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Research Proposal

Anticipated acceptance regarding


mandatory premarital HIV testing
among unmarried adults in India

Presented by:Bibek Raj Giri


MPH
Introduction
• UNAIDS (2015) reported that, total of 36.7 million people of all ages are
living with HIV and 2.1 million new cases were seen in 2015.
• In India alone, there are 2.1 million HIV infected persons and 68000
deaths due to AIDS
• It is well-known fact that HIV/AIDS has been among the major
communicable diseases from decades but 95 percent of those infected
worldwide do not know that they are harboring the most fatal virus,
and are therefore spreading it unintentionally.
• The primary reason for this is that routine AIDS testing is virtually
absent in most countries and is developing is many countries.
• In India, husband related risk factors increase the chance of women for
HIV infection. The prevalence of HIV among ever married women is
higher than the national average.
Review of Literature
S.N Authors Date Title Findings
o.
1. Dereje Habte 2003 Assessment of Out of the 640 individuals who
et.al the utilization underwent civil marriage, 55% reported
of pre-marital having had pre-marital HIV testing.
HIV testing Individuals of both sexes who had frank
services and discussion as a couple about HIV were
determinants found to be more likely to have pre-
of VCT in marital HIV testing .The promotion of
Addis Ababa, discussion between couples about HIV
2003 and VCT through intense IEC activities as
well as involving marriage agencies to
encourage such discussion is
recommended.
2. Jamshid 2012 Acceptability Among 1000 males and 1000 females
Ayatollahi of HIV/AIDS with different age groups. Overall 58.2%
et.al testing among were willing to pre-marital HIV testing.
pre-marital There was a statistically significant
couples in difference between age groups
Iran (2012) regarding their willingness to pre-
marital HIV testing .
S. Authors Date Title Results
No
3. P Ghosh 2011 Factors Significant risk factors for all women and married
et.al associated women only were: aged 26–35 years. For husband and
with HIV wife pairs, suffering sexual violence ,husband having
infection other wife/wives and husband’s education being
among Indian secondary level or higher were significant. Intervention
women strategies in India should target young married (aged
25–35 years) and formerly married urban women who
are poor, as well as those who have suffered sexual
violence from their husbands, and/or are (or whose
husbands are) multi-partnered. Empowerment of
women is fundamental to HIV/AIDS prevention in India.
4. C. J. 2007 Mandatory Of the total of 319 individuals screened, 25 were
UNEKE pre-marital confirmed HIV-positiveThe highest prevalence of HIV
et.al HIV testing in infection (8.9%) was recorded among individuals in the
Nigeria: The 21-30 years age category, while the least HIV infection
public health prevalence (5.3%) was observed among persons above
and social 40 years old. Mandatory pre-marital HIV screening
implications could generate social stigmatization of the fundamental
human rights of infected individuals. Voluntary
counselling and confidential HIV testing and especially
pre- and post-test counselling as the basis of pre-
marital HIV testing are more desirable.
S.No Date Title Findings
5. 2013 Factors influencing the The premarital rate was 34.8% (95% CI:
decision to participate in 31.0% to 38.5%). Several demographic
medical premarital factors (age, residence, profession),
examinations in Hubei awareness, knowledge, and attitudes
Province, Mid China towards premarital screening all had
significant influence on participation in
the premarital screening program.

6. Premarital Screening for Examined the impact of mandatory


Antibodies to Human premarital HIV screening on marriage
Immunodeficiency Virus rates in Louisiana and Illinois. After
Type 1 in the United States screening began 9% and 16% fewer
marriage licenses than in the previous
two years were issued in Louisiana and
Illinois, respectively.
Research gap
• India is still among top countries in having high prevalence of
HIV/AIDS patients.
• Determining about acceptance or rejection of mandatory
premarital HIV testing can be helpful for government while
implementing service and prevent HIV transmission.
• Internationally, study about perception, acceptance and factors
influencing in decision making are conducted in voluntary
premarital HIV testing but not in mandatory.
• However, this type of study has not been conducted in India and
Indian sub-continents, this study can be useful for countries with
matching status to apply for making of such policy.
Utility
• National Policy can be made about mandating
premarital HIV testing, if result suggests.
• Stigma about the HIV can be eliminated
slowly.
• In long run prevalence of HIV can be
deceased.
Research Questions
• What is the attitude of adults (18-35 years) towards mandatory HIV
premarital testing in India?
• What is the ratio of acceptance and rejection of mandatory
premarital HIV testing?
• What are the factors that influence the decision of an individual on
premarital HIV testing among unmarried adults?

