LIRA UNIVERSITY

P.O. Box 1035

Lira, Uganda
Tel: +256 -0414-694716
Email: [email protected]
Web: www.lirauni.ac.ug

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

Research report

Factors influencing uptake of Voluntary HIV

Counseling and Testing among students in
Abongomola Seed Secondary School, Kwania
District.

Atim Romeo
2021

i
APPROVAL

This report has been submitted to Faculty of Health Sciences of Lira University with my approval
as the University supervisor

Signature…
……………………………Date…1/11/2021……………………………….

Dr. Omech Bernard

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TABLE OF CONTENTS

Contents
Research report ............................................................................................................................................. i
LIST OF TABLES ..................................................................................................................................... vi
LIST OF FIGURES .................................................................................................................................. vii
ABSTRACT ................................................................................................................................................ xi
1.1 BACK GROUND ...................................................................................................................... 13
1.2 PROBLEM STATEMENT ............................................................................................................ 14
1.3 OBJECTIVES OF THE STUDY ................................................................................................... 15
1.3.1 MAIN OBJECTIVE ................................................................................................................ 15
1.3.2 SPECIFIC OBJECTIVES ....................................................................................................... 15
1.4 RESEARCH QUESTIONS ............................................................................................................ 15
1.5 SCOPE OF THE STUDY ............................................................................................................... 16
1.6 SIGNIFICANCE OF THE STUDY............................................................................................... 16
1.7 JUSTIFICATION OF THE STUDY ............................................................................................. 16
1.8 CONCEPTUAL FRAMEWORK .................................................................................................. 17
1.8.1 THE NARRATIVE FRAME WORK .................................................................................... 17
CHAPTER TWO LITERATURE REVIEW ......................................................................................... 19
2.1 INTRODUCTION........................................................................................................................... 19
2.2. Overview of uptake of voluntary HIV counseling and testing services in Uganda .................. 19
2.3. Factors associated with uptake of voluntary HIV counseling and testing services by
secondary school students. ................................................................................................................... 20
2.3.1 Individual factors ..................................................................................................................... 20
2.3.2 Health facility factors............................................................................................................... 21
2.3.3 Community related factors ..................................................................................................... 21
2.5 Summary of literature review ........................................................................................................ 21
CHAPTER THREE RESEARCH METHODOLOGY ......................................................................... 23
3.1 Introduction ..................................................................................................................................... 23
3.2 Study design..................................................................................................................................... 23
3.3 Study site and setting ...................................................................................................................... 23
3.4 Study populations............................................................................................................................ 23

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 3.5 Study procedure .............................................................................................................................. 24
3.6 Sample size determination.............................................................................................................. 24
3.7 Eligibility criteria ............................................................................................................................ 25
3.7.1 Inclusion criteria ...................................................................................................................... 25
3.7.2 Exclusion criteria ..................................................................................................................... 25
3.8 Sampling procedure ........................................................................................................................ 25
3.11 Method and instruments .......................................................................................................... 26
3.12.1 Data entry and data cleaning. ............................................................................................... 27
3.12.2 Data analysis ........................................................................................................................... 27
3.13 Data Quality Control Issues (Validity and Reliability Issues). ................................................. 28
3.14 Ethical considerations ................................................................................................................... 28
3.15 Anticipated Study Limitations and Solutions. ............................................................................ 28
CHAPTER FOUR..................................................................................................................................... 30
RESULTS .................................................................................................................................................. 30
4.0 Introduction ..................................................................................................................................... 30
4.2 Awareness of VCT services by students ........................................................................................ 32
4.2.1 Knowledge of students on VCT .............................................................................................. 32
4.3 Health facility related factors......................................................................................................... 36
4.4 Community related factors ............................................................................................................ 38
CHAPTER FIVE ...................................................................................................................................... 41
DISCUSSION OF RESULTS .................................................................................................................. 41
5.0 Introduction ..................................................................................................................................... 41
5.2 Awareness of VCT services ............................................................................................................ 41
5.2.2 Attitudes of respondents .......................................................................................................... 42
5.3 Health facility related factors......................................................................................................... 43
5.4 Community related factors ............................................................................................................ 44
CHAPTER SIX ......................................................................................................................................... 46
CONCLUSION AND RECOMMENDATIONS .................................................................................... 46
6.0 Introduction ..................................................................................................................................... 46
6.1. Conclusion ...................................................................................................................................... 46
6.2 Recommendations ........................................................................................................................... 46
6.2.1 To Ministry of Education and Sports ..................................................................................... 46
6.2.2 To school Administrators ........................................................................................................ 46

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 6.2.3 To the future researchers ........................................................................................................ 47
REFERENCES .......................................................................................................................................... 48
APPENDICES ........................................................................................................................................... 54
Appendix I: Informed consent/assent form ........................................................................................ 54
Appendix II: Questionnaire ................................................................................................................. 55
Appendix VI: Work plan and Timeframe 2021 ................................................................................. 58
Appendix VII: Budget .......................................................................................................................... 59
Appendix VI . Acceptance Letter ................................................................................................... 60
Appendix x: The sketch map of the abongomola subcounty............................................................. 61

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LIST OF TABLES
Table 1 Distribution of the socioeconomic and demographic characteristics of respondents by sex 30
Table 2 Bivariate analysis for the association between socio-demographic and utilization of VCT . 31
Table 3 Multivariate analysis for the association between Demographic factors ............................... 32
Table 4 Shows knowledge of students on VCT....................................................................................... 32
Table 5 attitudes of students towards VCT service utilisation ............................................................. 35
Table 6 Bivariate analysis for the association between knowledge and utilization of VCT ............... 36
Table 7 Bivariate analysis for the association between Health facilities related factors .................... 37
Table 8 Multivariate analysis for the association between Health facilities related factors .............. 38
Table 9 Bivariate analysis for the association between communities related factors ......................... 39
Table 10 Multivariate analysis for the association between communities related factors ................. 39

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LIST OF FIGURES
Figure 1. A conceptual frame work ............................................................................................................ 17
Figure 2 Sources of information on VCT................................................................................................ 34
Figure 3 Experience of student when they went for VCT ..................................................................... 36

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ACKNOWLEDGEMENTS

First I acknowledge the Almighty God who made it possible for me to come up with this study
topic amidst challenges about me with minimal social constraints encountered during my
education. I also tenderly thank Dr.Omech Bernard for his tireless kind-hearted academic
supervision and criticism that led to this success.

I am grateful to the staff of Public health department, Lira University for enabling a supportive
environment. I am affectionately obliged to my Class mates, colleagues at work place and friends;
Obura Jimmy, Udo Sam, Tino Irene, Anyanti Dickens, Acio Eveline, Ojara Patrick, Okellira
Humphreys, Okwir George, Aliro Omara, Aweri Christian, Ocen Andrew, Oruk James, Aceng
Docus, Ojok Sam, Akello Grace and Opio Alex who supported me academically, socially and
morally by giving me words of encouragement.

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ABBREVIATIONS AND ACRONYMS

I.E. - See.

KAP - Knowledge, Attitude and Practices

MIP - Malaria in pregnancy

UAC - Uganda Aids Commission.

UDHS - Uganda Demographic Health Survey

VCT - Voluntary counseling and testing

VHTs - Village Health Teams

WHO - World Health Organization

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OPERATIONAL DEFINITIONS

Utilization; This is the action of making practical and effective use of VCT

Knowledge; These are facts, information about VCT

Attitude; This is a settled way of thinking or feeling about VCT

Assent; is a term used to express willingness to participate in research by persons who are by
definition too young to give informed consent but are old enough to understand the proposed
research in general, its expected risks and possible benefits, and the activities expected of them
as subjects.

Mortality; Refers to the state of being with no evidence of life.

Morbidity; Refers to the unhealthy state of an individual.

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ABSTRACT
Background : Voluntary counseling and testing (VCT) for HIV is key to HIV/AIDS prevention
efforts. The current prevention measures including abstinence, avoidance of multiple sexual
partners, condom use, and treatment of HIV-infected individuals and male circumcisions requires
on high coverage and acceptability of VCT services in all age groups. However,the uptake of
VCT services is still low particularly in schools in Uganda.

