontekstuele bedoeling van die teks en die frekwensies en persentasies is gebruik vir die deelnemer se demografiese informasie. Bykans 67% van die deelnemers verstaan nie die Africa Centre se aktiwiteite nie, terwyl 27% weier omdat hulle hul eie dokters gebruik vir MIV-toetsing. Daar is verder gevind dat 46% van deelnemers deelname weier aan die MV-waarnemingsprojek omdat hulle nie hulle toetsuitslae kry nadat hulle deur Africa Centre veldwerkers getoets is tydens tuisbesoeke nie, selfs nadat hulle meegedeel is dat die toetse anoniem is. 17% van die deelnemers was nog nooit deur Africa Centre veldwerkers gevra om ‘n vingerprik te doen om ‘n monster te gee nie, alhoewel hulle name op die lys verskyn van deelnemers wat geweier het. Vrees dat veldwerkers nie konfidensialiteit sal handhaaf nie is deur 18% van die deelnemers ge-opper. Die resultate toon dat 38% ingestem het om te toets, maar hulle is gelys as deelnemers wat geweier het. Gemeenskapsopvoedig en bewusmaking oor gesondheid en MIV-waarneming is belangrik om deelnemers in te lig dat selfs indien hulle ‘n toestemmingsvorm geteken het vir MIV-toetsinge, hulle nie hulle toetsuitslae sal ontvang nie en dat die uitslae nie aan hulle gekoppel kan word nie. Dit is verder belangrik dat hulle verstaan dat MIV-toetsing gebruik word om MIV voorkoms in die gemeenskap te bepaal. Veldwerkers moet goed opgelei word in die belangrikheid daarvan om korrekte inligting te versamel. Die hersiening van ander strategieë soos aansporings moet ondersoek word om deelname aan die MIV-waarnemingsprojek te verhoog.

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