Utilization of Voluntary Counseling and Testing Experience among Mizan-Tepi University Students in Southwestern Ethiopia

Background Voluntary counseling and testing (VCT) is the primary gateway to HIV prevention, caution, and handling, where people learn whether they are infected. This study was aimed to assess the determinants of voluntary counseling and testing experience among students. Methods An institution-based cross-sectional study was conducted between November and January, 2020. A simple random sampling procedure was used to select participants from the target group. The Chi-square test, descriptive analysis, and a binary logistic regression analysis were used to identify the factors associated with VCT experience among students. Results Out of 398 participants, 42.5% experienced VCT services. From 59.5% of female participants in the study, only 22.9% experienced VCT services. The logistic regression results revealed that male participants less likely experienced VCT (AOR = 0.549; 95%CI: 0.330, 0.910; p=0.020) compared to female students. Students who had VCT service access in their surroundings (AOR = 2.348; 95%CI: 1.371, 4.020; p=0.002), a sexual partner (AOR = 3.795; 95%CI: 1.214, 11.868; p=0.022), and media access (AOR = 2.374; 95%CI: 1.059, 5.320; p=0.036) were more likely to utilize VCT services than their reference categories. Conclusions VCT utilization among students remains limited. In this study, sex, age, region, the education of mother and father, having boy/girlfriend, the source of information, service access, media access, and attitude were the identified factors of VCT utilization. To enhance the usage of VCT services, the facilities should be publicized, and all information regarding VCT should be made available to teenagers.


Background
Voluntary counseling and testing is a confidential counseling process that allows a person to make an informed decision about learning his or her HIV status and obtaining recommendations on how to continue [1,2]. On a global basis, it is well-recognized as a successful and necessary tool for HIV prevention and treatment [3]. According to 2020 WHO estimates, over 30% of all new HIV infections globally are estimated to occur among youths aged 15 to 25 years [4]. Almost 3.3 million youths in sub-Saharan Africa are HIV-positive [5]. It has a critical role in fostering behavioral change, reducing unprotected sex, and reducing the prevalence of HIV and other sexually transmitted infections [6]. HIV/AIDS is a major public health issue in many regions of the world. Finding HIV-positive people and enrolling them in care is critical to meeting the UNAIDS 90-90-90 targets of diagnosing 90% of HIVpositive people, initiating 90% of those diagnosed on ART, and attaining viral suppression in 90% of those on ART. To meet the first goal, no one should be denied access to HIV testing services [7].
At least 90% of people with HIV must be tested at least once, and this goal is being approached or set by several African countries [8,9]. Voluntary counseling and testing (VCT) is one of the most important preventative techniques and a gateway to AIDS treatment. Ethiopia is one of the countries hardest hit by the HIV epidemic in sub-Saharan Africa, where unprotected heterosexual contact and mother-to-child transmission are the main modes of infection and VCT experience is extremely limited [1,[10][11][12][13].
In Ethiopia, one of the most important policy responses to the HIV/AIDS epidemic has been voluntary counseling and testing (VCT). However, the country's VCT experience has been limited [10]. According to several research findings in Ethiopia, volunteer counseling and testing service experience is limited, and its level of utilization varies across different groups of the community [14,15]. It is also supported by studies conducted among university and college students. According to the research conducted in Bahir Dar, 38.6 percent of the university students were tested [16]. Another study in Debre Birhan found that 35.2 percent of college students were affected [17]. e epidemic continues to affect teenagers and adults, particularly adult and young women. Almost one-fourth of HIV patients are under the age of 25. According to the literature, young people aged 15 to 24 years are at the forefront of the HIV/AIDS epidemic, and VCT uptake is very low among university students, who are regarded to be a high-risk population for HIV/AIDS infection [5,18,19].
An essential preventive measure to lower HIV transmission is HIV testing. Uncertainty exists regarding the relationship between HIV-related knowledge and the use of HIV testing services [20]. Some achievements have been recorded after 40 years, however, significant obstacles are still there. Although the worldwide adoption of voluntary HIV counseling and testing (VCT) has increased, challenges still exist in some parts of the world because of a lack of funding, a lack of national priority, low levels of awareness and access to VCT programs, and overworked medical professionals [21,22].
Youths in Ethiopia, particularly high school and university students, are among the most sexually active and HIV-positive young people. Yet, VCT uptake among this demographic is low, which is in the range of 35% to 38% [16]. Because of the tremendous influence of peer pressure and the formation of their sexual and social identities, youths are prone to HIV [23]. Preparatory school and university students have low knowledge, attitude, and practice (KAP) when it comes to VCT, according to many studies. Ignorance, fear of being positive, lack of a perception of being at risk, cost of VCT, insufficient number of VCT clinics, and stigmatization were identified to be key barriers to VCT for HIV acceptance [23][24][25][26].
ere is a scarcity of research in Ethiopia addressing VCT acceptance or experience among university students, especially in these topic areas. Furthermore, teens account for a substantial proportion of HIV-positive people. As a result, the purpose of this study was to determine the prevalence of voluntary counseling and testing experiences among Mizan-Tepi University students and the characteristics that contributed to these experiences.

