The present study showed that have never been tested and there is high intention to use VCT services. Most health workers test their blood by themselves which may indicate the existence of fear of disclosure of HIV status and high perceived risk of HIV infection.
Like that of studies in Ethiopian and Tanzanian [6, 12, 22], this finding revealed no significant statistical association between socio-demographic factors and intention to use VCT. This finding has an implication that VCT services are accessible, available and affordable to the health professionals that the social determinants of health are not barriers for VCT use intention. The socio-demographic factors are not predictors since as part of primary health care, VCT services are provided in every health centers in the study area for free for everyone. VCT campaigns are also common that may increase accessibility of VCT services.
Findings of the present study suggested no statistical difference among the age group in requesting for VCT which contradicts with studies conducted in Tanzania and Ghana showing significant differences among age group with likely to be tested among teenagers due that high HIV prevalence among them and increasing tendency for young people to be tested before marriage [15, 17]. This difference might be due to that, most of the respondents in this study were married and the low Perceived risk to HIV in this age category might have hampered the association.
In line with the previous Nigerian study on medical students [23] the present study depicted insignificant difference among the two sexes in willingness to seek VCT services. But the current finding was not similar with other studies [24, 25]. It is conventional that the gender differences in seeking VCT are mainly due to factors like cultural, social and biological like male dominance, vulnerability to risk, social factors like rape especially in developing countries, that make female vulnerable to HIV infection.
In this study, the level of education might have influenced the socio-cultural factors positively that may leads to the differences among male and female, hence reducing the differences in seeking VCT services. Therefore, the insignificant gender differences in this aspect may be due to the social status of female HCWs is different from that of females in the general population.
The intention to use VCT services was primarily due to subjective norms and attitude while their perceived behavioral control was statistically insignificant predictor. Other studies also found similar results that subjective norms were more important predictors [24, 25]. However, other studies showed that perceived behavior control was the leading predictor of intention followed by attitude and subjective norm [23, 26]. In present study subjective norm was more important predictor than the other components of TPB which indicated that significant others have great role to play in the use VCT services. The possible reason for this variation could be due to variation across behavior, population and situation under which the behavior is occurring, according to the TPB perspective [13, 22]. Given the population for this study were HCWs they could have high perceived behavioral control on VCT. Unlike the general public, the HCWs are expected to have also the knowledge and skill related to HIV/AIDS including VCT.
In assessing the effect of past history of VCT use on the behavioral intention, the present study did not find a significant association after controlling for the effects of socio- demographic variables and components of TPB. This is contrary to previous studies [20, 27] and agrees with the assumption of the TPB [13, 22] which says past behavior experience affects the future expression of the behavior provided that it must be mediated by the proximal TPB components. The possible reason may be due to that the many HCWs have tested themselves for HIV which may not reflect the actual intention to VCT use.
In this study, none of the external to TPB variables significantly predicted intention to VCT. The finding of this study will goes with a study in Zimbabwean [28] in which the perceived risk was not associated with behavioral intention. The possible explanation related to this may be that HCWs are expected to have high knowledge about HIV/AIDS, unlike the other population group leads to the insignificant association to intention because motivation for VCT might be driven by knowledge and education of VCT itself rather than risk perception for this group. However, previous studies [29–31] claimed that high risk group tends to be less likely to participate in VCT services.
As suggested by the principle of the TPB [13, 22], there was positive correlation between the respective indirect and direct components of the theory of planned behavior. Hence, the indirect measures predicted the respective direct measures of attitude, subjective norm and perceived behavioral control. This implies that interventions can be designed on the salient beliefs identified during the elicitation study; so that, by influencing the direct measures of the TPB, intention to VCT use can be increased. The components of TPB explained intention to use VCT in a similar manner with studies of other public health topics in Ethiopia and other African countries [16–18, 29]. Since this study was conducted among the health care workers, there may be social desirability bias that could have affected not only the main study but also the elicitation study.