Geographical variations and factors associated with recent HIV testing prevalence in Ghana: spatial mapping and complex survey analyses of the 2014 demographic and health surveys

Correlates of HIV testing among men in Ghana: Cross-sectional analysis of the 2022 demographic and health survey

IntroductionNew HIV infections are on the rise in Ghana, with approximately 16,574 new cases reported in 2022 alone. Although HIV prevalence rate is higher among women aged 15-49 years (2.0 [1.7-2.3]) than men aged 15-49 (1.0 [0.8-1.2]) in Ghana, evidence form the country's 2022 Demographic and health Survey suggest that only 12% of men had ever been tested for HIV once in their lifetime relative to 17% of women, and yet more men (35%) than women (23%) reported having sexual intercourse with persons who were neither their wife nor live-in partners. More so, the Ghana National HIV and AIDS Policy has over the years positively influenced the utilization of HIV testing (HIVT) services among women in Ghana through antenatal care visits. While this policy encourages women to undertake testing with their husbands, most men in the Ghanaian Context rarely accompany their spouse to antenatal care due to several reasons including conflicting work schedules, thus limiting their chances of getting tested. Using a nationally representative dataset, this study adds to the broader literature by exploring the factors associated with HIVT among men.MethodsUsing the 2022 Ghana Demographic and Health Survey (N = 7044 males), and employing multiple logistic regression models, this study explored the factors associated with HIVT among men.ResultsMarried men (OR = 1.723; p < .001), the employed, particularly, those paid in cash only (OR = 2.021; p < .001) and those paid both in cash and kind (OR = 1.823; p < .001), those who had knowledge of HIV test kits (OR = 1.708; p < .001), aware and approve to use Pre-Exposure Prophylaxis (PrEP) (OR = 1.1280; p < .001), as well as those who visited a health facility in the past 6 months (OR = 1.615; p < .001), all significantly reported higher odds of testing. Moreover, Educational attainment, age, household wealth, religion, ethnicity, and the region of residence significantly predicted HIVT in the study context.ConclusionSocio-demographic, economic, geographic and health-related factors have significant influence on the uptake of HIVT among men in Ghana, thus underscoring the need for tailored interventions that consider diverse contextual factors in HIV prevention and healthcare delivery.

Assessing regional variations and sociodemographic barriers in the progress toward UNAIDS 95-95-95 targets in Zimbabwe

BACKGROUND

The HIV/AIDS epidemic remains critical in sub-Saharan Africa, with UNAIDS establishing "95-95-95" targets to optimize HIV care. Using the 2020 Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) geospatial data, this study aimed to identify patterns in these targets and determinants impacting the HIV care continuum in underserved Zimbabwean communities.

METHODS

Analysis techniques, including Gaussian kernel interpolation, optimized hotspot, and multivariate geospatial k-means clustering, were utilized to establish spatial patterns and cluster regional HIV care continuum needs. Further, we investigated healthcare availability, access, and social determinants and scrutinized the association between socio-demographic and behavioral covariates with HIV care outcomes.

RESULTS

Disparities in progress toward the "95-95-95" targets were noted across different regions, with each target demonstrating unique geographic patterns, resulting in four distinct clusters with specific HIV care needs. Key factors associated with gaps in achieving targets included younger age, male gender, employment, and minority or no religious affiliation.

CONCLUSIONS

Our study uncovers significant spatial heterogeneity in the HIV care continuum in Zimbabwe, with unique regional patterns in "95-95-95" targets. The spatial analysis of the UNAIDS targets presented here could prove instrumental in designing effective control strategies by identifying vulnerable communities that are falling short of these targets and require intensified efforts. We provide insights for designing region-specific interventions and enhancing community-level factors, emphasizing the need to address regional gaps and improve HIV care outcomes in vulnerable communities that lag behind.