Objective: To assess factors influencing uptake of Voluntary HIV Counseling and Testing among
students in Abongomola Seed Secondary School, Kwania District. So as to inform the policy
direction in the Uganda health sector and the district health department to improve the utilization
of VCT among Students.
Methodology: A cross sectional survey employed quantitative techniques. Where was the study
done? Simple random sampling was used for selection of the study participants. structured
questionnaires was used to collect data Data entry and analysis was done using Statistical package
for Social Scientists (SPSS) version 20. Univariate analysis was performed to ascertain frequencies
and percentages to describe variables while bivariate and multivariate analyses were performed
using chi-square determine independent factors influencing uptake of VCT.

Results

One hundred forty-seven questionnaires (390) were given out to the respondents, three hundred
eighty-two (382) were filled and returned and this gave a response rate of 97.9%. More than three
quarter of the students (89.8%) had ever heard of VCT. Eighty one point two (81.2%) of
respondents were unable to tell what VCT was. Age and class of students were found to be
influencing utilisation of VCT services (p-value<0.05)

About only a quarter of students (24.3%) had ever utilized VCT services. Health facility was the
point of VCT service delivery which was mostly used (75.7 %). Radio is the dominant source of
information on VCT to students as reflected by 44% of students obtained information over the
radios.

The study found that VCT services at health facilities are provided after more than sixty minutes
(66%) and all most every student (86%) who had ever used VCT services reported that health
workers were not friendly. Majority of the students (58.9%) reported that their homes were more

xi
than two kilometers (2km) from the health facilities. Having separate VCT unit, time at which
VCT services are provided and how fast a client is served are significantly associated with
utilisation (p-value<0.05).

Three quarter of students (70.4%) lacked access to information on VCT utilization in the school,
Majority of students (28.17%) are prevented from utilizing VCT services by stigma and
discrimination. Sensitizing the school community about VCT services and having ever been
guided on VCT are influencing utilisation of VCT as confirmed by p-value less than 0.05

CONCLUSION
This study showed high utilisation of VCT services among students and the research findings
further revealed that majority of the respondents possessed good knowledge of VCT, positive
attitudes towards VCT services. This study further show that Age, class of students, having
separate VCT unit, time at which VCT services are provided and how fast a client is served as the
factors that are significantly associated with Uptake of VCT services.

Key words
VCT services, HIV, infection, school, students, Abongomola Seed Secondary School and Kwania
District.

xii
 CHAPTER ONE: INTRODUCTION

This chapter provides an overview of the nature of this study. The research problem which had
been identified is described in detail, research questions, significance of the study, scope of the
study as well as the justification of this study.

1.1 BACK GROUND

HIV/AIDS remains a pandemic of public health interest, globally it is estimated that 38.0 million
people worldwide have been infected with HIV. It is estimated that 5.0 million young people
aged 10-24 years are living with HIV worldwide, with over 460,000 new HIV cases occur
among young people aged 10-24 years. Globally, only 35% of young people were aware of their
HIV status in 2015 (Joint United Nations Programme on HIV/AIDS).

AIDS is the leading cause of death among young people in Africa (Jr & H,2011). Sub-Saharan
Africa, particularly Southern Africa, remains the region most heavily affected by the epidemic.
In 2019, sub-Saharan Africa accounted for approximately 68 per cent of people of all ages living
with HIV and 88 per cent of children and adolescents living with HIV worldwide (Mpango et al.,
2017). In sub-Sahara Africa only 13%of the female and 9% of the male of the young people had
ever tested for HIV and received their results in the last 12 months.

In Uganda, about 170,000 young people are living with HIV and yet young people are key in
achieving HIV target in Uganda (Mafigiri et al., 2017). HIV has disproportionately remained a
challenge in secondary students aged 10-24 years, as these young people are victims of various
risky behaviors due to the body transformation changes from childhood to puberty and
adulthood.

The sources reveal that 39.4% of young people (15-24) had tested and received their HIV results
in the past 12 months in Uganda (Uganda Bureau of Statistics (UBOS) and ICF, 2017).

Some studies have pointed out that low VCT uptake could be associated with knowledge and
attitude towards VCT services, engagement in sexual relations, and fear of HIV results among
others. Despite the availability of these services, their uptake among secondary school students
remains low

13
The government of Uganda through the Ministry of Health adopted both the community-
based and facility-based HIV counselling and testing(Ministry of Health (Uganda), 2018).
However, the uptake of HTS in health facilities and community-based approaches has
remained low by secondary school students. This has been attributed to attitude of
healthcare workers, fear of stigmatization, and fear over HIV test confidentiality(Avert,
2019). Additionally, institutional groundings towards offering comprehensive HTS to
young people also constitutes a major barrier to provision of HTS although this is not well
documented (Wanyenze et al., 2017).

More efforts are still needed in terms of repositioning health facilities to accommodate all
persons regardless of their occupation, sexual orientation and age category. Additionally,
factors such individual and institutional biases that hinder young people from accessing
health facilities need to be studied and addressed(Matovu et al., 2019; Wanyenze et al.,
2017).There is scanty literature on the uptake of voluntary HIV testing and counseling
services by secondary school students in Uganda. Kwania District has a host of health
facilities with capacity to reach out to secondary students and yet little is known about
accessibility of these facilities by secondary students. The purpose of this study is to assess
factors influencing uptake of voluntary HIV counseling and testing among secondary
students aged 10-24 years in Kwania District.

1.2 PROBLEM STATEMENT

Utilization of Voluntary HIV Counseling and Testing (VCT) remains low among students and this
makes it one of the most important causes of HIV/AIDS morbidity and mortality in northern
Uganda (Z. Sanga et al., 2015). Despite low uptake of these being in all populations of different
age groups, young people particularly secondary school students have a very low uptake of these
services and yet they are more vulnerable to HIV acquisition because of their sex behaviors and to
much excitement in worldly things (Nuwaha et al., 2011).

Secondary school students are subject of stigma, denial and judgmental tendencies from health
care provides from various health institutions who advocate for abstinence strategy in HIV
prevention among secondary students. Nonetheless the government of Uganda through the
Ministry of Health and other stake holders in the field of HIV has adopted both the community-

14
based and facility-based HIV counselling and testing to increase access of HIV testing and
counseling to all categories of people irrespective of sex , occupation age among other, through
government aided facilities, non-governments organization and village health teams (VHT),
however utilization of the services by student at secondary schools is still minimal compared to
the community members which makes it difficult to attain the global target of total reduction in
numbers of HIV cases by 2030. Therefore this study seeks to dig out a clear understanding of the
barriers and facilitator towards uptake of voluntary HIV counseling and testing services by
secondary students in Kwania District in Northern Uganda.

1.3 OBJECTIVES OF THE STUDY

1.3.1 MAIN OBJECTIVE
To assess factors influencing uptake of Voluntary HIV Counseling and Testing among students in
Abongomola Seed Secondary School, Kwania District.

1.3.2 SPECIFIC OBJECTIVES

1. To assess the awareness of VCT services by secondary students in Abongomola,
Kwania District.
2. To assess health facility related factor influencing uptake of voluntary uptake of HIV
counselling and testing services by secondary school students in Abongomola, Kwania
District.
3. To assess community related factor influencing uptake of voluntary uptake of HIV
counselling and testing services by secondary school students in Kwania District.
1.4 RESEARCH QUESTIONS
1. To what extent are the students aware of VCT services secondary school students in
Abongomola, Kwania District?
2. What are the health facility related factors associated with the uptake of voluntary HIV
counselling and testing among secondary school students in Abongomola, Kwania
District?
3. What are the community factors associated with uptake of voluntary HIV testing
services among secondary school students in Abongomola, Kwania District?

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1.5 SCOPE OF THE STUDY
The study assessed factors influencing uptake of Voluntary HIV Counseling and Testing among
students in Abongomola Seed Secondary School, Kwania District. This was because students were
normally at risk of HIV/AIDS infection within communities in Uganda. Abongomola Seed
Secondary School was the first and the only secondary in the Sub-County aided by Government
and had a population of 813 students. The study was conducted in June to July 2021

1.6 SIGNIFICANCE OF THE STUDY

Due to the fact that above research questions were pending, the findings of this study are beneficial
to program development, implementation or evaluation which can be applicable to researchers and
health evaluators as well.

