HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling

Betregiorgis Zegeye; Nicholas Kofi Adjei; Bright Opoku Ahinkorah; Getayeneh Antehunegn Tesema; Edward Kwabena Ameyaw; Eugene Budu; Abdul-Aziz Seidu; Sanni Yaya

doi:10.1093/inthealth/ihad031

HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling

Int Health. 2023 Sep 1;15(5):573-584. doi: 10.1093/inthealth/ihad031.

Authors

Betregiorgis Zegeye¹, Nicholas Kofi Adjei², Bright Opoku Ahinkorah³, Getayeneh Antehunegn Tesema⁴, Edward Kwabena Ameyaw⁵, Eugene Budu⁶, Abdul-Aziz Seidu^{7

8

9}, Sanni Yaya¹⁰

Affiliations

¹ HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia.
² Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
³ School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
⁴ Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁵ Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong.
⁶ Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
⁷ Department of Estate Management, Takoradi Technical University, P.O. Box 256, Takoradi,Ghana.
⁸ Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi,Ghana.
⁹ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.
¹⁰ School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, Ontario K1N 6N5, Canada.

Abstract

Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y).

Methods: Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs).

Results: The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor.

Conclusion: More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/household factors were associated with HIV testing. Stakeholders should therefore consider all above-mentioned factors to plan an integrated approach to enhancing HIV testing through health education, sensitization, counselling and empowering older and married women, those with no formal education, those who do not have comprehensive HIV/AIDS knowledge and those in rural areas.

Keywords: AIDS; DHS; HIV test; global health; sub-Saharan Africa; women’s health.

MeSH terms

Acquired Immunodeficiency Syndrome*
Female
HIV Testing
HIV*
Health Surveys
Humans
Marital Status
Marriage