Prevalence and factors associated with knowledge of HIV Self-Test kit and HIV-Self Testing among Ghanaian women: multi-level analyses using the 2022 Ghana demographic and health survey

BACKGROUND

The Ghana AIDS Commission reported in 2022 that out of 354,927 people living with HIV, 67.5% were females. While considerable progress has been made in expanding access to HIV testing services, a significant proportion of individuals remain unaware of their HIV status, presenting a significant barrier to effective prevention and treatment. Although HIV Self-Testing (HIVST) has emerged as a promising approach to increase the uptake of HIV testing, its adoption and utilisation have been limited by various sociodemographic factors. We investigated the knowledge of HIV Self-Testing Kit as well as prevalence of HIVST and their associated factors among Ghanaian women.

METHODS

This was a cross-sectional study among 15,014 women of their reproductive age using data from the 2022 GDHS. The data were analysed using STATA version 17.0. Simple frequencies were used to summarise the data. A multilevel binary logistic regression using four models (Models I-IV) was used to examine the association between the two outcome variables and the explanatory variables, controlling for individual- and contextual-level factors. Statistical significance was set at p < 0.05 at 95% CI.

RESULTS

We discovered that only 18.2% [95% CI = 17.1-19.3] and 2.4% [95% CI = 2.1-2.8] of Ghanaian women in their reproductive age had adequate knowledge of HIV Self-Testing Kit (HIVSTK) and had used the HIVSTK for HIV testing respectively. The odds of knowledge of HIVSTK were higher among women aged 20-24 years (aOR = 1.33, 95% CI = 1.07, 1.64; p = < 0.01), those with a higher level of education (aOR = 6.14, 95% CI = 4.41, 8.55; p < 0.001), those who listen to radio (aOR = 1.41, 95% CI = 1.20, 1.65; p < 0.001) and use the internet at least once a week (aOR = 1.49, 95% CI = 1.24, 1.78; p < 0.001). The odds of knowing about HIVSTKs increased with higher levels of wealth distribution with the highest recorded among those in the wealthiest group (aOR = 1.85, 95% CI = 1.32, 2.58; p < 0.001). Compared with women with no formal education, the odds of HIVST were higher among those with higher education (aOR = 20.29, 95% CI = 9.16, 44.97; p < 0.001). The odds of HIVST were also higher among those who listen to radio (aOR = 1.51, 95% CI = 1.05, 2.17; p < 0.05) and those who use the internet at least once a week [aOR = 1.80, 95% CI = 1.15, 2.83; p < 0.001). Furthermore, the odds of self-testing for HIV were higher among women with a history of HIVST (aOR = 6.73, 95% CI = 3.34, 13.55; p = < 0.001) and those with the wealthiest wealth quintiles (aOR = 4.31, 95% CI = 1.31, 13.02; p = < 0.001).

CONCLUSION

Our study revealed a shallow knowledge of HIV Self-Testing Kit as well as a low prevalence of HIV self-testing among women in their reproductive age in Ghana. The evidence suggests that more than nine in ten women had never undertaken an HIV self-test. The observed HIVST in this study may have implications for achieving the objectives of the HIVST policy. This may impede the achievement of SDG 3.3 which seeks to end the AIDS epidemic by 2030. Practical strategies including education and awareness, may be utilized through electronic media as well as radio and television, especially among those with little or no education. Additionally, the government can subsidise testing kits to create opportunities for those in the low-wealth quintiles to purchase and self-test themselves.

Sociodemographic correlates of late HIV diagnosis among men who have sex with men (MSM) in Ghana

Timely HIV diagnosis and medical engagement are crucial for effective viral load suppression and treatment as prevention. However, significant delays persist, particularly in Africa, including Ghana. This study focused on Ghanaian men whose route of exposure to HIV was through same-gender sexual contact (MSM), a group disproportionately impacted by HIV. Using structured surveys, we investigated the sociodemographic factors associated with late HIV diagnosis, a topic with limited existing research. Results indicate that older age groups were associated with an increased risk of late diagnosis compared to the 18-24 age group. Among the demographic variables studied, only age showed a consistent association with late HIV diagnosis. This study underscores the importance of targeted interventions to address HIV diagnosis disparities among MSM in Ghana, particularly for older age groups. The findings emphasize the need for tailored interventions addressing age-related disparities in timely diagnosis and engagement with medical services among this population. Such interventions can play a crucial role in reducing the burden of HIV within this community and fostering improved public health outcomes.

