Factors influencing HIV testing uptake in Sub-Saharan Africa: a comprehensive multi-level analysis using demographic and health survey data (2015-2022).

ABSTRACT

BACKGROUND: Human Immunodeficiency Virus (HIV) is a global health concern, causing over 35 million deaths, with 97% occurring in developing nations, particularly impacting Sub-Saharan Africa. While HIV testing is crucial for early treatment and prevention, existing research often focuses on specific groups, neglecting general adult testing rates. This study aims to identify predictors of HIV testing uptake among adults in Sub-Saharan Africa. METHOD: Data were obtained from the official Demographic and Health Survey program database, which used a multistage cluster sampling technique to collect the survey data. In this study, a weighted sample of 283,936 adults was included from thirteen Sub-Saharan African countries. Multilevel multivariable logistic regression analysis was employed to identify predictors of HIV testing uptake. Akaike's information criteria guided model selection. Adjusted odds ratios and corresponding 95% confidence intervals determined significant predictor variables. RESULT: Among adults in Sub-Saharan African countries, the prevalence of HIV testing uptake was 65.01% [95% CI (64.84%, 65.17%)]. Influential factors included male sex [AOR 0.51, 95% CI (0.49,0.53)], varying odds ratios across age groups (20-24 [AOR 3.3, 95% CI (3.21, 3.46) ], 25-29 [AOR 4.4, 95% CI (4.23, 4.65)], 30-34 [AOR 4.6, 95%CI (4.40, 4.87)], 35-39 [AOR 4.0, 95%CI (3.82, 4.24)], 40-44 [AOR 3.7, 95%CI (3.50, 3.91)], 45-49 [AOR 2.7, 95%CI (2.55, 2.87)], 50+ [AOR 2.7, 95%CI (2.50, 2.92)]), marital status (married [AOR 3.3, 95%CI (3.16, 3.46)], cohabiting [AOR 3.1, 95% CI (2.91, 3.28)], widowed/separated/divorced [AOR 3.4, 95%CI (3.22, 3.63)]), female household headship (AOR 1.28, 95%CI (1.24, 1.33)), education levels (primary [AOR 3.9, 95%CI (3.72, 4.07)], secondary [AOR 5.4, 95%CI (5.16, 5.74)], higher [AOR 8.0, 95%CI (7.27, 8.71)]), media exposure (AOR 1.4, 95%CI (1.32, 1.43)), wealth index (middle [AOR 1.20, 95%CI (1.17, 1.27)], richer [AOR 1.50, 95%CI (1.45, 1.62)]), Having discriminatory attitudes towards PLWHIV [AOR 0.4; 95% CI (0.33, 0.37)], had multiple sexual partners [AOR 1.2; 95% CI (1.11, 1.28)], had comprehensive knowledge about HIV [AOR 1.6; 95% CI (1.55, 1.67)], rural residence (AOR 1.4, 95%CI (1.28, 1.45)), and lower community illiteracy (AOR 1.4, 95%CI (1.31, 1.50)) significantly influenced HIV testing uptake in the region. CONCLUSION: This study highlights the need for tailored interventions to address disparities in HIV testing uptake among adults in Sub-Saharan Africa and progress towards the achievement of 95-95-95 targets by 2030. Thus, tailored interventions addressing key factors are crucial for enhancing testing accessibility and emphasizing awareness campaigns, easy service access, and targeted education efforts to improve early diagnosis, treatment, and HIV prevention in the region.