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

[摘要] 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 resultsSeventeen 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.

[发布机构] Stellenbosch University