Trends and factors associated with recent HIV testing among women in Haiti: a cross-sectional study using data from nationally representative surveys

INTRODUCTION

In the Latin America and Caribbean region, Haiti is one of the countries with the highest rates of HIV. Therefore, this study examined the factors associated with HIV testing among women in Haiti and trends in HIV testing in 2006, 2012, and 2016/17.

METHODS

Data from the last three Haitian Demographic and Health Surveys (2006, 2012, and 2016/17) were used. The analysis was restricted to women aged of 15-49 years who made their sexual debut. STATA/SE 16.0 was employed to analyze the data by computing descriptive statistics, Chi‑square, and multilevel regression model to describe the trends and identify factors associated with HIV testing in Haiti. P-value less than 0.05 was taken as a significant association.

RESULTS

HIV testing prevalence increased more than twofold from 2006 (8.8%) to 2017 (21.3%); however, it decreased by 11.6% between 2012 and 2016/17. Additionally, the results indicated that age, place of residence, region, education level, wealth index, mass media exposure, marital status, health insurance, age at first sex and number of sexual partners were significantly associated with HIV testing.

CONCLUSIONS

To significantly increase HIV testing prevalence among women, the Haitian government must invest much more in their health education while targeting vulnerable groups (youth, women in union, and women with low economic status).

Spatial variation of premarital HIV testing and its associated factors among married women in Ethiopia: Multilevel and spatial analysis using 2016 demographic and health survey data

BACKGROUND

Africa is the most severely affected area, accounting for more than two-thirds of the people living with HIV. In sub-Saharan Africa, more than 85% of new HIV-infected adolescents and 63% of all new HIV infections are accounted for by women. Ethiopia has achieved a 50% incidence rate reduction. However, mortality rate reduction is slow, as the estimated prevalence in 2021 is 0.8%. In sub-Saharan Africa, heterosexual transmission accounts for the majority of HIV infections, and women account for 58% of people living with HIV. Most of these transmissions took place during marriage. Thus, this study aimed to explore the spatial variation of premarital HIV testing across regions of Ethiopia and identify associated factors.

METHODS

A cross-sectional study design was employed. A total of 10223 weighted samples were taken from individual datasets of the 2016 Ethiopian Demographic and Health Survey. STATA version 14 and ArcGIS version 10.8 software's were used for analysis. A multilevel mixed-effect generalized linear model was fitted, and an adjusted prevalence Ratio with a 95% CI and p-value < 0.05 was used to declare significantly associated factors. Multilevel models were compared using information criteria and log-likelihood. Descriptive and spatial regression analyses (geographical weighted regression and ordinary least squares analysis) were conducted. Models were compared using AICc and adjusted R-squared. The local coefficients of spatial explanatory variables were mapped.

RESULTS

In spatial regression analysis, secondary and above education level, richer and above wealth quintile, household media exposure, big problem of distance to health facility, having high risky sexual behaviour and knowing the place of HIV testing were significant explanatory variables for spatial variation of premarital HIV testing among married women. While in the multilevel analysis, age, education level, religion, household media exposure, wealth index, khat chewing, previous history of HIV testing,age at first sex, HIV related knowledge, HIV related stigma, distance to health facility, and community level media exposure were associated with premarital HIV testing among married women.

CONCLUSIONS AND RECOMMENDATION

Premarital HIV testing had a significant spatial variation across regions of Ethiopia. A statistically significant clustering of premarital HIV testing was observed at Addis Ababa, Dire Dawa, North Tigray and some parts of Afar and Amhara regions. Therefore area based prevention and interventional strategies are required at cold spot areas to halt the role of heterosexual transmission in HIV burden. Moreover, the considering the spatial explanatory variables effect in implementations of these strategies rather than random provision of service would make regional health care delivery systems more cost-effective.

Antenatal and postnatal cervical precancer screening to increase coverage: experience from Battor, Ghana

Background

Cervical precancer screening in low-resource settings is largely opportunistic with low coverage. Many women in these settings, where the burden of cervical cancer is highest, only visit health institutions when pregnant or after delivery. We explored screening during antenatal and postnatal visits aimed at increasing coverage.

