Trend, spatial distribution, and factors associated with HIV testing uptake among pregnant women in Ethiopia, based on 2005-2016 Ethiopia demographic and health survey: A multivariate decomposition analysis and geographically weighted regression.

Introduction: HIV testing during pregnancy is an integral component and first step of prevention for mother to child transmission, initiation of antiretroviral treatment and diagnosis of HIV/AIDS. However, Ethiopia and other sub-Saharan African countries face challenges in meeting the first target of the 95-95-95 global initiatives. This study examines trends, spatial distribution, and factors influencing HIV testing among pregnant women in Ethiopia from 2005 to 2016, using data from the Ethiopia Demographic and Health Surveys.

Methods: The study was based on three consecutive demographic and health survey in Ethiopia. A total weighted sample of 13,020 women who gave birth within 2 year proceeding each survey year was included in each survey. Logit based decomposition analysis technique was employed to identify factors contributing to the change in HIV testing uptake among pregnant women overtime. ArcGIS version 10.7.1 and SaT Scan version 10.1software were used for the spatial analysis and geographically weighted regression.

Results: HIV testing uptake among pregnant women has significantly increased from 0.51% in 2005 to 32.4% in 2016 with 2.9% annual rate of increment in Ethiopia. About 75.9% of the overall increase in HIV testing uptake among pregnant from 2005-2016 was due to increases in women's composition with knowledge of Mother to child transmission of HIV (3.2%), HIV counseling (10.3%), 4 or more antenatal care visits (31.4%), health facility delivery (6.3%), not perceiving distance from the health facility as a big problem (1.1%), and urban residence (0.6%). Spatial variation of low proportion of HIV testing was non-random in all three surveys (Moran index, p-value<0.05). Hot spot clusters exhibited in all the three waves includes Tigray and SNNPRs in 2005 and consistent hotspot areas in Benishangul-Gumuz, Somali, SNNPR, and Gambella in 2011 and 2016 EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of antenatal care visit, lack of media exposure, and health facility delivery were significant predictors for the spatial variation of low proportion of HIV testing uptake across regions in Ethiopia in 2016.

Conclusion And Recommendation: Over all, there has been a substantial increase in HIV testing uptake among pregnant women overtime in Ethiopia, but it still far away from achieving the 2025 HIV testing targets. Knowledge of Mother to child transmission of HIV, HIV counseling, Number of Antenatal care visit, previous place of delivery, residence and distance to health facility were significant contributing factors for the change in HIV testing uptake. There was geographical disparity in HIV testing uptake across regions in all three EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of ANC visit, lack media exposure, and health facility delivery were significant predictors. Geographic-based interventions, together with broader public health strategies, are essential for advancing HIV testing uptake.