The research findings are beneficial for the Management of health care facilities, Government and
stakeholders of Secondary Schools in Kwania District.

The research outcome provided information that can be used for designing HIV/AIDS control
program i.e. VCT utilization and interventions that would focus more on the population at risk and
the vulnerable members of the community particularly the students.

1.7 JUSTIFICATION OF THE STUDY

Voluntary HIV counselling and testing is vital in HIV prevention, treatment and control in a way
to meet the global HIV target. However there was low uptake of voluntary HIV counseling and
testing services by secondary school students. There is scanty literature on uptake of voluntary
HIV counselling and counselling services particularly among secondary school students in
Uganda, therefore this study seeks to understand level of uptake of voluntary HIV counselling and
testing services and associated factors among secondary school students aged 10-24 years in
Kwania District.

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 1.8 CONCEPTUAL FRAMEWORK

Awareness
Community related
Knowledge about factors
HIV.
Traditional practices
Awareness
Stigma &
Attitude discrimination
VCT
utilization

Sociodemographic factors Health service factors

Age Physical Accessibility

Sex Availability of the service

Educational status Service cost

Reduce new infections

Figure 1. A conceptual frame work

1.8.1 THE NARRATIVE FRAME WORK

A number of factors have been shown to influence VCT utilization as discussed below.

Individual factors Like Knowledge regarding voluntary HIV counseling and testing utilization
which includes; media for creating awareness, misinformation, and misconception. This greatly
contributes to the decision making of an individual, low knowledge leads to a low utilization of
voluntary HIV counseling and testing.

17
Attitudes regarding VCT utilization that covers beliefs, norms, and the challenges/barriers attached
among students in Abongomola seed secondary school. Poor attitude will be a great challenge to
VCT utilization.

Socio-demographic factors like; Age, Sex, level of education, family size, and ethnicity which
greatly influence knowledge, attitude and awareness on VCT utilization.

Health service factors like Physical Accessibility, Availability of the service, Service cost leads
to either good or poor VCT utilization.

Community related factors like Traditional practices, Stigma & discrimination may make the
students not to utilize VCT services

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 CHAPTER TWO LITERATURE REVIEW
2.1 INTRODUCTION

This chapter reviewed literature in relation to; the various VCT services, level of uptake of
voluntary HIV counseling and testing services by secondary school students, the factors associated
with uptake of voluntary HIV counseling and testing services by secondary students.

2.2. Overview of uptake of voluntary HIV counseling and testing services in Uganda

HIV counseling and testing is key in HIV prevention and control, Uganda through the ministry of
health adopted this model of voluntary HIV counseling and testing programme in Africa and this
has expanded to some of the districts of Uganda, voluntary HIV counseling and testing has been
mainly provide through facility and home based models, (Rhoda k Wanyenze et al, 2013). VCT is
client-initiated, as opposed to provider-initiated testing and counseling (PITC) when health care
providers initiate discussion of HIV testing with clients who are seeking health care for other
reasons. VCT approaches include; routine HIV counseling and testing where the client goes to the
facility willingly, home-based VCT, use of community-based lay counselors, student counselling
and testing and same-day mobile VCT. These approaches have never been ideal for most young
students attending secondary schools (M. Sanga, 2015).

In a population-based cross-sectional on voluntary HIV counselling and testing among men in

rural western Uganda; implications for HIV prevention, (Francis M Bwambale et al, 2008) showed
that overall VCT use among men was low, thus there was need in boosting promising intervention
such as routine counselling and testing for HIV of patients seeking health care in health units,
home-based VCT programmes, and mainstreaming of HIV counselling and testing services in
community development programmes.

VCT uptake among young people especially students is generally low (WHO, 2013). A cross
sectional study conducted among secondary school students in Arusha city, Tanzania, 93.5%
participants were aware of VCT services, 79.1% had high knowledge and 75.9% had positive
attitude while only 29.3% had ever tested (Sanga et al, 2015). This is mere evidence that despite
high knowledge and awareness about VCT services, very few students go ahead to utilize these
services. Another study conducted in Western Uganda found out that VCT uptake was low among

19
males compared to females (Bwambale et al., 2008) and consistent results were got from a study
among adolescent high school girls in Ethiopia (Gatta et al., 2011). This perhaps was due to little
involvement of men in HIV prevention and hence our study considers gender factors.

However, in a trial protocol study conducted in Tanzania to compare opt in and opt out strategies
among young people, VCT uptake was significantly higher (Baisely et al, 2012). But, this uptake
was notably higher among communities who were offered opt out strategies. Same results were
obtained from several studies in Sub Saharan Africa (Leon et al., 2010, Creek et al., 2007, Bassett
et al., 2007, Luganda et al., 2010). In contrast, this was an interventional study as compared to my
study which will be cross sectional. Associated factors included inadequate knowledge of HIV
acquisition, increasing life time partners, attitude among others .In addition, low uptake among
students could be due to information gap where by most schools fail to sensitize or teach the
students about the existence of VCT services (Sanga et al, 2015).
2.3. Factors associated with uptake of voluntary HIV counseling and testing services by
secondary school students.
2.3.1 Individual factors
Some studies have suggested some inhibitors to uptake of VCT services and these include fear of
test results, inadequate knowledge and attitude on VCT, stigma and distance to the VCT centers,
engagement in sexual relations among others (Sanga et al, 2015, Baisely et al, 2012). In addition,
low VCT uptake was also linked to some socio demographic factors. Age was suggested by some
studies (Sanga et al, 2015, Haddson et al, 2012), level of education in others (Sanga et al, 2015,
Wringe et al., 2007) and also gender where by low VCT uptake was reported among males
(Bwambale et al., 2008, Gatta et al., 2011).

Fear of stigma was also reported as one of the barriers to VCT uptake in some studies (Sanga et
al, 2015, Wringe et al., 2007). A study conducted among students (18-24) in Kwazulu Natal,
knowledge of VCT was significantly high (Njagi et al., 2006). This was due to the participants’
desire to know their own statuses and their perceptions of risk. But in the same study, a significant
number were an aware of their statuses.

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2.3.2 Health facility factors

Teklehaimanot et al., 2016 revealed that the factors including walking distance to the nearest health
facility, unwelcoming attitudes of the health workers reduce the drive to go to the facilities for
VCT. This coincided with a study done on factors influencing the uptake of voluntary HIV
counseling and testing among secondary school students in Arusha city, Tanzania, Among 374
respondents revealed that, 358 (95.7%) rated distance as among the factors influencing VCT
uptake. Those who reported that, the VCT centre was near their area were 60% more likely to test
for HIV than those who rated it as far (OR = 1.6; 95% CI = 1.0-2.5; p = 0.034).
2.3.3 Community related factors

Low uptake of voluntary HIV counseling and testing services in general population may be
associated with a perception of low risk of HIV infection, in a study on HIV testing and risk
perception among secondary school students in Kampala, Uganda (George Aluzimbi et al 2017),
showed that students were more fearing pregnancy rather than HIV, still students behaviors were
more influenced by peers and facilitated by alcohol to engage in unprotected transactional sex in
settings which provide proximity to potential HIV exposure.
Inadequate comprehensive knowledge about HIV among young people in Uganda is still a
hindrance in the efforts towards HIV prevention. Results from the Lot Quality Assurance sampling
in Northern Uganda in 2018 showed that comprehensive knowledge among young people (15-24)
remain as low as 33.3% and 29.3% among men and women respectively (UAC, 2018). This is
much lower than the National Strategic Plan baseline target. And as much as 21% boys and 28.1%
girls have sexual debut by age 15. This suggests that Ugandan youth are vulnerable and factors
like knowledge and engagement in sexual relations could indicate the need of VCT services in
schools.

