Determinants of non-testing for HIV among women during antenatal care follow up in sub-saharan Africa: a hierarchical analysis of recent Demographic and Health Survey datasets.

Introduction: HIV/AIDS is a global public health concern that is closely related to other sociocultural problems. The prevention of mother to child transmission cascade often begins with and is integrated into antenatal care in order to ensure a high rate of case detection and optimal treatment coverage. Although guidelines suggest that all pregnant women should have HIV testing as part of their regular screening checks during antenatal care, a significant proportion of pregnant women were not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Hence, this study was aimed at assessing the determinants of women not tested for HIV during antenatal care follow-up in sub-Saharan Africa.

Method: A cross-sectional study was conducted to assess the determinants of non-testing for HIV among women as part of antenatal care in sub-Saharan Africa, utilizing secondary data from the 2015-2022 Demographic and Health Surveys. The study included a weighted sample of 788,421 women who had antenatal care follow-up during their most recent pregnancy within five years preceding the survey. A multilevel mixed effect logistic regression analysis was employed to identify the determinants of non-testing for HIV among these women. The adjusted odds ratios with 95% confidence intervals were calculated to determine the associations between the outcome and explanatory variables. Statistical significance was determined using a p-value of less than 0.05.

Result: The hierarchical analysis of this study identified several significant factors associated with women not being tested for HIV during antenatal care in sub-Saharan Africa. These factors include young age, low or no education, not being in a union, unemployment, and low household wealth index. Additionally, limited media exposure, stigmatizing attitudes towards people living with HIV, male-headed households, and rural residence were significant at the individual and household levels. At the community level, low media exposure and high illiteracy rates were significant, while at the country level, high fertility rates and low literacy rates were also associated with lower rates of HIV testing during antenatal care.

Conclusion: This study identified significant individual, community, and country-level factors associated with women not testing for HIV during antenatal care in sub-Saharan Africa. Key factors include young age, low education, unemployment, not being in a union, low household wealth, limited media exposure, stigmatizing attitudes towards people living with HIV, male household head, rural residence, low community media exposure, high community illiteracy, high fertility rates, and low literacy rates. These findings highlight the need for targeted, context-specific interventions to improve HIV testing rates and enhance maternal and child health outcomes in the region.