HIV testing and self-testing coverage among men and women in South Africa: an exploration of related factors.

OBJECTIVES: Uptake of HIV testing is critical to halting the spread of HIV. Our study aimed to examine the coverage of HIV testing and self-testing and the individual-level, household-level and community-level factors associated with HIV testing and self-testing awareness. METHODS: We analysed data of 12 312 men and women from 2016 SADHS and used multilevel mixed-effects models to examine the factors associated with uptake of HIV testing and self-testing awareness. RESULTS: About 80% of participants had ever tested for HIV, and 64% had tested in the past year. Only 49% of adolescents aged 15-19 years had ever tested for HIV compared with over 80% of adults. Self-testing awareness was low (22%), and only 2.9% of respondents had ever self-tested for HIV. The odds of having ever tested for HIV were significantly higher among respondents who were aged 25-29 (AOR: 4.02; 95% CI: 3.27-4.95), had a higher level of education (AOR: 3.18; 95% CI: 2.19-4.61), were married (AOR: 1.63; 95% CI: 1.36-1.94), had high media exposure (AOR: 1.23; 95% CI: 1.06-1.44) and had ever had sex (AOR: 5.57; 95% CI: 4.67-6.64), but lower among men (AOR: 0.39; 95% CI: 0.35-0.44). CONCLUSION: In conclusion, HIV testing coverage is high in South Africa relative to most countries in sub-Saharan Africa, but falls short of the UNAIDS first 95. We found no evidence of socioeconomic and geographic inequalities in access to HIV testing. However, adolescents had a lower level of HIV testing uptake, suggesting a need for interventions to expand testing in this age group.

OBJECTIFS: Le recours au dépistage du VIH est essentiel pour enrayer la propagation du VIH. Notre étude vise à examiner la couverture du dépistage du VIH et de l'auto-dépistage et les facteurs au niveau individuel, familial et communautaire associés au dépistage du VIH et à la sensibilisation à l'auto-dépistage. MÉTHODES: Nous avons analysé les données de 12.312 hommes et femmes de la SADHS 2016 et utilisé des modèles à effets mixtes à plusieurs niveaux pour examiner les facteurs associés à l'adoption du dépistage du VIH et à la sensibilisation à l'auto-dépistage. RÉSULTATS: Environ 80% des participants ont déjà subi un test de dépistage du VIH et 64% l'ont fait au cours de l'année écoulée. Seuls 49% des adolescents âgés de 15 à 19 ans avaient déjà subi un test de dépistage du VIH contre plus de 80% des adultes. La connaissance de l'auto-dépistage était faible (22%) et seulement 2,9% des personnes interrogées s'étaient déjà autotestées pour le VIH. Les chances d'avoir déjà subi un test de dépistage du VIH étaient significativement plus élevées chez les répondants âgés de 25 à 29 ans (AOR: 4,02; IC95%: 3,27 à 4,95), ayant un niveau d'éducation plus élevé (AOR: 3,18; IC95%: 2,19- 4,61), étaient mariés (AOR: 1,63; IC95%: 1,36-1,94), avaient une exposition médiatique élevée (AOR: 1,23; IC95%: 1,06-1,44) et avaient déjà eu des relations sexuelles (AOR: 5,57; IC95%: 4,67-6,64), mais plus faible chez les hommes (AOR: 0,39; IC95%: 0,35-0,44). CONCLUSION: La couverture du dépistage du VIH est élevée en Afrique du Sud par rapport à la plupart des pays d'Afrique subsaharienne, mais elle est en deçà des recommandations de l'ONUSIDA. Nous n'avons trouvé aucune preuve d'inégalités socioéconomiques et géographiques dans l'accès au dépistage du VIH. Cependant, les adolescents ont un niveau de dépistage du VIH plus faible, ce qui suggère la nécessité d'interventions pour étendre le dépistage dans ce groupe d'âge.

Trends in emergency contraception awareness among women and girls in 28 sub-Saharan countries.

BACKGROUND: Studies have shown that emergency contraception (EC) remains underutilised in preventing unintended pregnancy in sub-Saharan Africa (SSA). Small-scale surveys have attributed EC underutilisation to gaps in EC awareness among SSA women and girls. However, limited studies have explored trends in EC awareness in SSA. We address this gap by examining trends in EC awareness using data from 28 SSA countries. Our analysis was disaggregated by age distribution, place of residence, level of education, and wealth to show differences in EC awareness trend. METHODS: We analysed the Demographic and Health Surveys (DHS) data of 1,030,029 women aged 15 to 49 on emergency contraception awareness. EC awareness was defined as having ever heard of special pills to prevent pregnancy within 3 days after unprotected sexual intercourse. Frequencies and percentages were used to summarise trends in EC awareness between years 2000 and 2019. RESULTS: Overall, there was an upward shift in the level of EC awareness in all countries, except in Burkina Faso, Niger, Chad, and Ethiopia. While some countries recorded a significant upward trend in EC awareness, others recorded just a slight increase. Women in Kenya, Ghana, Gabon, and Cameroon had the highest upward shift in EC awareness. For example, only 28% of women were aware of EC in Ghana in 2003, but in 2014, 64% of women knew about EC, an increase of over 36 percentage points. Increase in EC awareness was starker among women aged 20-24 years, those who resided in urban areas, had higher education, and belong to the highest wealth quintile, than those aged 15-19, in rural areas, with no formal education and belonging to the lowest wealth quintile. CONCLUSION: Our analysis shows that the level of EC awareness has increased substantially in most SSA countries. However, EC awareness still differs widely within and between SSA countries. Intervention to improve EC awareness should focus on women aged 15 to 19, those with no formal education, residing in rural areas, and within the lowest quintile, especially, in countries such as Chad, Niger, Burkina Faso, and Ethiopia where level of EC is low with lagging progress.