2.5 Summary of literature review

The literature studies above have been conducted elsewhere in different settings/countries and the
findings cannot be used for effective intervention in Abongomola, Kwania District. Some studies
(Baisley et al., 2012, Sanga et al., 2015) investigated the level of uptake of VCT services among
young people. Likely predictors of VCT uptake in most of the studies included socio demographic
factors like age, level of education, place of residence and other factors like desire to know ones
status, knowledge about VCT, involvement in sexual relations among others. Therefore this

21
research will unearth the factors influencing uptake of Voluntary HIV Counseling and Testing
among students in Abongomola Seed Secondary School, Kwania District and will be used to plan
for an effective intervention to address the HIV/AIDS of students so that the intervention becomes
effective.

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 CHAPTER THREE RESEARCH METHODOLOGY
3.1 Introduction
This chapter describes the research study design, study site/area and setting, study procedure, study
population, sample size determination, sampling techniques, eligibility criteria, data management,
data collection techniques/methods and instruments, data entry, data cleaning, data analysis,
measurement of variables, quality control, ethical considerations, study limitations and
delimitations.

3.2 Study design

The study used a descriptive Cross-sectional study design. This was because it gives an accurate
account of the characteristics of particular phenomenon or situation, community or person (Bless
and Achola, 1988). A descriptive study involves the systematic collection and presentation of data
and this study collected quantitative data by use of structured questionnaires to meet the objective
of the study.

3.3 Study site and setting

The study was conducted in Abongomola Seed Secondary School, Kwania district. Kwania district
is located in northern Uganda approximately 250km (direct) from Kampala. Kwania lies between
longitudes 32° E and 34° E and latitudes 2° N and 3° N, at an average altitude of 1150 m above
sea level with 11% of the district consisting of open swamps(Okia et al., 2018). It is bordered by
the districts of Kole in the North, Dokolo in the East, Apac in the West, and Amolatar district in
the South through Lake Kwania and Kyoga respectively. The district covers a total area of 2847
km2 of which 11% is under open water while 15% is under forest living 76% for human settlement.
(Okia et al., 2018). Kwania is predominantly inhabited by Lango tribe. The National Population
and Housing Census (2002) revealed that there were a total of about 817 micro-scale enterprises
in Kwania District with Abongomola sub-county constituting 37.69% of it. The economic
activities which take place in Kwania District are Fishing, constructions activities, trade, market
vending dealing on cooked and uncooked food stuff, transportation among others. The population
of Kwania district are served by both private for profit, privet not for profit and public health
service providers.

3.4 Study populations

The study population were Students at Abongomola Seed Secondary School, Kwania District.

23
3.4.1 Target population
All students who were attending Abongomola seed secondary school aged 10-24 years
3.4.2 Accessible population
All students who were present during the time of our study
3.5 Study procedure
Using the permission granted by the university through a data collection permission letter which
was given upon the approval of the research proposal, data collection activities commenced. The
letter was presented to Abongomola seed secondary school authority to seek for their permission
as well as making an appointment before the actual date of data collection.

Here the questionnaires were pre tested in Amuca SDA Secondary School, Lira District where the
actual data collection was not carried out from. Repetitions, overlapping response options and
other inconsistencies in the tools were identified and corrections were then made to ensure that
relevant data was collected.

The questionnaires were self-administered (by the researcher) to the selected research participants
(to answer by filling in the blank spaces accordingly) in the schools, collected and kept by the
researcher immediately after the study such that no unauthorized individual gets access to them.
Probability based sampling technique was employed. Simple random sampling to select the
proportional number of participants (students).

3.6 Sample size determination

The sample was determined using Leslie Kish formula (1965) for single proportion.

n = (Zα/2)2.pq/d2
Where

n = Estimated sample size

Zα/2=confidence level of significance for a 95% to confidence interval (Zα/2=1.96)

P= percentage of VCT utilization among secondary school student 64.3% (Z Sanga 2015)

q= (1-p), probability of VCT low utilization occurring, (1-0.643) = 0.357

d= precision of the study which is 5% (0.05)

24
n=(1.96x1.96x0.643x0.357)
(0.05x 0.05)

n ≈ 354

Due to non-response anticipated in the study limitations, 10% of 354 will be added to make 389
respondents.

Hence n = 389 participants

3.7 Eligibility criteria

All students found present at school during the study period.

3.7.1 Inclusion criteria

All students aged 10-24 years found present at school were included in the study
3.7.2 Exclusion criteria
 All students who were out of school did not participate in the study.
 All those students who were very ill and unable to talk did not take part in the study.
3.8 Sampling procedure
Abongomola seed secondary school was purposely selected from all the schools in Kwania sub-
county, Kwania district.
A simple random sampling technique was used following a given list of all students with details
of all students (~800) attending Abongomola seed secondary school. An approximation of 20 study
participants were interviewed each day and this took 18 days to hit the study population. Following
the systematic frame work the sample interval was determined by dividing sample population by
the expected number of participants each day (354/20) = 18 sample interval. The first study
participant was selected randomly by performing lottery and the subsequent participants were
picked following the sampling interval of 18, and every 18th person were included in the study
provided he /she met the criteria. The sampling frame was obtained from the student registration
books of the schools. This sampling procedure was selected to achieve the target sample population
with limited resources and time.

25
3.9 Study variables
3.9.1 Dependent variable
 Level of uptake of voluntary HIV counselling and testing services by students of
Abongomola seed secondary school, Kwania District.
3.9.2 Independent variables
 Social-demographic factors (age, sex, level of education, place of residence)
 Awareness of VCT Health facility related factors like Accessibility of VCT services
 Community related factors like Stigma and fear of test results
3.10 Study outcomes
3.10.1 Primary outcome
Extent of uptake of voluntary HIV counselling and testing services by secondary school
students
3.10.2Secondary outcome
 Social-demographic factors (age, sex, level of education, place of residence)
 Individual factors like Attitude, knowledge
 Health facility related factors like Accessibility of VCT services
 Community related factors like Stigma and fear of test results
3.11 Method and instruments
Upon an Informed consent, structured questionnaire were administered in a quiet, safe place
observing high levels of confidentiality and comfort of the study participant. Students gave their
responses under the guidance of the researcher.

3.11.1Data collection tools

The study used interviewer administered structured questionnaire contains four sections; social-
demographic section, section on Individual related factors, Health facility related factors and
community related factors on the uptake of voluntary HIV counselling and testing services by
Abongomola Seed secondary school students, Kwania District. All questions in this questionnaire
had corresponding answers on to them therefore the study participant chose from these
alternatives.

3.12 Data management

26
At the end of each data collection date, questionnaires were checked for completeness and those
with incomplete field with be recalled for correction. Entry of data in statistical analysis software
were done to ensure accuracy in data entry. Data cleaning was done before commencement of data
analysis using SPSS.

3.12.1 Data entry and data cleaning.

The Questionnaires were filled and checked by the researcher to ensure accuracy and completeness
of the information collected. Quantitative data were entered using SPSS. Statistical command were
made to identify the missing data, to check for mistakes and made corrections during entry accordingly.

3.12.2 Data analysis

3.12.3 Quantitative data Analysis.
Data analysis was done using SPSS (Statistical Package for Social Sciences) version 20 computer
software. The data analysis composed of univariate analysis where descriptive statistics of the
socio-demographic characteristics, Individual related factors, Health facility related factors and
Community related factors of the respondents will be analyzed and presented using absolute
numbers, simple percentage, range and measures of central tendency (mean, mode) where
appropriate. A bivariate analysis was used to describe the association between variables.

3.12.4 Univariate Data Analysis.

At univariate level of analysis, frequency distribution and percentages were presented in form of
tables, charts, graphs and texts after analysis by using statistical package for social scientists
(SPSS) version 20. Frequencies and percentages were generated to describe the data. Data were
presented in form of tables, charts, texts and graphs
3.12.5 Bivariate Data Analysis.

At the bivariate level, the independent variables (socio-demographic, Individual related factors,
Health facility related factors and Community related factors etc) were cross tabulated with the
dependent variable (uptake of voluntary HIV counselling and testing services by Abongomola seed
secondary school students) so as to investigate any association between them. The researcher ran
Chi- square test to obtaine the p-value at a confidence interval of 95% (CI 95%). P- Values less
than 0.05 was statistically significant. The results were presented in form of texts and tables.