Methods

Pregnant women (in any trimester) attending antenatal care (ANC) and women attending postnatal care (PNC; 6-10 weeks) clinics were screened at Catholic Hospital, Battor and at outreach clinics from February to August 2022 (08/02/2022 to 02/08/2022). At the same visit, cervical specimens were obtained for high-risk human papillomavirus (hr-HPV) DNA testing (with the Sansure MA-6000 PCR platform) followed by either visual inspection with acetic acid (VIA) or mobile colposcopy with the enhanced visual assessment system.

Results

Two hundred and seventy and 107 women were screened in the antenatal and postnatal groups, respectively. The mean ages were 29.4 (SD, 5.4) in the ANC group and 28.6 (SD, 6.4) years in the PNC group. The overall hr-HPV prevalence rate was 25.5% (95% confidence interval (CI), 21.1-29.9) disaggregated as 26.7% (95% CI, 21.4-31.9) in the ANC group and 22.4% (95% CI, 14.5-30.3) in the PNC group (p = 0.3946). Overall, 58.9% of pregnant women (28.3% hr-HPV+) and 66.4% of postnatal women (22.5% hr-HPV+) only visited a health facility when pregnant or after delivery (at Child Welfare Clinics). The VIA 'positivity' rate for all screened women was 5.3% (95% CI, 3.1-7.6), disaggregated into 5.2% (95% CI, 2.5-7.8) in the ANC group and 5.7% (95% CI, 1.3-10.1) in the PNC group (p-value = 0.853).

Conclusion

A significant number of women in Ghana only visit a health facility during pregnancy or after delivery. ANC and PNC clinics would offer opportunities to increase coverage in cervical precancer screening in low-resource settings. Relying on community nurses ensures that such programs are readily integrated into routine care of women and no opportunity is missed.

Progress Towards UNAIDS's 95-95-95 Targets in Zimbabwe: Sociodemographic Constraints and Geospatial Heterogeneity

The HIV/AIDS epidemic remains critical in sub-Saharan Africa, with UNAIDS establishing "95-95-95" targets to optimize HIV care. Using the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) geospatial data, this study aimed to identify patterns in these targets and determinants impacting the HIV care continuum in underserved Zimbabwean communities. Analysis techniques, including Gaussian kernel interpolation, optimized hotspot, and multivariate geospatial k-means clustering, were utilized to establish spatial patterns and cluster regional HIV care continuum needs. Further, we investigated healthcare availability, access, and social determinants and scrutinized the association between socio-demographic and behavioral covariates with HIV care outcomes. Disparities in progress toward the "95-95-95" targets were noted across different regions, with each target demonstrating unique geographic patterns, resulting in four distinct clusters with specific HIV care needs. Key factors associated with gaps in achieving targets included younger age, male sex, employment, and minority or no religious affiliation. Our study uncovers significant spatial heterogeneity in the HIV care continuum in Zimbabwe, with unique regional patterns in "95-95-95" targets. The spatial analysis of the UNAIDS targets presented here could prove instrumental in designing effective control strategies by identifying vulnerable communities that are falling short of these targets and require intensified efforts. Our result provides insights for designing region-specific interventions and enhancing community-level factors, emphasizing the need to address regional gaps and improve HIV care outcomes in vulnerable communities lagging behind.

A multiplicative effect of Education and Wealth associated with HIV-related knowledge and attitudes among Ghanaian women

BACKGROUND

Knowledge and attitudes regarding HIV play a crucial role in prevention and control efforts. Understanding the factors influencing HIV-related knowledge and attitudes is essential for formulating effective interventions and policies. This study aims to investigate the possibility of an interaction between education and wealth in influencing HIV-related knowledge and attitudes among women in Ghana.

METHODS

Cross-sectional data from the Ghana Multiple Indicator Cluster Survey (MICS), a nationally representative sample, were analyzed. Statistical summaries were computed using place of residence, marital status, education level, wealth index quintile, use of insurance, functional difficulties, and exposure to modern media. Furthermore, a three-model Logistic regression analysis was conducted; Model 1 with main effects only, Model 2 with the interaction between education and wealth, and Model 3 with additional covariates. To account for the complexity of the survey data, the svyset command was executed in STATA.