Study Design and
Population. An institution-based cross-sectional study was conducted to assess the prevalence of the utilization of the voluntary counseling test (VCT) experience among university students between November and January, 2020. All Mizan-Tepi University Tepi campus students under two colleges and one school (College of Natural and Computational science, College of Engineering and Technology, and School of Computing and Informatics) were considered. All regular undergraduate students in the Tepi campus were selected as target population of this study.
ere is homogeneity among the study population, and the target population was known, therefore, the simple random sampling technique was used to select the sample from the target population by applying the lottery method.

Inclusion and Exclusion
Criteria. All Mizan-Tepi university undergraduate regular students were illegible to be included in the study. Students attending nonregular class, being seriously ill, and not volunteering to participate in these study were excluded.

Sample Size Determination.
e sample size was calculated using the single-population proportion formula using the following parameters: 95% confidence level (Z α/2 � 1.96), 5% margin of error (d � 0.05), and by taking 37.8% prevalence of utilization of VCT from the previous study [16]. en, the sample size (n) was determined as follows: By considering 10% of none response rate, the sample size was calculated as 398.

Data Collection Procedure and Instrument.
After acquiring consent and voluntariness from each respondent, basic sociodemographic and socioeconomic data, as well as sexual-related information, were obtained using a pretested, semistructured, and self-administered questionnaire.

Study Variables.
Voluntary counseling and testing (VCT) experience was used as a dependent variable and coded as 0 if the respondents did not experience VCTand 1 if the respondents experienced VCT at least once. e predictor variables included in this study were the sex of students, age of students, religion, region, mother's education, father's education, original residence of students, service access, source of information, having a sexual partner, media access, knowledge about VCT, and attitude towards VCT.

Statistical Data Analysis.
e collected data were cleared, coded, and analyzed using SPSS version 24. e descriptive statistics, such as frequency and percentage, and inferential statistics, such as the chi-square and multiple logistic regression with adjusted odd ratio (AOR), were applied to identify the significant factors. e predictor variables that were significant in the univariable analysis at 25% (p-value <0.25) level of significance and the variables that were considered more important were included in the multiple logistic regression analysis. e estimated adjusted odds ratios (AOR) and 95% confidence intervals with a p-value less than 5% indicates that the variables were statistically significant in the multivariable analysis.

Sociodemographic Characteristics of Study Participants.
All 398 participants completed questionnaires with the response rate of 100%. About 57.5% of the participants had never experienced a voluntary counseling test, whereas the remaining 42.5% experienced one ( Figure 1). Out of 398 participants included in this study, about 237(59.5%) was females, and of those females, only 91 (22.9%) experienced VCTservices, while of the total male students included in the study, 83 (20.9%) had no experience about the VCT service. 192 participants (48.2%) in the age group of 21-22, 139 (35%) in the age group of 23 and above, 22 (5.5%) in the age group of 18-20, 106 (26.6%) in the age group of 21-22, and 41 (10.3%) in the age group of 23 and above experienced VCT services (Table 1).
According to the educational background, 135 (33.9%) and 91 (22.9%) of mothers and fathers of the students were uneducated, respectively, and students from those parents, i.e., only 60 (15.1%) and 27 (7%) experienced VCT services, respectively. However, 94 (23.6%) students were from mothers who attended primary school, and 74 (18.6%) were from fathers who attended primary school. Students with secondary and above educated parents were more experienced than those with uneducated parents.