27
This was used to look for relationship between the independent variables and the dependent
variable so as to determine the association between the variables. The results were expressed in p-
value with 95% confidence interval. P- Values less than 0.05 will be statistically significant.

3.13 Data Quality Control Issues (Validity and Reliability Issues).

In the study, scientific research methods were applied to design the data collection tools as well as
the selection of the samples. Using critically assessed instruments, scientific sampling techniques
was followed to minimize information bias. The selection targeted the school students. The data
was collected by a trained researcher.

A pilot survey was performed a week before actual data collection in Amuca SDA Secondary
School, Lira District which is outside the study area. This was to pretest tools before actual data
collection for accuracy and comprehension and adjustments was made accordingly.

3.14 Ethical considerations

Approval
The proposal which was presented to the department of public health and thereafter to the Faculty
of Health Science. Approval letter that was issued was taken to the school authorities where the
study was conducted requesting for permission.

Consent
Informed consent was sought from students who participated in the study.

Confidentiality

All study participants were assured that all information received would be treated confidential
before the study is started and will only be used for study purposes. The data collection tool will
not bear the participant names and participants will be identified by numbers.

The privacy of participants was protected by interviewing the participants in private places such
as main halls, libraries or classrooms which were in use at that data collection time.

3.15 Anticipated Study Limitations and Solutions.

 Fear of the respondents hiding the required information. This was solved by assuring them
on the issue of confidentiality and good rapport building and communication skills.

28
 Refusal of the selected participants to participate in the study because of no financial
benefit as a result of participation. This was managed by explaining to them the relevance
of the study in the planning of the health care services concerning them (student)

29
 CHAPTER FOUR

RESULTS
4.0 Introduction

This chapter entails presentation of results of the research study in form of means, modes,
frequencies as well as bivariate analysis to establish any associations that exist between
variables. One hundred forty-seven questionnaires (390) were given out to the respondents, three
hundred eighty-two (382) were filled and returned and this gave a response rate of 97.9%. Both
questionnaire with and without missing values were all considered in the data analysis.
Table 1 below shows that greater proportion of students were within the age group of 11-14
years and the majority of the students (50.5%) were in S2 and a greater proportion of female
(45.7%) and male (55.1%) students were in S2 as well. It further reveals that more than half of
the students (63.1%) were coming from nuclear type of family and the rest were from extended
type of family. The order was still maintained among sexes. The dominant religion among
students was Catholic (34.3%).

Table 1 Distribution of the socioeconomic and demographic characteristics of respondents

by sex

Variable Frequency (%)

Female Male Total (%)
Age Group
11-14 87(81.7%) 56(55,9%) 144(43.7%)
15-18 68(63%) 64(38.7%) 132(41.3%)
19-23 64(60.5%) 43(27.2%) 107(37.80%)
Total 96(100%) 223(100%) 383(100%)
Class
S.1 35(18.8%) 52(26.5%) 87(22.8%)
S.2 85(45.7%) 108(55.1%) 193(50.5%)
S.3 56(30.1%) 31(15.8%) 87(22.8%)
S.4 10(5.4%) 5(2.6%) 15(3.9%)
Total 186(100.0%) 196(100.0%) 382(100.0%)
Family type
Extended 141(36.9%)
71(38.2%) 70(35.7%)
Nuclear 115(61.8%) 126(64.3%) 241(63.1%)
Total 186(100.0%) 196(100%) 382(100%)
Religion

30
 Anglican 45(24.2%) 45(23.0%) 90(23.6%)
Catholic 59(31.7%) 72(36.7%) 131(34.3%)
Muslim 21(11.3%) 28(14.3%) 49(12.8%)
PAG 40(21.5%) 29(14.8%) 69(18.1%)
SDA 21(11.3%) 22(11.2%) 43(11.3%)
Total 186(100.0%) 196(100.0%) 382(100.0%)
In table 2 below, age and class of students was found to be significantly associated with
utiolisation VCT services.
Table 2 Bivariate analysis for the association between socio-demographic and utilization of
VCT

UTILIZATION OF VCT SERVICES

YES (%) NO (%) X2 DF P-VALUE

AGE
11-14 8(8.7%) 46(55,9%) 21.197 11 0.031*
15-18 58(63%) 54(38.7%)
19-23 20(21.5%) 23(27.2%)
TOTAL 86(100%) 123(100%)
GENDER
MALE 49(52.7%) 147(50.9%) 0.094 1 0.760
FEMALE 44(47.3%) 142(49.1%)
TOTAL 289(100%) 93(100%)
CLASS
S.1 13(14.0%) 74(25.6%) 12.612 3 0.006*
S.2 52(55.9%) 141(48.8%)
S.3 28(30.1%) 59(20.4%)
S.4 0(0.0%) 15(5.2%)
TOTAL 93(100.0%) 289(100.0%)
RELIGION
ANGLICAN 23(24.7%) 67(23.2%) 4.212 3 0.378
CATHOLIC 32(34.4%) 99(34.3%)
MUSLIM 10(10.8%) 39(13.5%)
PAG 13(14.0%) 56(19.4%)
SDA 15(16.1%) 28(9.7%)
TOTAL 93(100.0%) 289(100.0%)
TYPE OF FAMILY
EXTENDED 40(43.0%) 101(34.9%) 1.964 1 0.161
NUCLEAR 53(57.0%) 188(65.1%)
TOTAL 93(100.0%) 289(100.0%)
* Statistically significant values, X2 =Chi-square value, df= degrees of freedom, CI=Confidence
interval

31
According to the multivariate analysis results in table 3 below, age of students showed positive
association with utilization of VCT services. A participant with higher age is 1.206 times likely to
use VCT services compared to a participant with lower age. Class of students is positively affecting
utilization of VCT services among students. Increase in class of a student increases VCT service
utilization. Students in S.2 were 2.389 times likely to use VCT services compared to those in S.1,
those in S.3 were 5.039 times likely to use VCT services compared to S.1 students and S.4 students
were 6.632 likely to use VCT services compared to their colleagues in S.1.

Table 3 Multivariate analysis for the association between Demographic factors

and utilization of VCT

Variable S.E DF P-value AOR CI

Age 0.058 1 0.001 1.206 1.088-1.364
Class
S.1
S.2 1.080 1 .420 2.389 0.288-19.838
S.3 1.049 1 .123 5.039 0.645-39.391
S.4 1.060 1 .074 6.632 0.830-52.990
4.2 Awareness of VCT services by students
4.2.1 Knowledge of students on VCT
Table 2 below indicates that more than three quarter of the students (89.8%) had ever heard of
VCT. The table further shows 81.2% of respondents were unable to tell what VCT was, about only
a quarter of students (24.3%) had ever utilized VCT services. Three quarter of the students (75.7
%) who had ever utilized VCT services got from health facilities. More than half (68.1%) of the
students knew that not everyone is supposed to test while 10.2% did not know whether everyone
is supposed to test.

Table 4 Shows knowledge of students on VCT

Have you ever heard of VCT? Frequency Percent

No 39 10.2
Yes 343 89.8
Total 382 100.0

32
 Are you position to tell what
VCT is?
No 310 81.2
Yes 72 18.8
Total 382 100.0
Have you ever utilized VCT
services?
No 289 75.7
Yes 93 24.3
Total 382 100.0
In what setting did you get VCT
services?
Health facility 70 75.7
School/community 23 24.3
Total 93 9.4
Is everyone supposed to test?
I don’t know 39 10.2
Yes 83 21.7
No 260 68.1
Total 382 100.0
Figure 3 below indicates that Radio is the dominant source of information on VCT to students as
reflected by 44% of students obtained information over the radios unlike TV (11%), posters (15%),
newspapers (16%) and health workers (14%).

33
 Posters, 93,
15% TV, 71, 11%

News Paper,
98, 16%

Health
workers, 90, Radio, 280,
14% 44%

Figure 2 Sources of information on VCT

4.2.2 Attitudes of respondents

Nearly all students (89.6%) agreed with the statement that low utilization of VCT increases the
rate of HIV/AIDS transmission, more than three quarter of the students (79.8%) agreed that it is
necessary to have VCT service at school. Three quarter of the students (75.4%) showed their
feelings to utilize VCT soon. Ninety one point six percent of the students expressed that it is
important to create awareness among students about proper VCT utilization practices and 84.3%
agreed that it god to know their HIV status. However, 54.7% of students had knowing their HOIV
statuses. More than half (50.93%) of students reported that they were anxious when they went for
VCT while more than a quarter (29.8%) reported delay of service provision.

