315402
A Multilevel Analysis of Factors Associated with HIV Testing and Receipt of Test Results among Women in sub-Saharan Africa
Methods: Cross-sectional examination of 255,048 women who participated in the Demographic and Health Survey and AIDS Indicator Survey between 2006 and 2012 in 25 sub-Saharan African countries. Multilevel modeling techniques were used to identify the association between individual, community and country-level factors and HIV testing and receipt of test results.
Results: Overall, 40% of women reported having been tested and receiving test results. In the multivariable-adjusted model, individual level factors that include being currently or previously married, increasing parity, having some education, increasing wealth index, being employed, having some exposure to media, having low level enacted stigma, having premarital sex and residing in urban area were associated with higher likelihood of testing for HIV and receipt of test results. At the country level, for each one-unit increase in a country's expenditure on public health as a percentage of GDP, the odds of testing and receipt of test results increased by 48% (aOR=1.48; 95% CI 1.19 to 1.83; p< 0.01). After adjustment for individual, community and country-level factors, the community and country-level variation in the odds of testing for HIV and receiving test results remained statistically significant. The results of the final model showed that approximately 31% of the variance in the odds of testing for HIV and receiving test results could be attributed to the community-level (τ= 0.413, p<0.01) and 22% to the country-level (τ=1.033, p< 0.01) factors.
Conclusions: Interventions aimed at improving HIV testing in sub-Saharan Africa should take into account individual, community and country-level enablers and barriers to women’s participation in HIV testing and receipt of test results.
Learning Areas:
Biostatistics, economicsDiversity and culture
Epidemiology
Public health or related public policy
Public health or related research
Social and behavioral sciences
Learning Objectives:
Identify individual, community and country-level factors associated with HIV testing and receipt of test results in sub-Saharan Africa
Compare patterns of HIV testing and and receipt of test results across countries in sub-Saharan Africa
Analyze multi-country complex survey data using multilevel modeling techniques
Keyword(s): Epidemiology, Women and HIV/AIDS
Qualified on the content I am responsible for because: I am currently completing my PhD in Epidemiology and I have been the author and co-author of research publications on peer reviewed journals focusing on maternal and child health outcomes, immunization, malaria and HIV/AIDS in sub-Saharan Africa. My scientific interests include infectious disease epidemiology, social determinants of health and international health.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.