Comprehensive Knowledge, Attitudes, Behaviors, and Associated Factors of HIV/AIDS in Gondar City Public Health Facilities Among HIV Testing and Counselling Service Users, Northwest Ethiopia, 2022; an Ordinal Logistic Regression Analysis [Response to Letter]

Dear editor

We extend our gratitude to Prof. Elanda Fikri for the thoughtful response to our article, “Comprehensive Knowledge, Attitudes, Behaviors, and Associated Factors of HIV/AIDS in Gondar City Public Health Facilities Among HIV Testing and Counselling Service Users, Northwest Ethiopia, 2022; an Ordinal Logistic Regression Analysis”. Prof. Fikri’s observations and recommendations are invaluable. We acknowledge the limitation of focusing solely on public health facilities in Gondar city and recognize the need to expand our sampling scope to include private health facilities and additional regions for a more comprehensive analysis. However, incorporating private health facilities was not feasible for us during the data collection. The first reason is that VCT users at private facilities were not similar to the general population, especially in terms of their better economic level and unpredictable number of visits per day. Furthermore, private facilities charged a fee for their services, and only those who could afford it would visit them. As a result, their satisfaction rate might be higher compared to public health facilities. Prolonged data collection time, an unknown number of users per day, a lack of cooperation in the study, and a budget deficit were among the main challenges in including them in the study.

We agree that our study population was limited to users of HIV testing and counseling services in public health facilities in Gondar city, which may not be representative of the wider population, such as individuals who do not use these services or who use services in private health facilities. In the future, we plan to conduct studies that include a more diverse population, including individuals from different regions, socioeconomic backgrounds, and healthcare settings. We also suggest that future researchers conduct a comparative cross-sectional study among public and private health facilities to uncover the real differences in a better way. Community-based studies might also make significant contributions to the service area. However, considering our previous objectives, we firmly believe that our contribution has paved the way for upcoming researchers and policymakers to extend it to a wider audience.

Regarding the exploratory factor analysis, thank you for bringing this to our attention. You are correct that our study did not conduct an exploratory factor analysis of the questionnaires used. This is a limitation of our study, as factor analysis is a crucial step in the development and validation of questionnaires. It helps to identify the underlying dimensions of the questionnaire items and ensures that the questionnaire is measuring the constructs it is intended to measure. However, since, we have previously applied questionnaires from similarly published articles and settings, not exploring the factor analysis will not greatly affect the generalizability of the study findings and their coefficient estimation. However, for upcoming events regarding HIV/AIDS, we will conduct this analysis.

The suggestion to incorporate a mixed method or qualitative methods, such as in-depth interviews or focus group discussions, is well taken. We agree that qualitative insights will provide a deeper understanding of the nuanced factors influencing HIV/AIDS knowledge and behaviors.

Prof. Fikri’s point about exploring specific media types and content influencing HIV/AIDS knowledge is well noted. As described in the results section, we have asked participants whether being exposed to various mass media, such as listening to radio or reading newspapers about HIV/AIDS, was associated with comprehensive knowledge of HIV/AIDS. Since several years ago, various governmental and private mass media agencies have been creating awareness regarding HIV/AIDS among the community at large. Therefore, we have tried to assess the effectiveness of the exposure to the community regarding HIV/AIDS, although it cannot be proven by our studies. Further studies might uncover this dilemma.

We believe, future research endeavors will indeed include a more nuanced analysis of media dynamics to inform targeted and effective communication strategies including the contents in terms of time, culture, and other similar factors in detail.

We appreciate the emphasis on considering broader socioeconomic and cultural determinants. In subsequent research, we commit to exploring these factors more thoroughly to contribute to a holistic understanding of the dynamics surrounding HIV/AIDS.

Moving forward, we will implement these valuable recommendations to refine our analyses and strengthen the overall quality of our research. We are thankful for Prof. Fikri’s engagement with our work and look forward to continued collaboration and dialogue on matters related to HIV/AIDS research.