34
 Table 5 attitudes of students towards VCT service utilisation

Variable Responses
Agree Neutral Disagree Total
Low utilization of VCT increases the 342(89.5%) 23(6.0%) 17(4.5%) 382(100%)
rate of HIV/AIDS transmission.
It is necessary to have VCT service at 305(79.8%) 37(9.7%) 39(10.2%) 382(100%)
school.
1. I I feel like utilizing VCT services soon. 288(75.4%) 37(9.7%) 56(14.7%) 382(100%)
2.
It is important to create awareness 350(91.6%) 16(4.2%) 16(4.2%) 382(100%)
among students about proper VCT
utilization practices.
I have fear of knowing my HIV/AIDS 209(54.7%) 32(4.2%) 141(36.9%) 382(100%)
status low
Knowing my HIV/AIDS status is good
322(84.3%) 28(7.3%) 32(8.4%) 382(100%)
Total
1816(79.2%) 173(7.5%) 301(13.1%) 2292(100.0%)

A question on whether a student has ever gotten information on VCT services has been chosen to
represent the knowledge of students in the bivariate analysis.
According to the table below, knowledge of VCT has no influence on utilisation of VCT as
confirmed by p-value more than 0.05.

35
Table 6 Bivariate analysis for the association between knowledge and utilization of VCT

Utilization of VCT services

Knowledge Yes (%) No (%) X2 df P-value
of VCT?
Yes 86(92.5) 257(88.9) 0.965 1 0.326
No 7(7.5) 32(11.1)
Total 289(100) 93(100)
* Statistically significant values, X2 =Chi-square value, df= degrees of freedom, CI=Confidence
interval

4.3 Health facility related factors

Nearly all (87%) those who ever used VCT services reported that the service delivery unit is
always separated from other units. More than half of them (62%) further expressed that they did
not pay for the services given. Greater proportion of the students who got VCT services from
health facilities (42%) reported that at health facilities, VCT services are provided at any time
however, a quarter of the students of them (33%) reported that service are provided in morning.
The study found that VCT services at health facilities are provided after more than sixty minutes

Figure 3 Experience of student when they went for VCT

36
(66%) and all most every student (86%) who had ever used VCT services reported that health
workers were not friendly. from health facilities.
Having separate VCT unit, time at which VCT services are provided and how fast a client is
served are significantly associated with utilisation (p-value<0.05).
Table 7 Bivariate analysis for the association between Health facilities related factors
and utilization of VCT

Variable Utilization of VCT

Yes (%) No (%) X2 Df P-value
Is VCT service delivery unit separated from
other units?
Yes 80(86%) 0(0%) 382.000 1 0.000*
No 13(14%) 0(0%)
total 93(100%) 0(0%)
Do you pay for the VCT?
No 58(62.4%) 0(0%) 382.000 1 0.000*
Yes 35(37.6%) 0(0%)
Total 93(100%) 0(0%)
At what time of the day is VCT always
carried out at the health facility?

Afternoon only 12(12.9%) 5(1.7%) 108.367 3 0.000*

Any time 18(19.4%) 12(4.2%)
Morning only 21(22.6%) 4(1.4%)
Total 93(100%) 21(100%)
How far is the facility from home?
<1km 9(9.7%) 37(12.8%) 1.019 2 0.601
>2km 54(58.1%) 171(59.2%
)
1-2km 30(32.3%) 81(28%)
Total 93(100%) 289(100%)
How fast were you served?
<30min 2(2.2%) 0(0%) 382.000 3 0.000*
>30-<60 30(32.3%) 0(0%)
More than 60min 61(65.6%) 0(0%)
Total 93(100%) 0(0%)
Were the health workers friendly to you
when you visited the facility?
Yes 0(0%) 13(14.0%) 382.000 1 0.000*
No 0(0%) 80(86%)
Total 0(0%) 93(100%)
* Statistically significant values, X2 =Chi-square value, df= degrees of freedom, CI=Confidence
interval

37
In the table 8 below, having separate VCT units has a positive significant influence on the
utilization of VCT survives. Students who found the VCT service delivery units not separated were
0.573 likely to get services. Participants who did not pay for the services were 2.169 times likely
to get VCT services compared to those who aid for the services.

Table 8 Multivariate analysis for the association between Health facilities related factors
and utilization of VCT

Variable S.E DF P-value AOR CI

Having separate
VCT units
Yes
No 0.522 1 0.047 0.573 0.559-2696
Pay for VCT
services
Yes
No 0.300 1 0.034 2.169 0.255-1.32
Time at which
VCT services
are provided
Afternoon only
Any time 0.762 1 0.044 0.457 0.103-2.036
Morning only 0.661 1 0.058 0.286 0.078-1.043
How fast a
client is served
<30 mins
30=<60 mins 0.662 1 0.034 1.057 0.133-1.534
>60 mins 0.561 1 0.0470 1.286 0.098-1.093

4.4 Community related factors

the study reveals that about three quarter of students (70.4%) reported not accessing information
on VCT utilization in the school, eighty one point four percent (81.4%) of students said health
teams did not sensitize the school community about VCT. Moreover, about three quarter of
students (65.7%) are allowed by their relatives and friends to test for HIV.

The table below shows that sensitizing the school community and having ever been guided on
VCT are influencing utilisation of VCT as confirmed by p-value less than 0.05. While, usual

38
 getting information related to VCT and being allowed by friends/relatives to test for HIV are not
statistically significant (p-value >0.05).

Table 9 Bivariate analysis for the association between communities related factors
and utilization of VCT

* Statistically significant values, X2 =Chi-square value, df= degrees of freedom, CI=Confidence

Variable Utilization of VCT
Yes (%) No (%) X2 Df P-value
Usually get information related to VCT
utilization in this school?
Yes 60(64.5%) 209(72.3%) 2.056 1 0.152
No 33(35.5%) 80(27.7%)
Total 94(100%) 289(100%)
Health team sensitize the school
community about VCT
Yes 68(73.1%) 243(84.1%) 5.590 1 0.018*
No 25(26.9%) 46(15.9%)
Total 93(100%) 289(100%)
Friends/relatives allow you to test for HIV?
Yes 9(9.7%) 44(15.2%) 5.004 2 0.082
Not sure 14(15.1%) 64(22.1%)
No 70(75.3%) 181(62.6%)
Total 93(100%) 289(100%)
Have you ever been guided on VCT by any
of the above?
Yes 30(42.3%) 191(66.1%) 33.02 1 0.000*
No 63(66.7%) 98(33.9%)
Total 93(100%) 289(100%)
interval

In table 11 below, senstising the school community on VCT services as a significant positive
association with utilization of VCT services. Those students who were not sensitized at school
were less likely to utilize vct services (P=value: 0.000, OR: 0.940 and CI:2.4.4-6.459). in the sam
trend, having ever been guided on VCT services has positive significant association with
utilization of VCT services. Students who were not guided on VCT servicer were less likely to get
the VCT services ((P=value: 0.032, OR: 0.412 and CI:1.234-1.616)

Table 10 Multivariate analysis for the association between communities related factors

39
and utilization of VCT

Variable S.E DF P-value OR CI

Senstising the
school
community on
VCT services
Yes
No 0.344 1 0.000 0.940 2.404-6.459
Having ever
been guided on
VCT
Yes
No 0.269 1 0.032 0.412 1.234-1.616

40
 CHAPTER FIVE

DISCUSSION OF RESULTS

5.0 Introduction

More than three quarter of the students (89.8%) had ever heard of VCT. Eighty one point two
(81.2%) of respondents were unable to tell what VCT was. Age and class of students were found
to be influencing utilisation of VCT services (p-value<0.05)

About only a quarter of students (24.3%) had ever utilized VCT services. Having separate VCT
unit, time at which VCT services are provided and how fast a client is served are significantly
associated with utilisation (p-value<0.05).

