Reasons for HIV testing were assessed by a question asking the participant the main reason for coming to the clinic for an HIV test. Response choices were:

I was feeling ill,

I had sex without a condom,

I had sex with someone who is HIV positive,

I was sexually assaulted,

I have had many sexual partners,

My partner has been unfaithful,

My partner told me to get tested,

My partner was ill or died,

My child was ill or died,

I was taking care of someone with HIV,

I was offered a test by a health provider as routine part of care,

Other, (specify).

Patients reporting reasons related to risky sexual behavior or other potential HIV exposures were regarded to be motivated by current/previous HIV risk. Reasons provided under “Other” were categorized based on whether they were symptom or perceived HIV risk-related. The majority reported just wanting to know or just to check their HIV status, which we grouped into an additional category (just to know). We then dichotomized self-reported reasons for HIV testing into asymptomatic and symptomatic. Patients who reported testing out of their own initiative or because of a perceived HIV exposure, and those offered a test as part of routine care were categorized as asymptomatic.

We measured perceived social support (PSS) using an 8-item measure of social support where participants indicated the overall level of agreement with the support they have access to (Cronbach's alpha = 0.61).[21] Rating of overall satisfaction for each item ranged from 1 to 4. Mean scores were categorized as either “low PSS” (score < 2), “medium (2 to < 3), or “high PSS” (score > = 3). We developed a household amenities index through factor analysis of participants’ household characteristics (type of toilet facilities, energy used for cooking, housing structure, household density, and food availability), and ownership of household assets (television, radio, refrigerator, satellite television, cellular telephone, landline telephone, microwave oven, and personal computer).[22] The total score for the household amenities index ranged from 0 to 1, with higher total scores reflecting greater household access to amenities (Cronbach alpha = 0.81). A cut-off score of 0.3 or less indicated “low” amenities score, above 0.3 to 0.67 indicated “medium” amenities score, and a score higher than 0.67 indicated “high” amenities score.

Depression was measured using the Centre for Epidemiologic studies-Depression (CES-D) 10 scale, a 10-item questionnaire with a four-point scale (scores range 0 to 3) that measures general depressive symptoms experienced up to 7 days prior.[23,24] The total score ranged from 0 to 30 with higher scores reflecting greater occurrence of depression (Cronbach alpha = 0.80), with a cut-off score of 12 or higher indicating the presence of major depressive symptoms.[24,25] We created a dichotomous variable for depression categorized into no depression (CES-D 10 total score <12) and major depressive symptoms (CES-D 10 total score ≥12).

Other patient-level factors collected include sociodemographic characteristics: age, sex, highest education completed, English literacy, marital status; employment status, whether the patient is the household breadwinner, the number of child dependants and source of primary income. We assessed health care seeking behavior using history of visiting any other health provider or clinic, and HIV testing history. Factors relating to sexual risk behavior assessed included condom usage at last sex, and number of sexual partners in the preceding 12 months. Assessment of current social support factors included to whom the patients had disclosed their intention to come for HIV testing to, whether anyone accompanied them to the testing clinic and their intention to disclose their HIV status. Blood collection for baseline CD4 counts was done on the day of testing. Baseline CD4 results are categorized as <350, 350 to 500, and >500 cells/μl.

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