|Year : 2014 | Volume
| Issue : 2 | Page : 97-103
Effect of health education on the uptake of HIV counseling and testing among long distance drivers in Jos North Local Government Areas of Plateau State
Zuwaira I Hassan, Tolulope O Afolaranmi, Yetunde O Tagurum, Danjuma A Bello, Jonathan C Daboar, Chundung A Miner, Ayuba I Zoakah
Department of Community Medicine, University of Jos, P. M. B. 2084, Jos, Plateau State, Nigeria
|Date of Web Publication||18-Aug-2014|
Dr. Zuwaira I Hassan
Department of Community Medicine, University of Jos, P. M. B. 2084, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Background: The impact of HIV/AIDS has been felt in virtually all aspects of life. Long distance drivers are of particular concern to HIV prevention and care programs because they constitute a high risk group. HIV Counseling and Testing (HCT) is an intervention, which gives the client an opportunity to confidentially discuss his or her HIV risks and be assisted to learn his/her HIV status for purposes of prevention, treatment, care and support. The objective of this study was to determine the effect of health education on the uptake of HCT among Long Distance Drivers (LDDs) in Plateau State.
Methodology: This was a quasi-experimental study with a pre and post intervention phase carried out among 161 LDDs in Jos North Local Government Areas. Health education intervention was provided using a structured health education guide in the form of lecture and discussion. Epi-info TM statistical software version 3.5.4 developed by Centre for Disease and Control and Prevention (CDC) 1600 Clifton Rd. Atlanta, GA 30333 usa was used for data analysis and 95% confidence interval was used for the study and P ≤ 0.05 was considered as statistically significant.
Results: The mean age of the respondent in this study was 41.0 ± 7.9 years with majority (92.5%) of the LDDs married and 91.3% resident within the state. Knowledge and uptake of HCT among LDDs improved significantly from 4.17 ± 1.43 to 6.70 ± 1.55 and 18.6-57.2% following the intervention ( P < 0.001) respectively.
Conclusion: This study has shown that health education is an effective tool in improving the uptake of HCT among long distance drivers. Therefore, it should be used to improve HCT uptake among high risk groups.
Keywords: Health education, HIV counseling and testing knowledge, plateau state, uptake
|How to cite this article:|
Hassan ZI, Afolaranmi TO, Tagurum YO, Bello DA, Daboar JC, Miner CA, Zoakah AI. Effect of health education on the uptake of HIV counseling and testing among long distance drivers in Jos North Local Government Areas of Plateau State. J Med Trop 2014;16:97-103
|How to cite this URL:|
Hassan ZI, Afolaranmi TO, Tagurum YO, Bello DA, Daboar JC, Miner CA, Zoakah AI. Effect of health education on the uptake of HIV counseling and testing among long distance drivers in Jos North Local Government Areas of Plateau State. J Med Trop [serial online] 2014 [cited 2021 May 10];16:97-103. Available from: https://www.jmedtropics.org/text.asp?2014/16/2/97/139065
| Introduction|| |
HIV/AIDS is a global pandemic and remains a major public health problem. , The impact of HIV/AIDS has been felt in virtually all aspects of life. , Long Distance Drivers (LDDs) are drivers of heavy duty vehicles who spend >1 day on the road before reaching their final destination or interstate commercial bus and taxi drivers who travel relatively long distances. , LDDs are of particular concern to HIV prevention and care programs because they constitute a high risk group.  It is estimated that 9 out of 10 HIV infected individuals in the world do not know of their HIV status. 
A comparison of 2005 and 2007 Nigeria National HIV/AIDS and Reproductive Health survey (NARHS) revealed that the uptake of HIV Counseling and Testing (HCT) increased from 12% to 14.7% for males. , In view of opportunities for HIV prevention and treatment, there is a need to scale up client initiated HCT. , This can be achieved through effective health education using Health Belief Model framework as a veritable tool for instituting behavioral change. , This also formed the basis upon, which the intervention in this study was delivered. Hence, this study was conducted to improve the knowledge and uptake of HCT among LDDs in Jos North Local Government Areas (LGA).
| Methodology|| |
Plateau State is one of the six states in north central zone of Nigeria with its capital in Jos. It is bordered in the North West by Kaduna State, in the North East by Bauchi State, in the South West by Nassarawa State and in South East by Taraba State. It has a population of 3,178,712 (1,593,033 males and 1,585,679 females). , It is located within latitude 80 22 I north and 100-24 I north and longitude 80 32 I East and 100 38 I East and has a total land area of 26,899 km 2 . The altitude ranges from around 1,200 m (4000 feet) to a peak of 1,829 m (6000.7 feet) above sea level in the Shere hills near Jos. It has a near temperate climate with an average temperature of between 18.7 and 51.7 Fahrenheit, while the annual rain fall varies from 131.75 cm in the southern part to 146 cm on the Plateau. 