Three quarter of students (70.4%) lacked access to information on VCT utilization in the school,
Sensitizing the school community about VCT services and having ever been guided on VCT are
influencing utilisation of VCT as confirmed by p-value less than 0.05

Class of students is also positively affecting utilization of VCT services among students. VCT
service utilization increased with increase in class of a student. Students in S.2 were 2.389 times
likely to use VCT services compared to those in S.1, those in S.3 were 5.039 times likely to use
VCT services compared to S.1 students and S.4 students were 6.632 likely to use VCT services
compared to their colleagues in S.1. this finding concurred with a study done prevallence of
Voluntary Counseling and Testing Utilization and Its Associated Factors among Bahirdar
secondary Students. Individuals from s.2 were 2.71 times (AOR (95% CI) = 2.71 ), from s.3 were 3.54
times (AOR (95% CI) = 3.54 ), and from s.4 were 5.87 times (AOR (95% CI) = 5.87 ) more likely to have
undergone HIV testing than s.1 counterparts. This could be due increased level of knowledge among
students as they climb the academic ladder.

5.2 Awareness of VCT services

.5.2.1 Knowledge of students on VCT

More than three quarter of the students (89.8%) had ever heard of VCT. This was in line with a
study done on factors Affecting Voluntary HIV/AIDS Counseling and Testing Service Utilization
Among Youth in Gondar City, Northwest Ethiopia which showed that the majority (71%) were
aware of VCT services (Alem et al., 2020b). Although there is high level of awareness, this study

41
found that it was not translated in to practice where only 24.3% had ever utilized VCT services.
Furthermore, this study shows that 81.2% of respondents were unable to tell what VCT was. This
means that greater proportion of students still do not know their HIV statuses although studies
have shown that knowing one’s serostatus helps prevent and control the spread of HIV/AIDS
infection (SeyedAlinaghi, 2016)

Three quarter of the students (75.7 %) who had ever utilized VCT services got from health
facilities. This was in line with a study conducted by Rhoda and Wanyenze in 2013 which revealed
that voluntary HIV counseling and testing has been mainly provided through facility (Rhoda k
Wanyenze et al, 2013). Getting VCT services from Health facilities is most safe with maximum
privacy, psychosocial and infection prevention and control and above all the HIV positive clients
can be initiated on ART immediately. However, getting VCT services from homes can expose
people to stigma related to HIV since there will not be privacy. This stigma if not addressed may
bring about psychological trauma which sometimes are likely to result in to suicidal tendencies.
Furthermore, learning one’s HIV status may be beneficial, if there is no follow-up service
available, either social or medical, the benefits of that knowledge may be wasted. The study did ot
recommend that this approach be generally adopted in Uganda (Yoder et al., 2020)

More than half (68.1%) of the students knew that not everyone is supposed to test. This was in
contrary to the finding of Dagne et al., 2017, which showed that 52.6% were aware that everyone
is supposed to test for HIV. This shows poor perception of VCT because everyone is supposed to
test to know their HIV statuses but the client are the ones to initiate the process (van der Kop et
al., 2016).

This study showed that utilization was not dependent on knowledge of VCT as confirmed by p-
value more than 0.05. This finding is not in line with the study in Ethiopia and Uganda (Gedefaw,
2016) and (Dagne et al., 2017). Knowledge of the respondents were found to be influencing uptake
of VCT service.
5.2.2 Attitudes of respondents
Nearly all students (89.6%) agreed with the statement that low utilization of VCT increases the
rate of HIV/AIDS transmission. This agreed with a study conducted by Bhandari et al., 2014. Low
use of VCT services leaves many people without how to prevent HIV transmission and these
people continue with practices which might put them at higher risk of HIV infection.

42
More than three quarter of the students (79.8%) agreed that it is necessary to have VCT service at
school. This same finding was also dug out by Alem et al., 2020 where it recommended
programmers and health care providers to design interventions in particular areas of HIV/AIDS
for better health outcomes in school community. This will probably meet the Sexual and
reproductive health needs of students as ninety one point six percent of the students expressed that
it is important to create awareness among students about proper VCT utilization practices in this
study.

Three quarter of the students (75.4%) showed their feelings to utilize VCT soon. This was in
contrary to Tsegay et al., 2013 where less than half of the respondents (38%) showed interest to
test for HIV soon. On the other hand the study concurred with M. Sanga, 2015. The majority of
students (57%) wanted to have VCT in the future. The good attitude if translated in to practice increases
the utilisation of VCT services which in turn can help in decision making on HIV infection
prevention.

More than three quarter (84.3%) of respondents agreed to the statement that it is good to know
their HIV status. This finding was supported by Tsegay et al., 2013. Majority of the respondents
showed that it is important to test for HIV to their HIV statuses. This prepares a person to make
informed decision on how to be protected on HIV infection.

Generally, there were positive responses on the attitudes questions. These responses showed
positive attitudes towards VCT utilisation.

5.3 Health facility related factors

This study showed that more than half (50.93%) of students reported that they were anxious when
they went for VCT. Similar findings were found in studies conducted by Cheruiyot et al., 2019,
and Yoder et al., 2016. The respondents reported experience of anxiety when they went for HIV
testing. This is one of the psychological state that if not addressed before testing through
counselling may lead to bad outcomes during HIV testing.
Nearly all (87%) those who ever used VCT services reported that the service delivery unit is always
separated from other units. Having a separated VCT service delivery unit strengthens privacy and
reduces stigma and discrimination associated with HIV.
More than half of them (62%) further expressed that they did not pay for the services given. Free
VCT services would attract more youth especially school going age group who can not raise money

43
on their own to pay for VCT services. However this may not apply for private health facilities and
there is need for schools to integrate VCT services among health services offered at school clinic.
Greater proportion of the students who got VCT services from health facilities (42%) reported that
at health facilities, VCT services are provided at any time however, a quarter of the students of
them (33%) reported that service are provided in morning. A qualitative done among youth on
perception of VCT services by Sisay et al., 2014 revealed that respondents reported “VCT services
were not considered a priority compared to other health issues”. This seems to be in contrary to
the current study and this if not addressed may discourage the youth including students from
accessing the VCT services.
The study found that VCT services at health facilities are provided after more than sixty minutes
(66%) while more than a quarter (29.8%) reported delay of service provision. This concurred with
a study done on factors influencing the uptake of voluntary HIV counseling and testing among
secondary school students in Arusha city, Tanzania, Among 374 respondents which revealed that,
358 (95.7%) rated delay in service delivery as among the factors influencing VCT uptake. Delays
in VCT service delivery where a client is served after a hour builds mistrust in clients especially
students who are adolescent and do not want themselves associated with HIV related activities and
this may make them have poor VCT service seeking behaviours.
All most every student (86%) who had ever used VCT services reported that health workers were
not friendly. This coincided with a study done by Teklehaimanot et al., 2016 which revealed that
the factors including unwelcoming attitudes of the health workers among others reduce the drive
to go to the facilities for VCT services. The poor attitudes of health workers scares away the
students and the general public seeking for VCT services and this contributes to continuous
transmission of HIV in the population.
This study further revealed significant association having separate VCT unit, time at which VCT
services are provided and how fast a client is served are significantly associated with utilisation
(p-value<0.05).
In the multivariate analysis, having separate VCT service delivery units paying for the VCT
services were found positively influencing VCT service utilization.
5.4 Community related factors
This study revealed that about three quarter of students (70.4%) reported not accessing information
on VCT utilization in the school. This was further confirmed by Gedefaw, 2016 where more than

44
half (57%) of respondents reported lack of information on VCT as their limitation. This results in
low utilisation and the effect of this is much more pronounced among persons with disabilities
such as persons with hearing and visual impairments.

Eighty one point four percent (81.4%) of students said health teams did not sensitize the school
community about VCT. Bhandari et al., 2014 confirmed this be true since most times the health
teams work from the health facilities and community not schools. This leaves school population
with limited access to information on VCT and VCT services.

