Assessing Secular Trends in HIV Rapid Diagnostic Test Uptake and Positivity in Northeast Iran, a country in MENA region, and Recommending Gender-Specific Health Policies to Improve.

Abstract

Background Iran is among the first three countries in MENA region where two-thirds of new HIV infections are reported. The HIV rapid diagnostic testing (HIV-RDT) program, established for early detection of HIV infection, is evaluated in Mashhad, a metropolitan area, and 14 cities in Khorasan-Razavi Province, Iran. Methods In this cross-sectional study, de-identified records of HIV-RDT clients between 2017 and 2021 were extracted from the electronic health information system of 122 testing sites. Descriptive, bivariate and multivariate logistic regression analyses were performed to identify the factors associated with HIV-RDT uptake and risks and drivers of HIV-RDT positivity. Results Conducting 66546 HIV-RDTs among clients with a mean age of 30.31 years, 63% female, 75.2% married, and 78.5% diploma or below, yielded 312 (0.47%) positive results. Prenatal care and suspicious heterosexual intercourse were the most frequent reasons for taking HIV-RDT among women and men, respectively (76% and 61.2%). Test uptake was relatively low among men and the unmarried population. Male gender (odd ratio (OR) = 9.5), higher age at the time of testing (OR = 1.03), widowhood (OR = 3.98), education levels of high school diploma or below (OR = 2.35), and unemployment status (OR = 2.91) were significant sociodemographic predictors of positive HIV-RDT (P-value < 0.05). Furthermore, gender-stratified multivariate analyses revealed unsanitary dental procedures (OR = 15.7), mother-to-child transmission (MTCT)(OR = 29.95), drug injection (OR = 8.21), and male homosexuality (OR = 19.38) as behavioral predictors of test positivity among males (P-value < 0.05). Whilst substance abuse (not only injection) (OR = 12.15), MTCT (OR = 13.54), and being an occupational trainee (OR = 15.08) were predictors among females (P-value < 0.05). Conclusion The study provides significant targets to implement innovative strategies to increase test uptake and yield in the region, and also suggests gender-specific strategies, according to the sociodemographic and behavioral risks, for HIV primary prevention and early detection.