All ETDs from UAB

Advisory Committee Chair

Andrzej Kulczycki

Advisory Committee Members

Janet Turan

David Becker

Jodie Dionne-Odom

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Of the estimated 150,000 new HIV infections in children in 2015, 122,000 occurred in sub-Saharan Africa (SSA), with Nigeria accounting for a third of all cases. Most of these infections were acquired via mother-to-child transmission (MTCT). HIV testing and counseling, a critical first step in the prevention of MTCT (PMTCT), can ensure that HIV-positive women access services that can reduce HIV transmission risk. Incorporating HIV testing and counseling into antenatal care (ANC) is an integral component of the World Health Organization (WHO) strategies. This dissertation aims to understand factors that influence HIV testing and counseling during ANC. It is comprised of three manuscripts based on the following three aims: (1) Which are the institutional-level factors that influence HIV testing and counseling utilization during ANC in SSA? (2) What is the influence of individual-level factors on HIV testing utilization during ANC in Nigeria? and (3) How do institutional-level factors influence the provision and utilization of HIV testing and counseling during ANC in Nigeria? The first manuscript in this dissertation (aim 1) is a systematic review of 40 quantitative, qualitative, and mixed-methods studies. Findings emphasized the importance of adequate institutional resources for the provision of HIV testing and counseling services in ANC. The second manuscript (aim 2) analyzed individual-level predictors [defined using the Anderson Behavioral Model including predisposing (socio-demographic and cultural), enabling (socio-economic, knowledge and attitudes) and need (risk perception and health behaviors) factors] on HIV testing utilization (defined as: ideal (counseled and tested); less ideal (tested but not counseled); opted-out (counseled but not tested) and missed opportunity (neither counseled nor tested). Finding suggest that interventions focused on vulnerable populations may go a long way in increasing HIV counseling and testing utilization. The third manuscript (aim 3) examined how institutional-level factors, such as type of ANC facility and type of provider influence the provision and utilization of HIV testing and counseling during ANC in Nigeria. Results show that PMTCT training should first target lesser-skilled ANC providers and those who work in ‘non-health’ facilities.

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