PREVALENCE OF VOLUNTARY COUNSELING AND TESTING SERVICE UTILIZATION AND ITS ASSOCIATED FACTORS AMONG PREPARATORY SCHOOL STUDENTS IN GONDAR TOWN, AMHARA REGION, ETHIOPIA

Objectives: The objective of this study was to assess the prevalence of voluntary counseling and testing (VCT) services utilization and associated factors among preparatory school students in Gondar town, Amhara region, Ethiopia.
Methods: Institutional based cross-sectional study design was employed. Multistage sampling procedure was conducted. Data were collected using pre-tested self-administered questionnaire and the data were entered, clean, and analyzed using SPSS software. Descriptive, bivariate, and multivariate analysis were employed. Multivariate analysis with 95% CI was computed to identify factors associated with VCT service utilization at p<0.05.
Results: The study included a total of 654 study participants, with a response rate of 97%. According to the research, 48.3% of adolescents used VCT services (95% CI: 44.5–52.1). The results of multivariate analysis revealed that age, site of birth, mother education, and discussion with parents were all substantially associated with the use of VCT services.
Conclusions: The majority of those who took part in the survey did not use VCT services. Only a small percentage of respondents have ever taken a VCT test and discussed it with their parents. The primary barrier for adolescents in the study area was cultural taboos, which they did not discuss with their parents. As a result, it will take an endless amount of effort from all relevant parties to promote teenage service use, as well as family life education, to encourage students and parents to use VCT.


INTRODUCTION
The World Health Organization defines adolescents as people aged 10-19 years old and young people aged 10-24 years old [1]. Adolescents make up about 1.2 billion people on the planet, accounting for the fifthlargest population, with 80 percent of them living in poor countries [2]. Out of a total population of 7.3 billion people, there are little under 1.8 billion young people in the world today [3]. Accessible, acceptable, and suitable reproductive health care for young people is referred to as youth-friendly reproductive health care. Among the services offered are family planning, volunteer counseling, and testing and treatment for sexually transmitted diseases (STDs) [4].
Voluntary counseling and testing refer to those who seek HIV counseling and testing in a private context. The services are delivered in a private setting. The primary focus is on preventing HIV acquisition by risk assessment, risk reduction, and testing [5]. HIV counseling and testing clients are typically sexually active, of reproductive age, and have been disproportionately affected by the infection [6]. HIV/AIDS is a human group disease with demographic and social consequences that spread from infected individuals to the entire group. Because it mostly affects young and middle-aged adults, this epidemic has a significant impact [7].
Young people in Sub-Saharan Africa are more likely to have sexual and reproductive health difficulties than young people in other regions of the world [8]. Youth in this region are at the highest risk of sexually transmitted infections, accounting for more than half of all new HIV infections [8]. Young persons aged 15-24 years account for more than half of new HIV infections in developing countries [9]. With 110 million new cases per year, Africa has the highest frequency of STDs, particularly in Sub-Saharan Africa [10].
Ethiopian adolescents and young people aged 10-24 account for one-third of the population (31,426,691), with about half of them (15,485,880) being teenage girls and young women aged 10-24 [11]. Infection with HIV affects 0.2% of adolescent females and males between the ages of 15 and 24. In adolescent girls and young women aged 15-24, HIV prevalence is three times higher than in boys of the same age (female 0.3% and male 0.1%). In Somalia, HIV prevalence among young women and male's ranges from <0.1% to 1.3% [12]. According to an Ethiopian demographic and health survey, educated persons are more likely than uneducated people to test positive for HIV. HIV testing was 14% among non-educated women compared to 44% among women with at least a secondary education, and 13% among non-educated males compared to 39 percent among men with at least a secondary school [13].
In a vicious spiral, AIDS' vulnerability, danger, and impact are all connected. Vulnerability can be reduced by providing young people with education, encouraging safe family settings, and increasing populationwide access to health and support services. HIV testing in conjunction with prevention intervention is used in a variety of HIV/AIDS prevention, care, and support strategies [14]. HIV/AIDS prevention and additional services, such as MTCT prevention, prevention and clinical management of HIV-related illnesses, and psychosocial and legal assistance, all begin with voluntary counseling and testing (VCT). VCT is in high demand, and it benefits people who test positive as well as those who test negative. VCT helps to reduce anxiety, enhance client knowledge of their HIV vulnerability, motivate behavioral change, enable early referral for care and support, including antiretroviral therapy, and remove stigma in the community [15]. Ethiopia's government has developed policies, strategies, initiatives, and institutional arrangements to combat HIV/ Source and study population All Gondar town preparatory school students were used as a source of population. The study population consisted of students from public and private schools in the study area who attended selected preparatory schools.

