Spatial variation of HIV testing and associated factors among pregnant women: a Spatial and multilevel analysis, DHS of sub-Saharan African countries

Abstract

Abstract Background Human Immunodeficiency Virus (HIV) has infected an estimated of more 84 million individuals. Even though Sustainable Development Goal’s 3 targets to end HIV/AIDS epidemics by year 2030, and many organizations work to eliminate mother-to-child transmission HIV/AIDS. Despite these efforts, Mother-to-child transmission of HIV continues as a major public health problem in sub-Saharan African countries. Methods To recruit study participants, a two-stage stratified sampling procedure was used in conjunction with the Demographic Health Survey (DHS). A total of 118, 748 women were considered from the most recent DHS data of 33 sub-Saharan African countries. The data management and analysis was done using STATA V.17. ArcGIS version 10.7 and SaTScan version 10.1 software used for spatial analysis and SaTScan analysis, respectively. Multilevel logistic regression analysis was employed to account for the hierarchical nature of the DHS data. Deviance (-2LL) was applied to select the best fitted model. Results HIV testing among pregnant women accounts about 87% in this study. The spatial hotspot indicates significantly low HIV testing areas found in Madagascar, Ethiopia, Democratic Republic of Congo, Guinea, Chad, Senegal, Mali, Mauritania, Niger, Burkina Faso and Angola. Age from 25 to 34 years (AOR = 1.82: 95% CI; 1.43, 2.32), being married (AOR = 3.69: 95% CI; 1.33, 10.20), media exposure (AOR = 1.47: 95% CI; 1.15, 1.88), having higher level of education (AOR = 1.83; 95% CI; 1.31, 2.55), richest wealth index (AOR = 6.24: 95% CI; 3.57, 10.90), working (AOR = 2.09: 95% CI; 1.67, 2.63), discriminatory attitude (AOR = 1.91: 95% CI; 1.48, 2.46), high risky sexual behavior (AOR = 3.23: 95% CI; 2.32, 5.74), visiting healthcare facilities (AOR = 1.63: 95% CI; 1.23, 2.16), early sexual initiation (AOR = 1.71: 95% CI; 1.15, 2.56), and community media exposure (AOR = 1.73: 95% CI; 1.10, 2.72), were significant factors associated with HIV testing in pregnant women, as shown from a multi-level analysis. Conclusion The prevalence of HIV testing among pregnant women was lower than expected by Sustainable Development Goal’s 3 targets. Hotspot analysis indicates that most western African countries were areas of low HIV testing. Both individual and community level factors were found to be associated with HIV testing uptake significantly. Therefore, giving special attention for pregnant women in hotspot areas of SSA could increase HIV testing uptake.

Keywords

• HIV/AIDS
• Pregnant women
• Spatial analysis
• Sub-Saharan Africa