Objectives
• To identify attitudes towards mandatory premarital HIV testing
• To get the knowledge about acceptance and rejection towards
utilizing and mandating premarital HIV testing services
• To determine the factors influencing the decision of an individual on
premarital HIV testing among unmarried adults
Methodology
• Study Design
A qualitative, descriptive cross-sectional community based study.
• Study Setting
The study will be conducted in urban part of Pune district. In-depth
interview will be conducted in household level if they are comfortable, if
not nearby garden/ temple, whatever will be feasible to the participants.
Focus group discussion will be conducted in a hall.
• Data Collection and Approach
The study will contain same number of male and female participants in in-
depth interview as well as focus group discussion. The study will also
incorporate the people with different age groups in both in-depth
interview and focus group discussion. This will be done so that diversity in
perceptions, beliefs and attitudes can be obtained.
• Sample Size
In-depth interview of 30 adults will be taken and 5 to 6 focus group
discussion with 8-10 people in each focus group will be conducted.
•Sampling method

Focus Group Discussion

Among 5-6 focus groups:


In-depth interview •One group will contain people living with HIV
of 30 individuals with
different education •One of the focus group will also incorporate
background and different people who have been working with HIV
related fields, whether it is NGO sector,
age groups will be
government sector, hospital sectors.
conducted
Inclusion and Exclusion Criteria

Inclusion criteria:
Those who are willing to be a part of the study. Adults (both
men and women) who are never married and age in between
18 to 35 years will be included.

Exclusion criteria:
Adults (men and women) who are migrants and people
speaking languages other than English, Hindi and Marathi.
• Variables
 Socio-demographic - Age, gender, level of education,
religion, occupation
 Knowledge and awareness about HIV/AIDS, premarital HIV
testing
 Opinion about premarital HIV testing
 Attitudes towards mandatory premarital HIV testing
 Attitude about aacceptance of mandatory premarital HIV
testing
•Data Collection Tools or Techniques

In-depth interviews and focus group discussions


will be the methods. Semi structured
questionnaire for in-depth interview will be
formed. For focus group discussion a questionnaire
with 6-8 questions will be formed. The focus group
discussion will be recorded and even noted down
whenever needed.
•Data Analysis

The in-depth interviews and focus group


discussions will be transcribed and translated
in English. There will be open coding system
and themes formation. These translated
interviews and focus group discussions will be
coded in MAXQDA software. The codes will be
identified and categorized based on the data.
Emerging themes will be the result of this
analysis.
Ethical consideration
• The study will be initiated after approval by
the ethics committee of Savitribai Phule Pune
University.
• Written informed consent will be obtained
from those who are willing to participate in
the study and purpose of study will be
explained to the study participants in detail.
• Participant’s views and answers will be
confidential.
Work Plan
Duration in Months
Sr. No. Activity
0-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24
1. Ethical
consideration and
other permissions
2. Hiring staff,
procuring
consumables
3.
Sample selection

4. Validation of
questionnaire,
finalizing and
training
5.
Data collection

6.
Data entry

7.
Data analysis

8.
Writing of research
articles and report
Budget allocation
Budget items Quantity Unit cost Duration (months) Total (Rs.)
Non-Recurring
Laptop 2 50000 - 100000
MAXQDA software 2 60000 120000

Recurring

Staffs

Data collector and entry 4 10000 9 360000


Project Assistant (FGDs) 2 20000 9 360000

Miscellaneous expenses
Stationeries - - - 10000
Xerox - - - 10000
Incentive for participants - - - 10000
(snacks and tea)
Travel - - - 60000
Contingencies (5%) 51500
Institutional overhead costs 162225
(15%)
Total 1243725
References
• National AIDS Control Organisation. Narrative country progress report of India:
Global AIDS Response Progress Reporting 2015 [Internet]. New Delhi-110001:
National AIDS Control Organisation; 2015 p. 18. Available from:
www.unaids.org/sites/default/files/country/.../IND_narrative_report_2015.pdf
• RICHARD HOLBROOKE, RICHARD FURMAN. A Global Battle’s Missing Weapon.
2004 Feb; Available from:
• Ghosh P, Arah OA, Talukdar A, Sur D, Babu GR, Sengupta P, et al. Factors associated
with HIV infection among Indian women. Int J STD AIDS. 2011 Mar;22(3):140–5.
• Uneke CJ, Alo M, Ogbu O. Mandatory pre-marital HIV testing in Nigeria: The public
health and social implications. AIDS Care. 2007 Jan;19(1):116–21.
• Habte D, Deyessa N, Davey G. Assessment of the utilization of pre-marital HIV
testing services and Shabbir Ismael determinants of VCT in Addis Ababa, 2003.
Ethiop J Health Dev. 2006;20(1):18–23
THANK YOU