Background: Each year around 1.5 million women living with Human immuno deficiency Virus (HIV) become pregnant, and without antiretroviral drugs there is a chance that their child will become infected. Following the introduction of Routine Human immuno deficiency Virus testing policy in Zambia, the Human immuno deficiency Virus test is offered to all pregnant women unless they decline. However, more pregnant women are declining to be tested. Objective: The main objective of this study was to investigate factors that influence acceptability of routine HIV testing by pregnant women in Lusaka district urban clinics. Materials and Methods: A cross sectional study using a quantitative approach was conducted in Lusaka District clinics. The sample size was 366 ante natal pregnant women who were selected by simple random sampling, selected from three (3) selected research setting. The study population included pregnant women aged 15 to 49 years, coming for ante natal visit for the first time, before being tested for HIV, were eligible and agreed to participate in the study. A pretested semi structured interview schedule was used to collect data. Data were entered and analysed with Statistical Package for Social Sciences (SPSS) version 20 program. Chi-square was used to test for significant associations and Binary Logistic regression modelling was carried out to predict the outcome. A 5% level of significance (p value) 0.05 confidence interval was set. Results: Study findings revealed that majority 85.6% (317) of respondents indicated willingness to undergo routine HIV testing in pregnancy though 77.3% perceived it a compulsory test. Binary logistic regression revealed that maternal age, educational level and information education and communication (IEC) contributed significantly to the model. The odds revealed that acceptability of routine HIV testing by older pregnant women (37 - 49 years) were 8 times (OR = 7.67, p = 0.003) higher than the younger ones. The odds of acceptability by respondents with tertiary education were 141 times (OR-141.23, p-0.0001), likely to accept HIV testing than those with primary or no education. And the odds also revealed that acceptability by women who cited adequate IEC (OR-2.6, p-0.024) were 3 times higher than those who cited inadequate IEC. Conclusion: The study showed that majority of the pregnant women was willing to undergo Routine HIV testing however a percentage regarded the test as a mandatory test without any choice of denial. Therefore there is need to address some factors that are likely to affect the routine HIV testing and impede the success of implementation of the PMTCT programme in the country which goes beyond testing for HIV alone. Recommendations: Ministry of Health needs to provide health education messages in different tribes. MOH should also intensify male involvement in HIV Testing and Counselling. LDHO should consider training more community health care givers as Voluntary Counselling and Testing providers. The District should organize regular refresher courses and presentations on Routine HIV testing to health workers and Ministry of Health should consider conducting a country wide study.
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