Association of Voluntary Counseling Test (VCT) of Students and Explanatory Variables.
e results of the chisquare test of the association revealed that the sex of students, age of students, mother education level, father education level, service access, source of information, having a sexual partner, and attitude toward VCT had a statistically significant association with the voluntary counseling test (VCT) experience, whereas the remaining variables had no statistically significant relationship with the voluntary counseling test (VCT) experience (Table 1).

Factors Associated with Voluntary Counseling and Testing (VCT) Experience among Students.
e results of binary logistic regression analysis revealed that sex, age, region, mother's education, father's education, service access, source of information, having a sexual partner, media access, and attitudes toward VCT service had statistically significant effects on the voluntary counseling and testing experience of students. Male students were less likely to have VCT experiences (AOR � 0.549; 95%CI: 0.330-0.910,   It implies that students with the fathers who were primary and above educated were more likely to experience VCT compared to students with uneducated father (Table 2). Students with VCT services in their surroundings were more likely to experience VCT (AOR � 2.348; 95%CI: 1.371-4.020, p-value � 0.002) compared to students not having any VCT service access in their surroundings. Students whose information source was mass media had an odds ratio of (AOR � 3.221; 95%CI: 1.213-8.556, p-value � 0.019), which implies that students who got information about the VCT service from mass media were 3.221 times more likely to experience VCT services than students who got information from their parents. e participants who had a boyfriend or girlfriend were 3.795 times more likely to practice VCT service compared to students who had no friends (AOR � 3.795; 95%CI: 1.214-11.868, p-value � 0.022). Media access plays a central role in sharing information in many directions. In this regard, the students who had media access in their surroundings had an odd ratio of (AOR � 2.374; 95%CI: 1.059-5.320, p-value � 0.036).
is result shows that students who had media access in their surroundings were 2.374 times more likely to practice VCT services than students without media access. Respondents who had a positive attitude toward VCT services had an odds ratio of (AOR � 1.330; 95%CI: 1.173-2.838, p-value � 0.017), which implies that students with a positive attitude toward VCT services practice a voluntary counseling test 33% more than students with a negative attitude ( Table 2).