The National Union of Road Transport Workers (NURTW) in the state has its headquarters in Bauchi road motor park in Jos. It has 62 branches within the 17 LGAs. It is a labor organization whose members comprise of road transport workers involved with transportation of goods and passengers by road. The drivers drive trucks, buses, and taxis. They operate intra-state, interstate and intercity. The NURTW has 14,685 members. There are 46 Voluntary Counseling and Testing (VCT) sites spread across all the LGAs within the state.  The study was conducted in Jos North LGA of Plateau. Jos North Local Government is made up of four districts, which include Jos town which is the commercial hub of the state with a population of 437,217.  The inhabitants are mostly businessmen, civil servants and farmers. There are 11 motor parks for long distance travelling. ,
The study population was the LLDs in Jos North LGA who were both residents and nonresident in Jos North LGA, but registered with transport companies or unions.
The study was a quasi-experimental study with "before" and "after" design using a mixed method design comprising of quantitative and qualitative methods of data collection. Two formative Focus Group Discussions (FGDs) were conducted among the long distance drivers selected by the union officials.
Inclusion and Exclusion Criteria
All male long distance drivers who were 18 years of age and above, registered with any transport company or with NURTW with offices in Plateau State and had been driving for 1 year or longer were eligible to participate in this study. Excluded from the study were LDDs who: (1) Were <18 years of age, (2) not registered with any transport company or union and (3) those that had been driving for <1 year.
Sample Size Determination/Sampling
The sample size was calculated using the formula for health studies  and VCT uptake among men (15%) reported in the 2008 National Demographic and Health Survey.  The size of 161 was obtained after accounting for anticipated attrition.
A multistage sampling technique was used.
From a list of the 17 LGAs in Plateau State, Jos North LGAs was selected using simple random sampling technique by balloting.
There were 11 motor parks/truck stops for Long distance travelling in Jos North LGA. The motor parks/truck stops were stratified into three categories based on the type of vehicles. The categories were motor parks with minibuses and cars only, minibuses and luxurious buses only and trucks only. Four parks were in the category of motor parks with minibuses and cars only, four parks were also in the category of minibuses and luxurious buses only and three parks in the category of trucks. One park was chosen from the list of all the parks in each category using simple random sampling technique by balloting. The parks selected for the study were Plateau riders, Gadabiyu and Bauchi road parks.
A list of all the long distance drivers who had met the inclusion criteria and would be available for three consecutive days in all the three parks was obtained. A total of 810 (429 from the park with luxurious buses and mini buses, 100 from truck park and 281 from the park with cars and buses) long distance drivers were obtained from the three parks in Jos North LGA. The proportion of long distance drivers sampled from each park was gotten by the division of the number of available long distance drives in that park by the total number of long distance drivers available for the study in the three parks multiplied by the sample size. This gave a total a total of 85, 20, and 56 long distance drivers sampled in each park categorized as luxurious and mini buses, truck and car with minibuses, respectively. Every fifth long distance driver from each category of the park was sampled after obtaining a sampling interval from the division of the available number of long distance drivers per park by the number of LDDs to be picked in that park (429/85 for luxurious and mini buses park, 100/20 for truck park and 281/56 for the park with cars with minibuses). In each park, the first respondent was selected using simple random sampling technique by balloting after allotting numbers to all the eligible respondents.
Plateau Riders Park was picked as the starting point using simple random sampling technique by balloting in Jos North LGA. The list of the eligible drivers was got from the schedule of the drivers made available by the head drivers and union officials in each of the randomly selected parks.
Data Collection Instruments
Two sets of data collection instruments were used in this study. A semi-structured interviewer administered questionnaire adapted from 2007 NARHS was used to collect data from eligible respondents.  Two FGD sessions were conducted to obtain qualitative information from eligible respondents using an FGD guide, tape recorder, and note pad.
