Pregnant women’s knowledge, attitudes and behaviours towards the integration of HIV/AIDS counselling and testing into routine antenatal care in Ghana: a cross-sectional study in the Tamale Metropolis, Ghana

Routine Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) Counselling and Testing (HCT) is essential in eliminating mother-to-child transmission (EMTCT) of HIV/AIDS. In Ghana, HCT guidelines have been integrated into routine antenatal care (ANC) to enhance EMTCT outcomes. However, little evidence exists on the factors associated with pregnant women’s knowledge, attitudes and behaviours (KAB) towards this policy initiative. This study assessed the KAB of pregnant women towards the integration of HCT into routine ANC and the associated factors in the Tamale Metropolis, Ghana. A quantitative approach with a facility-based cross-sectional design was adopted. A multi-level stratified sampling technique was used to select 384 pregnant women receiving ANC at nine health facilities. Data were collected between August and October, 2024 using a structured questionnaire. Descriptive analysis and modified Poisson regression modelling were done using STATA 15. The results showed that most pregnant women (65.1%) were aware of the HCT guidelines. Overall, 78.9%, 65.1% and 58.6% demonstrated good knowledge, positive attitudes and good behaviours respectively towards the HCT guidelines. Majority (87.2%) tested for HIV, 64.1% received post-test counselling services while 21.1% underwent joint counselling and testing with their partners. At the 5% significance level, higher education, peri-urban residence, high gravida and perceived easiness of access to HCT were statistically significantly associated with higher knowledge. Higher education, high gravida, no experience with or low perceived HCT-related stigma were significantly associated with positive attitudes while age, income and perceived confidentiality during HCT were significantly associated with good behaviours. Overall, higher knowledge was statistically significantly associated with positive behaviours (APR = 1.60, 95% CI of 1.16–2.22). Despite the relatively higher knowledge and positive attitudes reported in the study, the behaviours of the pregnant women towards the Ghana HCT guidelines were relatively less favourable. The findings suggest that improving HIV/AIDS education during ANC, alongside increasing partner involvement and confidentiality measures, could enhance the uptake of routine HCT among pregnant women.