Association Between Girl-child Marriage and Intimate Partner Violence in Sub-Saharan Africa: Insights From a Multicountry Analysis of Demographic and Health Surveys.

While considerable attention has been given to the health consequences of child marriage in Sub-Saharan Africa (SSA), limited studies exist on its impact on intimate partner violence (IPV) in the region. We address this gap by examining the link between child marriage and IPV. We tested our study hypothesis using demographic and health survey data of 28,206 young women aged 20-24 years from 16 SSA countries with recent surveys (2015-2019). Binary logistic regression models were used to examine the effect of child marriage on IPV. Child marriage prevalence ranged from 13.5% in Rwanda, in East Africa, to 77% in Chad, in Central Africa, while IPV ranged from 17.5% in Mozambique in Southern Africa to 42% in Uganda, in East Africa. Past year experience of IPV was higher among young women who married or begun cohabiting before the age of 18 (36.9%) than those who did at age 18 or more (32.5%). This result was consistent for all forms of violence: physical violence (22.7% vs 19.7%), emotional violence (25.3% vs 21.9%), and sexual violence (12% vs 10.4%). After controlling for covariates, we found that young women in SSA who married before 18 years were more likely to experience IPV than those who married as adults (AOR: 1.20; 95% CI [1.12, 1.29]). Significant heterogeneity was observed in the country-level results, with a higher likelihood of IPV found in 14 of the 16 countries and lower in Angola and Chad. Child marriage is associated with a higher likelihood of IPV in most SSA countries, suggesting that ending child marriage will result in a substantial reduction in IPV. There is a need to institute policies to support and protect women who marry as children from abusive relationships in SSA.

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries.

BACKGROUND: Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. METHODS: We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015-2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. RESULTS: Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. CONCLUSION: Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

Low coverage of HIV testing among adolescents and young adults in Nigeria: Implication for achieving the UNAIDS first 95.

BACKGROUND: Most studies on HIV testing among young people in Nigeria are not nationally representative. As such, recent nationally representative data, such as the Multiple Indicator Cluster Survey (MICS), could help assess the current level of HIV testing among young people, a key target population for HIV prevention in the country. In this study, we examined the coverage and factors associated with HIV testing among adolescents and young adults (AYA). METHODS: We used the data for 14,312 AYA that examined recent and lifetime HIV testing from the 2017 MCIS. Our outcomes of interest were ever tested for HIV and recently tested for HIV. We examined the association between socio-demographic factors (e.g., age, marital status, education attainment, wealth status), stigma belief, exposure to media and HIV knowledge, and uptake of HIV testing using adjusted and unadjusted logistic regression models. RESULTS: Less than a quarter of the AYA (23.7%) had ever tested for HIV, and an even lower proportion (12.4%) tested in the year preceding the survey. More females (25.4%) compared to males (20.8%) had ever tested for HIV. Young people who were aged 20-24 years (AOR 1.52, 95% CI 1.34-1.72), married (AOR 2.42, 95% CI 1.98-2.97), had higher educational attainment (AOR 5.85, 95% CI 4.39-7.81), and belonged to the wealthiest quintile (AOR 1.99, 95% CI 1.53-2.60), had higher odds of having ever tested for HIV compared to those aged 15-19 years, never married, had no formal education and belonged to the poorest wealth quintile. Also, those who had positive stigma belief towards people living with HIV (AOR 2.93, 95% CI 2.47-3.49), had higher HIV knowledge (AOR 1.62, 95% CI 1.24-2.11), and higher media exposure (AOR 1.64, 95% CI 1.36-1.97), had higher odds of having ever tested compared to those who had more negative stigma belief, had low knowledge of HIV and low media exposure. CONCLUSION: The HIV testing coverage among AYA in Nigeria is well below the national target of 95% indicated in the national HIV/AIDS strategic framework (2017-2021). Also, the low rate of HIV testing found in this study means realising the UNAIDS first 95 will require interventions targeting AYA. These interventions should focus on improving young people's knowledge of HIV, reducing negative stigma belief through media campaigns and increasing access to HIV testing through home-based testing and "opt-out" strategy at the point of care.