Two formative FGDs were conducted among the long distance drivers purposively selected by the union officials who were willing to participate in the study to determine their perspectives on HIV/AIDS and HCT. The FGDs were limited to two because of the mobile nature and tight schedule of the LDDs bearing in mind that the two FGDs would still be able to elicit the desired responses. The FGDs were conducted in a conducive and quiet environment each lasting about 1 h per session. The participants were selected by the union officials using age of the drivers as a selection criterion (one FGD among the younger drivers below 40 years of age and the second FGD among older drivers aged 40 years and above), which allowed the opinion and perspective of the participants to be obtained in line with age. Forty years was used as cut off for selection into two groups as older LLDs aged 40 years and above would have driven for a longer duration of time and had more insight into the behaviors of LDDs, while the younger age category would bring to bear the youthful dimension to the inter-relationship between HIV/AIDS, LDDs and HCT. These sessions were moderated by the principal researcher and note taken by one of the research assistants. The participants were seated in a comfortable and conducive environment and were allotted numbers. After due introduction and assurance of confidentiality, the moderator used the FGD question guide to generate discussion and elicited responses. The information obtained from the two formative FGDs was used to structure the content of the health education intervention.
Preparation for Quantitative Data Collection
Field testing of the instrument of data collection prior to the commencement of the study was done among long distance drivers in Kugiya truck stop in Jos South LGA. This ensured that the questions were acceptable, there was a willingness to answer them and they were appropriate in eliciting responses that were consistent with the objectives of the study. Advocacy visit was paid to the management of the selected motor parks to intimate them about the research and solicit their support. Ten resident doctors from the Department of Community Medicine Jos University Teaching Hospital (JUTH) were trained as research assistants by the principal researcher on the content and procedures of research and participated in the data collection for the study. Verbal and written informed consent were sought from the eligible LDDs.
Anonymity and confidentiality of the information obtained was assured and maintained. Ethical clearance was obtained from Ethical Review Committee of JUTH, Jos.
| Intervention|| |
Health education intervention was provided to respondents by the principal researcher in English and Hausa languages to ensure the quality and standard of the content was maintained for the period of 2 days in each park, with morning and afternoon sessions each day lasting 1 h per session with a total of 4 h per park using the health education manual developed after the FGDs. The members of the HIV/AIDS units of all the selected parks that had HIV/AIDS unit participated in the health education intervention. In the parks without HIV/AIDS unit, the union officials participated in the health education intervention. The health education intervention took place in convenient halls within the motor parks where the drivers sat comfortably. The health education intervention was given in the form of lectures and discussions, which covered the following aspects (basic facts on HIV/AIDS, HCT, information on where to access HCT services, prevention of HIV/AIDS, reduction in stigma/positive living, options of care, treatment and support to HIV positive individuals, perception of risk of HIV/AIDS). The content of the health education intervention was developed from the findings of the formative FGDs.
Handbills and posters with information on HIV/AIDS and HCT were provided during the intervention to the respondents. Bulk short messaging service was sent to all the LDDs every 2 weeks for duration of 3 months to serve as reminder. The content of the message was originally developed for the study and stated as "Do you know your status? Go for HIV counseling and testing today. It is beneficial. Ka san matsayin ka? Kaje kayi Gwajin Cutar Sida a yau."
Three months after the intervention, quantitative data were again collected with the same data collection instruments from the respondents.
| Data Analysis|| |
Data analysis was performed using Epi-info TM statistical software package version 3.5.4developed by CDC 1600 Clifton Rd. Atlanta, GA 30333 USA.  A 95% confidence level was used for the study and P ≤ 0.05 (P ≤ 0.05) was considered as statistically significant.
Reporting of FDGs
The information obtained from the FGDs through the use of tape recorder and note taking was transcribed directly and had content analysis done.
Scoring and Grading of Responses
There were eight questions on the knowledge of HCT. One mark was awarded for each correct response and no mark for incorrect response. A total of eight maximum attainable scores was used for the knowledge of HCT. A score of 0-3 marks out of eight marks was assessed to be poor knowledge of HCT, while a score of 4-8 marks out of eight marks was assessed to be good knowledge of HCT. This scoring system was originally developed for this study.
| Results|| |
A total of 161 long distance drivers participated in this study at the preintervention phase, while 159 long distance drivers were available at the postintervention phase giving a response rate of 98.8% and an attrition rate of 1.2%.