RESULTS

Although most interaction terms between wealth index quintiles and education levels did not show statistical significance, a few exceptions were observed. Notably, women with primary education in the second, middle, and fourth wealth quintiles, along with those with secondary education in the second wealth quintile, exhibited a negative significant association with HIV-related attitude level. However, no significant associations were found between other factors, including age, place of residence, marital status, and health insurance, and HIV-related attitude. The study also found significant associations between socioeconomic variables and HIV-related knowledge. There was a significant positive association between higher levels of education and HIV-related knowledge level. Women in wealthier quintiles had a significant positive association with HIV-related knowledge level. Factors such as place of residence and media exposure, including radio and television were also observed to be associated with HIV-related knowledge level.

CONCLUSIONS

This study highlights the importance of socioeconomic status and media exposure in shaping HIV-related knowledge and attitudes among women in Ghana. Policy interventions should focus on reducing socioeconomic disparities, ensuring equitable access to education and healthcare services, and utilizing media platforms for effective HIV information dissemination.

Exploring Determinants of HIV/AIDS Self-Testing Uptake in South Africa Using Generalised Linear Poisson and Geographically Weighted Poisson Regression

Increased HIV/AIDS testing is of paramount importance in controlling the HIV/AIDS pandemic and subsequently saving lives. Despite progress in HIV/AIDS testing programmes, most people are still reluctant to test and thus are still unaware of their status. Understanding the factors associated with uptake levels of HIV/AIDS self-testing requires knowledge of people's perceptions and attitudes, thus informing evidence-based decision making. Using the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey of 2017 (SABSSM V), this study assessed the efficacy of Generalised Linear Poisson Regression (GLPR) and Geographically Weighted Poisson Regression (GWPR) in modelling the spatial dependence and non-stationary relationships of HIV/AIDS self-testing uptake and covariates. The models were calibrated at the district level across South Africa. Results showed a slightly better performance of GWPR (pseudo R² = 0.91 and AICc = 390) compared to GLPR (pseudo R² = 0.88 and AICc = 2552). Estimates of local intercepts derived from GWPR exhibited differences in HIV/AIDS self-testing uptake. Overall, the output of this study displays interesting findings on the levels of spatial heterogeneity of factors associated with HIV/AIDS self-testing uptake across South Africa, which calls for district-specific policies to increase awareness of the need for HIV/AIDS self-testing.

Men's Endorsement of Intimate Partner Violence and HIV Testing Behavior Across Sub-Saharan Africa

Despite an upward trend in HIV testing across sub-Saharan Africa, men continue to lag women in the use of HIV testing services. Inequitable gender attitudes held by some men may be implicated in their suboptimal HIV testing behaviors. We sought to ascertain the relationship between men?s endorsement of intimate partner violence (IPV), which is one manifestation of inequitable gender attitudes, and their lifetime and recent HIV testing, using nationally representative Demographic and Health Survey data from 23 sub-Saharan African countries. In a pooled analysis, we found that a unit increase in the IPV index scale is associated with 8% lower odds of lifetime HIV testing, and 6% lower odds of recent HIV testing. The strength of this relationship, however, varied across countries and regions. Our findings suggest that efforts to increase men?s HIV testing in the region should address the inequitable gender attitudes underpinning men?s endorsement of IPV, but that it is important to consider contextual variation.

HIV Testing among sexually active Ghanaians: an examination of the rural-urban correlates

HIV testing is critical in reducing the risk of HIV transmission. We investigated the rural-urban correlates of HIV testing amongst sexually active Ghanaians using data from the 2017/2018 Ghana Multiple Indicator Cluster Survey Six (GMICS 6). Robust Poisson models (reporting Adjusted Prevalence Ratios (APR) and 95% Confidence Intervals (CIs)) were used to achieve this aim. About 46% of the participants had ever tested for HIV. According to the results, approximately 52% and 39% of urban and rural dwellers, respectively, have undergone HIV testing. HIV knowledge, HIV stigma, gender, age, education, marital status, childbirth history, sexual history, health insurance coverage, media exposure, household wealth, and region of residence were significantly related to HIV testing with observed variations across rural-urban areas. The findings call for the expansion of advocacy efforts towards encouraging HIV testing, targeting sexually active Ghanaians particularly in rural areas.