Discussions
Voluntary counseling and testing (VCT) has been shown to be one of the most effective tools in the fight against HIV/ AIDS. It is widely acknowledged as a critical component of HIV/AIDS preventive methods. Despite the fact that several studies have demonstrated the limited consumption of VCT services, particularly in developing countries, this study attempted to investigate the prevalence and associated determinants of VCT experience among Mizan-Tepi University students [27]. In this study, of all participants, only 42.5% experienced the voluntary counseling and testing services. is result is almost similar to the study conducted in the same area prior to this study [28,29], higher than the prevalence of VCT utilization study conducted in the West Gojjam Merawi Preparatory school Ethiopia by 31.5% [1], Debre Birhan students training College by 35.19% [17], Bahir Dar University by 37.8% [16], and Addis Ababa University by 38.6% [30]. However, this result is lower than the prevalence of VCT utilization study conducted in the Debre Markos University by 58.5% [27] and the study done in the Northwestern parts among the university students by 61.8% [31]. It implies that the utilization of voluntary counseling and testing experience among university students were found to be very lower. e funding of this study revealed that male participants were less likely to practice voluntary counseling and testing compared to female participants. is study is in line with the study conducted in the Addis Ababa university [32], Ambo University [33], in Ethiopia [34], in sub-Saharan Africa [35], in South Africa [36], in Lesotho [37], in Arusha City, Tanzania [38], and it contradicts with the study done in the West Gojjam Merawi Preparatory school [1]. It might be the awareness gap between male and female students in the high school level and also the increment of the female students confidence in the higher institution compared to the lower class.
Students in the age group of 21-22 were more likely to practice VCT than their counterparts in the age group 18-20. is result revealed that when participants age increases, the experience of using VCT among youths increases and is consistent with the study conducted in the Addis Ababa University and in Butajira Senior Secondary school [32,39]. Students from Addis Ababa city administration practiced more compared to students from another regions and city administrations. e possible explanation may be enough information sources and service access in the city administration than other regions. e experience for voluntary counseling and testing was higher for students who were from primary and above educated mothers and fathers compared to students from uneducated mothers and fathers. is finding is consistent with the study done in the Gondar town [40]. e possible explanation maybe that mothers and fathers who were educated at a level of primary and above increased awareness about voluntary counseling and testing advantages in their children. In other words, parents with different levels of education had the knowledge to share information about the service to their families compared to uneducated parents.
In this study, students who had access to a volunteer counseling and testing service in their area were 2.348 times more likely to be experienced than students who did not have access to a voluntary counseling and testing service. Volunteer counseling and testing services were provided by health professionals at health facilities, and hence, the lack of health facilities and professionals was the known reason for persons not participating in voluntary counseling and testing. is finding is in line with the study conducted in the Arusha City, Tanzania [38] and in Mwanza region, Tanzania [41].
Considering the source of information about voluntary counseling and testing service, mass media had the significant effect on VCT as the source of information compared to students who get information from their parents. is study is also similar to an earlier study done in southeast Nigeria among polytechnic students [42], Kenya [43], and Ethiopia [44], and it revealed that a majority of the students had knowledge of VCT with mass media. It means that students who got information from at least one of the listed sources (newspaper, television, radio, and internet) were considered students who got information from mass media.
Students who had sexual partners (boyfriend or girlfriend) were more likely to practice voluntary counseling and testing compared to students who did not. ose who had a boyfriend or girlfriend may have had a higher likelihood of having VCT as a precondition for starting sex, or they may have discussed VCT with their spouse, increasing their selfefficacy to have VCT. ose who have never had a boyfriend or girlfriend, on the other hand, may believe that they are not at risk since they have not yet had sex. is finding is in line with the study done in Bahirdar University [16], Harar college [45], and Tigray [46] in Kenya [47]. Being associated with someone increases the likelihood of using VCT services substantially more than not being involved. However, a study conducted among school students in Gurage zone [48] contradicts this study. It might be attributable to the research population (school adolescents) and the sample method (volunteer sampling), where singleness is the norm.
According to different studies in different parts of the country, an individual who had access to different media, such as newspaper, television, radio, and internet, were more likely to experience voluntary counseling and testing service compared to those students who had no media access. is study is in line with the study conducted in southeast Nigeria among students [42] in tertiary institutions in Enugu State Nigeria [3], Kilimanjaro region, and Tanzania, among healthcare professional students [24] in Ethiopia using EDHS data [49], and a systematic review of contingent valuation studies [50]. Students with a positive attitude toward volunteer counseling and testing service were more likely to engage in voluntary counseling and testing service than students with a negative attitude, according to this study. is study is consistent with the study conducted in Merawi Preparatory school students in West Gojjam [1].

Conclusion
According to this study and different studies conducted prior to this study, VCT utilization experience was limited in Ethiopia higher institutions until now. is study identified the factors that determine the VCT utilization of students in higher institutions, specifically, in Mizan-Tepi University, Tepi campus. e sex of the students, ages, region, mother's education level, father's education level, if they had boy/ girlfriend, source of information, VCT service access, media access, and attitude towards VCT were identified as the significant factors for voluntary counseling and testing experience among students. To increase the use of VCT services, the VCT facilities should be publicly advertised, and all information about them must be made available to teenagers to raise awareness. Stand-alone VCT facilities should be built in communities and educational institutions to improve access to VCT services. Furthermore, community education programs in market, mass media, and other public places should be held to instruct parents who are accountable for their children.

Abbreviations
VCT: Voluntary counseling and testing AOR: Adjusted odds ratio CI: Confidence interval DF: Degree freedom EDHS: Ethiopian demographic and health survey HIV: Human immunodeficiency virus AIDS: Acquired immunodeficiency syndrome.
Data Availability e datasets used in this study are available from the corresponding author upon reasonable request.

Ethical Approval
e Institutional Ethical Clearance Committee of Mizan-Tepi University had ethically cleared the study, while permissions were obtained from the Mizan-Tepi University Tepi Campus, Chief Directorate, and each college and school.

Consent
An informed written consent was obtained from each study participant and confidentiality of the data was assured.

Conflicts of Interest
e authors declare that there are no conflicts of interest.

Authors' Contributions
Lema Abate conceived the research idea, designed methodology, conducted analysis, and drafted the manuscript. Sali Suleman and Admasu Markos reviewed and edited the manuscript. All authors contributed to interpretation and discussion of the study findings and agreed with the findings presented in the paper. All authors have read and approved the final manuscript.