The ages of the LDDs in this study ranged from 20 to 59 years with the mean age of 41.0 ± 7.9 years. On the marital status of the respondents, majority (92.5%) were married. Almost all (91.3%) of the respondents lived within the state while the remaining 14 (8.7%) lived outside the state. Slightly above half of the respondent (50.3%) had primary education as the highest level of education. On the type of vehicles driven by the respondents, 111 (68.9%) drove buses, 30 (18.6%) drove cars while 20 (12.4%) drove trucks. Buses in this context comprised of both luxurious buses and mini-buses. A total of 79 (49.1%) of the respondents spent cumulatively a range of 3-6 months away from their homes in a year. More than half of the drivers in this study 99 (61.5%) earned more than N150,000 a year with a mean annual income of N189,800.00 ± 33,100.00. The mean year of driving of the respondents was 14.2 ± 6.6 years [Table 1].
The proportion of the long distance drivers who had heard of HCT increased from 146 (90.7%) preintervention to 159 (100%) postintervention, which was statistically significant (P = 0.000). Health education produced a significant improvement in knowledge of the respondents as 86 (53.4%) of the respondents could correctly define HCT at preintervention, while at postintervention, the number of respondents who could correctly defined HCT increased to 153 (96.2%). Similarly, there was statistically significant increase in knowledge of HCT among the respondents as 67 (41.6%) had good knowledge of VCT preintervention and 142 (89.3%) postintervention (P < 0.001). The mean knowledge scores of HCT among the respondents increased from 4.17 ± 1.43 preintervention to 6.70 ± 1.55 postintervention, which was statistically significant (P < 0.001) [Table 2].
On the uptake of HCT among LLDs, there was significant improvement in the uptake of VCT following the health education as the proportion of the respondents who had HCT increased from 30 (18.6%) preintervention to 91 (57.2%) at post- intervention. Twenty-six (86.7%) of the respondents who had repeat HCT done in the future this however, increased after the intervention as 57 (62.6%) of the respondent who had done HCT were willing to still repeat the test in future (x 2 = 6.15; df = 2; P = 0.046). The proportion of respondents in the study group who mentioned two or more places where HCT services could be accessed increased from 31 (19.3%) preintervention to 104 (65.4%) postintervention (P < 0.001) [Table 3].
Knowledge of HIV counseling and testing
Many of the participants had heard of HCT, as they described it as a test done to know about ones HIV/AIDS status. However, very few of them could mention the processes involved. About half of them could mention at least a place where HCT can be done. A 42-year-old car driver had this to say "We use to hear on radio that we should go and test". Another participant, a 46-year-old long distance driver said "Some people came to the park about 8 years ago and talked to us about HIV/AIDS and testing (HCT), they offered the test to those of us who were willing to do it." Another participant said "It is a test that is done to know ones blood group". A Hausa participant had this to say "Whenever a person is sick and goes to the hospital, the doctors will just do HIV test for the person without informing the person until after the test has been done. This usually puts the person in anxiety state thereby killing the person before he dies."
Uptake of HIV counselling and testing
Majority of the participants said that HIV testing was not a common practice among the long distance drivers and suggested that if HCT services were made available in the parks more LDDs will get tested. A participant said this "Drivers usually test for HIV when they are sick and the doctors recommend it" Only few of the participants said that they had done HIV test to know their status.
| Discussion|| |
The mean age of the respondents in this study was 41.0 ± 7.9 years. Another study conducted in Ilorin, Kwara State recorded a slightly lower mean age of 37 ± 10 years among the drivers indicating that majority of long distance driver are above the age of 30 years.  In terms of educational status of the respondents in this study, about half of the respondents had completed primary education. This is similar to the findings of another study in which majority of the long distance drivers had primary school as the highest level of education.  The implication of these findings is that long distance driving does not require high level of education. Islam was the predominant religion among the long distance drivers in this study. This is similar to the finding of a the study conducted in Ilorin.  In another study conducted in Ibadan, Oyo State, similar finding was also obtained concerning the religion of the respondents.  In this study, majority of the respondents were resident within the state. This may be due to the fact that many transport companies have offices in Jos, Plateau State capital which is also a commercial center housing numerous individuals in transport business also. Majority of the respondents in both groups in the study were married. This finding on marital status is also corroborated by the findings on other studies done in Nigeria. ,, The mean years of driving of the respondents was 14.2 ± 6.6 years. A study carried out in Delta State in Nigeria gave the mean years of driving of long distance drivers as 10 ± 5.91 years.  These similar findings on the duration of time of driving may be due to the fact that long distance driving is a profession that can be practiced optimally between the ages of 25 and 50 years therefore making the duration of professional driving limited.