Predictors of HIV testing among women experiencing intimate partner violence in the Central Region of Ghana

HIV testing, which is important for the control of the HIV pandemic, has been hampered by several factors including Intimate Partner Violence (IPV), resulting in low uptake. This study sought to determine the predictors of HIV testing among women experiencing IPV. Secondary analysis of data generated from a cross-sectional mixed-method unmatched cluster-randomized controlled trial designed to evaluate a multi-faceted community intervention to reduce the incidence of IPV in Ghana was done (N = 2000). Logistic regressions were performed to determine the predictors of HIV testing among women experiencing IPV, using the trial baseline data. The prevalence of HIV testing among women exposed to IPV in the study setting was 42.4%. Less than a third of the respondents (30.2%) had ever used condom and 96.6% had unemployed partners. Age, educational attainment, employment, residence and condom use were found to be significant predictors of HIV testing among women experiencing IPV. Women aged 25-39 years were more than twice as likely to test for HIV (AOR:2.41; 95%CI:1.45-4.02) than those above 45 years. Women with formal education (Junior-High-AOR:2.10; 95%CI:1.42-3.12; Senior-High-AOR:3.87; 95%CI:2.07-7.26); who had ever used condom (AOR:1.42; 95%CI:1.05-1.93); those reporting life satisfaction (AOR:1.44; 95%CI:1.08-1.92); and coastal residents (AOR:1.97; 95%CI:1.45-2.67) were more likely to test for HIV than those who did not and inland residents. However, employed women (AOR:0.66; 95%CI:0.45-0.96) were less likely to test for HIV than unemployed women. Less than half of the women exposed to IPV had tested for HIV. Socioeconomic disadvantages related to age, education, employment, residence and life satisfaction predicted HIV testing among women exposed to IPV. Considering the vulnerability of women experiencing IPV to HIV infection, strategies to improve uptake of HIV testing must tackle contextual socioeconomic factors that hinder access to services.

Factors Associated with HIV Testing among Reproductive Women Aged 15-49 Years in the Gambia: Analysis of the 2019-2020 Gambian Demographic and Health Survey

Voluntary counselling and testing for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has always been one of the key policy interventions in the management and control of HIV/AIDS transmission. However, the prevalence of HIV testing among reproductive women in the Gambia remains low despite near universal information about HIV and Sexually Transmitted Infections (STIs) in the Gambia. Understanding factors influencing HIV testing uptake provides empirical data for the development of targeted evidenced-based strategies aimed at enhancing HIV testing uptake. Therefore, this study examined the factors associated with HIV testing among reproductive women aged 15−49 years in the Gambia. Data on weighted sample of 11,865 women from the 2019−2020 Gambia Demographic and Health Survey were analyzed in this study. Chi square, bivariate and multivariate logistic regression models were fitted and analysis conducted through Complex Samples Analysis in Statistical Package for Social Sciences (SPSS). Level of significance was set at p < 0.05 and 95% CI. Further analysis was conducted to determine the variability in HIV testing among women stratified by rural and urban centers. Prevalence of HIV testing among reproductive women was 42.1% (95% CI = 40.1−44.2%) in the Gambia. Women aged 20−24 years and 25−29 years (aOR = 3.10, 95% CI = 2.51−3.83) and (aOR = 4.52, 95% CI = 3.61−5.54) were more likely to test for HIV than those aged 15−19 years, respectively. Married women (aOR = 5.90, 95% CI = 4.84−7.02) were more likely to test for HIV compared to those who were not in any union. Respondents with higher education in urban centers (aOR = 2.65, 95% CI = 2.08−3.86) were likely to test for HIV compared to those in rural areas. HIV testing in the Gambia among reproductive women is low. Age, marital status, wealth index, place of residence, educational level, recent sexual activity, previous history of risky sexual behaviors, and history of an STI were associated with HIV testing. Health interventions targeted at increasing HIV testing uptake should factor in these.