Majority of students (28.17%) are prevented from utilizing VCT services by stigma and
discrimination, followed by fear (21.49%) and lack of information (20.3%). This finding was in
line a study Dagne et al., 2017 where perceived stigma and discrimination [AOR: 2.483,
95%CI:(1.455, 4.235 were found to be significantly associated with VCT service utilization by
students.
Moreover, about three quarter of students (65.7%) are allowed by their relatives and friends to test
for HIV. This concurred with other studies (Dagne et al., 2017) and (SeyedAlinaghi, 2016) where
there was association between peer friends, husbans, wives and utilisation of VCT services
confirmed by p-value < 0.05.

This study shows that sensitizing the school community and having ever been guided on VCT are
influencing utilisation of VCT as confirmed by p-value less than 0.05. This finding is supported
by a study that shows peer support and advice to go to health facilities for VCT services as being
facilitators of utilisation of VCT services (Alem et al., 2020). Also, during senstisation and
advices, health outcomes could be discussed and this could have increased health-seeking
behavior, including HIV testing and counseling.

This study revealed that senstising the school community on VCT services and having ever been
guided on VCT services have positive significant association with utilization of VCT services.
Those students who were not sensitized at school were less likely to utilize VCT services (P=value:
0.000, OR: 0.940 and CI:2.4.4-6.459) while students who were not guided on VCT servicer were
less likely to get the VCT services (P=value: 0.032, OR: 0.412 and CI:1.234-1.616). Mook et al,
2017, disagreed with this finding. In his study, separating the VCT service delivery units especially
for youth was viewed as promoting exclusion.

45
 CHAPTER SIX

CONCLUSION AND RECOMMENDATIONS

6.0 Introduction

This chapter entails the overall conclusion of the research study and also points out the possible
actions that can be taken to solve the problem.

6.1. Conclusion

This study showed that there was high utilisation of VCT services among students and The
research findings further revealed that majority of the respondents possess good knowledge,
positive attitudes of VCT.

This study further, has unraveled the factors that are significantly associated with Uptake of VCT
services. These were Age, class of students, having separate VCT unit, time at which VCT services
are provided and how fast a client is served.
6.2 Recommendations
Taking the study findings into consideration, the following recommendations are proposed.

6.2.1 To Ministry of Education and Sports

There is need in boosting promising intervention such as routine counselling and testing for HIV
adolescents (school going age group) seeking health care in health units, home-based VCT
programmes, and mainstreaming of HIV counselling and testing services in school health
programmes.

6.2.2 To school Administrators

The use of strategic information channels as a communication strategy should be enhanced in
schools to ensure proper sensitization coverage mainly in schools.

Schools should develop and redesign delivery strategies of VCT information on print and social
media, radios and television in a more effective way to disseminate factual information that should
strive to break barriers of fears and stigma.

46
6.2.3 To the future researchers
Future research is needed to discover administrative factors and socio-cultural beliefs which could
hinder uptake of VCT services among students.

47
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APPENDICES
Appendix I: Informed consent/assent form
Good morning/evening!

My name is Atim Romeo, a student from Lira University, Faculty of Health Sciences and
Department of Public Health. I am carrying out a research on VCT utilization among students of
Abongomola Seed Secondary School, Kwania District. The purpose is to provide information that
will be used to formulate interventions which will reduce the rate of HIV/AIDS among students in
the community so as to reduce HIV morbidity and mortality among students.

This study will include willing participants that i will ask them questions in the questionnaire
concerning their knowledge, attitude and awareness on VCT utilization.

There are no financial benefits attached to their participation, however their contributions will help
the relevant authorities to come up with effective measures to promote VCT utilization among the
students within the school.

One can choose not to participate in this study, if he/she does not want and if he/she decides. You
are also free to withdraw from participation at any time if you find the questions offensive after
we have begun. In case you do not understand a question, you’re free to ask the interviewer to
repeat or clarify on it.

Taking part in this study will not hurt you, neither your family. We will also not inform anyone
of your participation in the research study and your name will not appear on the questionnaire or
any report of this study.

Would you like to participate in the study? Yes No

Signature of participant…………………………………………… Date ……/…. /20……

Interviewer’s signature…………………………………………… Date ……/…./20…

54
 Appendix II: Questionnaire
Factors affecting uptake of VCT utilization among students of Abongomola Seed S S,
Kwania District, Uganda.

A. Socio-Demographic Characteristics (tick where necessary against the number)

3. How old are you (in complete years) …………
4. What is your sex (gender) 1. Male 2. Female
5. Which class are you in 1. S.1 2. S.2 3. S.3 4. S.4
6. Which one of the following is your religious affiliation?
1. Muslim Catholic 3. Anglican
4. PAG 5. SDA

7. What is the type of family you are living with?

1.Nuclear 2. Extended

B. Individual factors
Knowledge
8. Have you ever heard of VCT? 1.Yes 2 . No
9. Are you in position to tell what VCT services are? 1. Yes 2. No
10. Have you ever utilized VCT services 1. Yes 2. No
11. If yes to Qn8, In what setting did you get VCT services?
1. Health facility based 2. School/Community based
12. Is everyone supposed to test? 1.Yes 2 . No 3. I don’t know
13. From which media sources did you read/hear about VCT utilization? (More than one answer is
possible)
1. Television 2. Radio 3. Health workers
4. Newspapers 5. Posters

Altitude
14. Low utilization of VCT increases the rate of HIV/AIDS transmission.
1. Agree 2. Neutral 3. Disagree
15. It is necessary to have VCT service at school.
1. Agree 2. Neutral 3. Disagree

55
16. I feel like utilizing VCT services soon.
1. Agree 2. Neutral 3. Disagree
17. It is important to create awareness among students about proper VCT utilization practices.
1. Agree 2. Neutral 3. Disagree
18. I have fear of knowing my HIV status.
1. Agree 2. Neutral 3. Disagree
19. knowing my HIV status is good.
1.Agree 2. Neutral 3. Disagree
Health facility Related factors
20. If Yes to question 8, what was your experience when you came/went to utilise VCT?
1. Anxious 2. Delayed 3 Good 4. Health workers were harsh
21. Is VCT service delivery unit separated from other units?
1. Yes 2. No
22. Do you pay for the VCT?
1.Freely 2. Paid 3. both
23. At what time of the day is VCT always carried out at the health facility?
1. Any time 2. Morning 3. Afternoon

24. How far is the facility?

1. <1km 2. 1-2 km 3. > 2 km
25. If Yes to question 8, How fast were you served?
1. <30 mins 2. >30min-<60min 3. More than 1 hour
26. Were the health worker friendly to you when visited the facility
1. Yes 2. No

56
 Community Related factors
27. Do you usually get information related to VCT utilization in this school?
1. Yes 2. No
28. Do the health team sensitize the school community about VCT utilization?
1. Yes 2. No
29. Do your friends/relatives allow you to test for HIV
1. Yes 2. No 3. Not sure
30. What are some of the factors that prevent the students in this school from utilizing VCT (more
than one answer may be correct)
1. Fear 2. Stigma and discrimination
3. No VCT Services 4. Unfriendly staff

5. Lack/inadequacy of information

29. Who are responsible to guide the students on VCT services (more than one answer may be
correct)

1. Teachers 2. Health workers 3. Matron 4. Parents

30.. have you ever been guided on VCT by any of the above?

1. Yes 2. No

57
Appendix VI: Work plan and Timeframe 2021
Activities November May June July August Sept.
2020
Proposal writing
Data collection
Data analysis
Compiling Draft and fair copy
Producing final copy
Submission of bound copies

58
Appendix VII: Budget
S/No Item Quantity Unit cost Total cost (Ugx)
Stationeries
1 Ream of paper 01 20,000= 20,000=

Pens 05 500= 2,500=

Note book 02 5,000= 10,000=

Clip board 01 2,500= 2,500=

Umbrella 01 10,000 10,000=

Flash disk 01 20,000= 20,000=

2 Secretarial services 100,000=

3 Data analysis 01 300,000= 300,000=
4 Communication 60,000=
5 Transport 110,000=
6 Contingencies 35,000=
7 Total 670,000=

59
Appendix VI . Acceptance Letter

60
Appendix x: The sketch map of the abongomola subcounty.

Abongomola Seed Secondary School

61