Knowledge of HIV Counselling and Testing
This study revealed that majority of the respondents was aware of HCT both at preintervention and postintervention. This high level of awareness of HCT in this study is similar to the findings of a study done in Enugu Nigeria, which found that majority of the respondents were aware of HCT.  High level of awareness of HCT was also noted during the FGDs although comprehensive knowledge of HCT was lacking. This high level of awareness of HCT may be as a result of the mass media and other health awareness campaigns on HIV/AIDS and HCT. The finding of this study differed from that done in China in which awareness of HCT was as low as only 46.5%. 
Majority of the respondents did not know where to access HCT before the intervention as very few respondents knew two or more places where HCT services could be obtained. This low level of knowledge of where HCT services could be accessed was also obtained in a study done in Kano where only 26% of the respondents knew where HCT services could be assessed.  The result obtained in this study at preintervention was found to be lower than that obtained in the 2007 NARHS and 2008 Nigeria Demographic and Health Survey (NDHS) in which 56% and 57% of the respondents respectively knew where to access HCT. , The health education offered to the long distance drivers in this study had beneficial effect as the proportion of the respondents in study group who knew where to access HCT services increased postintervention (P < 0.001). Furthermore, there was statistically significant improvement in the knowledge of HCT among the respondents after health education intervention as majority had good knowledge as against less than half of the respondents who had good knowledge of HCT preintervention (P < 0.001). This finding has further brought to light the importance of health education in improving the knowledge of HCT among long distance drivers.
Uptake of HIV Counselling and Testing
Health education intervention provided to LLDs in the study produced significant improvement in the uptake of HCT as uptake of HCT was found to be low among the drivers prior to the intervention, while after the intervention, a higher proportion of the respondents reported to have had HIV test done, which was statistically significant. A study on uptake of HCT among the tertiary institution students in Plateau State also corroborated the effect of health education on the uptake of HCT as the proportion of students who had ever done HIV testing increased from 23.4% before the health education to 42.2% after the health education.  The level of uptake of HCT found among long distance drivers in the 2007 Integrated Behavioral Surveillance Survey was 22%, which was higher than what was obtained in this study prior to the health education intervention.  Another study conducted among long distance drivers in Enugu reported a lower uptake of HCT among the respondents.  The findings of this study at preintervention was also comparable to the findings of the 2008 NDHS in which only 16% of the respondents had ever had HIV test.  Low uptake of HCT among long distance drivers could be as a result of low perception of risk and this study has demonstrated that health education intervention is a valuable instrument in improving the uptake of HCT. During the FGDs, Majority of the participants mentioned that going for HIV testing was not a common practice among them.
Limitations of the Study
- The study could not ascertain if the drivers who tested positive during the HCT enrolled for HIV treatment, care and support services
- The study could not ascertain the prevalence of HIV/AIDS among the drivers as this was outside the scope of the study.
| Recommendations for Future Research|| |
The findings of this study can be used as basis for assessing the level of uptake of HCT services among the LLDs and other high risk groups. The findings of this study can be generalized to other high risk groups as well as the general population.
This study has demonstrated the effectiveness of health education as a valuable tool in increasing the uptake of HCT and promoting positive change in HIV/AIDS prevention among long distance drivers in Jos North LGA of Plateau State therefore, HCT services should be provided for long distance drivers in their parks as suggested by the participants during the FGDs and some of the drivers should be trained as members of the HCT service providers to further bring to bear the importance of HCT. Furthermore, health education sessions using IEC materials adapted to address specific behavioral needs of the drivers in appropriate languages should be provided at regularly interval to LLDs in the various parks in the state.
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[Table 1], [Table 2], [Table 3]
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