Inclusion and exclusion criteria
Preparatory school students from both public and private institutions were included in the study, although students who were ill or unable to talk, as well as nocturnal students, were excluded.

Sample size determination and techniques
The sample size was calculated using the single population proportion calculation with the following assumptions in mind. The sample size was determined using a 95% level of confidence, a 0.05 value (Z/2 = 1.96 on the standard normal distribution curve), a 5% margin of error (d = 0.05), a proportion of 29.8% taken from a previous study in Woreta town among adolescents aged 10-19, a 5% contingency, and two design effects.
The sample was increased to 337 by adding 5% contingency. To increase the sample size and choose the first sampling unit, a multistage sampling procedure was utilized. The sample of 337 was multiplied by two design effects, resulting in a final sample size of 674. The primary sampling unit was chosen and the sample fraction for each school was determined using a multi-stage sampling technique. In the research area, there were seven public and three private preparatory schools. The secondary sampling unit was chosen using a basic random sampling procedure. A total of six schools were chosen by lottery from among the ten preparatory schools: Four public schools and two private institutions. The systematic sampling approach was carried out by compiling a list of all pupils from each grade's roster.

Study variables
The outcome variable was the use of VCT services, whereas explanatory variables included demographic, socioeconomic, and individual factors, as well as health system aspects.

Data collection, quality control and analysis
The questionnaire was written in English first, then translated into Amharic and then re-translated into English by a second translator to ensure consistency. The data were then obtained using a selfadministered questionnaire. The survey asks about demographic, socioeconomic, and individual variables, as well as healthcare system characteristics.
To assure data quality, one school facilitator was assigned to each of the selected preparatory schools, who supervised the students while they filled out the data. The goal of the study, protocols and data gathering methodologies were all covered in detail throughout the      school outside of the study area to ensure the questionnaire's reliability. Before entering the data, the acquired data were double-checked for accuracy.

Variables Frequency (n) Percent (%)
Quantitative data was obtained from preparatory school students via a questionnaire, and statistical analysis was performed using SPSS version 16. The association between outcome and explanatory variables was examined using bivariate and multivariate analyses with p = 0.25 and 0.05, respectively, at a 95% confidence level. To determine the degree of association between each explanatory and the outcome variable, cross tabulation and chi-square procedures were utilized. The logistic regression model was used because it is the best method for determining the strength of the association between the outcome variable and the explanatory variables when the outcome variable is dichotomous and has a value between 1 and 0. The results in the table were described using descriptive statistics such as frequency and percentage.
The majority of their families earn more than 3550 birrs from their monthly family income. In terms of living arrangement, the majority of students 480 (74.6%) lived with both parents, eighty-six (13.1%) lived with their mother only and eighty (12.2%) lived with others. Others only blamed this with father, sister, brother, grandmother, aunt, and grand father.

VCT knowledge and sources of information
In terms of VCT knowledge, 81.7% of research participants know what VCT is, and 56.1% of respondents know that the media (TV) is the most important source of VCT information. 32.6% of those polled had recently discussed VCT with their parents, according to the study participants. The reasons for VCT were not discussed with their parents in 49.9% of cases, fear of the family in 10.6% of cases, and cultural taboos in 55.3% of cases.

Utilization of VCT services
VCT services were used by 48.3% of study participants, according to the findings. 89.2% of adolescents utilize VCT services to better comprehend the current situation, 5.1% for marriage objectives, and 5.7% for self-suspicion. The majority of interviewees who received VCT services in the survey cited this issue, with 41.1% from government health centers and 32.6% from private health centers.

Factors associated with VCT services utilization
The factors associated with the usage of VCT services were assessed using a bivariate approach. The degree of association between the independent and outcome variables was first assessed using bivariate analysis.
On bivariate analysis, the factors were found to be significantly associated with VCT services utilization were, sex, age, place of birth, marital status, mother's education, ever had sexual intercourse, media exposure, ever had girl or boyfriends, discussed with parents, cost and waiting time before got VCT p<0.25. These variables which were significant on bivariate analysis were entered into multivariate analysis by using enter. After that, mother's education, age, place of birth, and discussed with parents on the issue of VCT in the past time were found to be significantly and independently associated with VCT services utilization at p<0.05.

Discussion
The purpose of this study is to determine the prevalence of VCT service use and associated factors among Gondar town preparatory school students. VCT service utilization helps to control a variety of sexual and reproductive health problems while also fostering healthy, productive adolescents at the regional and country levels.
The sexual history of study participants revealed that (26%) had ever had sexual practice with the mean age of the first sexual intercourse being 18.62 (with SD1.714) years, which was slightly higher than the prevalence of (22.9%) with the mean age of 16.68 (SD 2.32) years found in a school-based study in Hadiya and lower than the 52.9% found in a study conducted in Goba [17,18].
The study found that 48.3% of respondents used VCT services, which is greater than other studies in Ambo University, Dire Dawa, and Goba, and Madawalabu Universities, but lower than other studies in Goba and Madawalabu University [19,20]. The fact that certain research included both sexually experienced and inexperienced adolescents could be one of the causes for the disparities. Adolescents from both in and out of school may make up the rest of the group.

Preparatory Schools in Gondar Town
Public

Demeke and Alazbih
The age of adolescents was found to be a major factor in the use of VCT services in this study. According to the findings of this study, adolescents above the age of 18 were 0.64 times more likely to use VCT services than those under the age of 18 (AOR = 0.642; 95% CI = 0.453-0.909). This research agrees with those of Madawalabu University and Jimma Town [21,22]. This could be because as people get older, their risk of experiencing VCT service use concerns rises.
The study revealed that place of birth was significantly associated with VCT services utilization. Adolescents in urban areas were 1.8 times more likely than those in rural areas to use VCT services (AOR = 1.785; 95% CI = 1.090-2.921). This research was similar to one conducted at Bahar Dar University [23]. This could be due to the fact that urban adolescents had better access to services, attitudes, and cultural acceptance than rural adolescents when it came to using VCT services.
The study indicated that discussion with parents on the issues of VCT was significantly associated with VCT service utilization. Participants who discussed VCT services with their parents were 2 times more likely to use them than those who did not (AOR = 2.038; 95% CI = 1.423-2.920), which was similar with research conducted at Madawalabu University and Bahir Dar University [21,23]. This could be attributed to an increase in adolescent discussions with parents about VCT as well as service use issues.

Conclusions
Bivariate and multivariate analyses were used to present the study's findings. According to the findings of the study, the majority of adolescents in the study region do not use VCT services. The survey found that adolescents were well-informed about VCT services. However, VCT service utilization among preparatory school students in the research area was extremely low. This could result in a distinction between knowledge and service consumption. According to the findings, adolescents who discuss VCT issues with their parents have a significant impact on their use of VCT services. When asked about the primary source of information about VCT services, a high proportion of respondents said that the media (TV) was the primary source of information. The use of VCT services was studied using multivariate analysis to examine if there was a link between demographic, socioeconomic, healthcare system, and individual characteristics. As a result, the mother's education, birthplace, age, and discussions with her parents were all linked to the use of VCT services.
To generalize knowledge and practice of service utilization, it takes a lot of work to plan and implement appropriate adolescents and young VCT service information, education, and communication programs in schools. To effectively serve the needs of adolescents and teenagers in VCT services, hospitals, health centers, and FGAE should form a network. To determine the effectiveness of VCT among adolescents and youth, more research is needed.

Ethical approval and consent to participate
At the start of the study process, ethical clearance was first obtained from the Department of Population Studies at the University of Gondar, College of Social Science and Humanities. The support letter was obtained from North Gondar Education Bureau and the next permission was obtained from Gondar town public and private preparatory school director offices in the verbal form. The verbal informed consent was obtain before conducting data collection. They were also informed about their right to participate, not participate or withdraw from the study at any time. The data were collected anonymously to keep the confidentiality of the information. Voluntary consent was obtained from each participant to participate in the study during data collection in a verbal form. Regarding consents from parents under 16 years old study participants, informed written consent was not obtained. Verbal permission was got from parents, relatives, and concerned bodies.