Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018

Abstract

Introduction Zambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth. Methods We carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018). We calculated the percentage of women and men ages 15–24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months. Results HIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20–24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30–1.84], among men; and aOR = 1.74 [1.40–2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32–1.88]) and in a union (aOR = 2.44 [1.83–3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82–17.19]). Education-based inequity was considerably widened among women than men by 2018. Conclusion HTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.

Prevalence and factors associated with self-reported HIV testing among adolescent girls and young women in Rwanda: evidence from 2019/20 Rwanda Demographic and Health Survey

“…The age group 20–24 has more information on sexual matters and is more likely to go for HIV testing than the 15–19-year-olds. This is in line with other previously published studies from Zambia, South Africa, and Tanzania [ 13 , 18 , 19 ]. The AGYW who lived with a man were more likely to test for HIV and this could be due to their possibly high sexual activities, hence they are at higher risk of HIV and other sexually transmitted diseases, for which they would visit the healthcare facilities and would also be allowed to test for HIV [ 20 ].…”

“…The declaration endorsed the 90–90-90 targets, requiring at least 90% of PLHIV would know their status, 90% of these would be on antiretroviral treatment (ART), and 90% of those on ART would achieve viral load suppression (VLS) [ 6 ]. Increasing access to and uptake of HIV testing is critical to achieving the first and the two corresponding targets [ 7 ]. The World Health Organization (WHO) also recommends annual testing in high HIV prevalent settings [ 7 , 8 ].…”

“…Increasing access to and uptake of HIV testing is critical to achieving the first and the two corresponding targets [ 7 ]. The World Health Organization (WHO) also recommends annual testing in high HIV prevalent settings [ 7 , 8 ].…”

HIV testing uptake and determinants among adolescents and young people in Burundi: a cross-sectional analysis of the Demographic and Health Survey 2016–2017

“…The conceptual and analytical framework used to identify different determinants was based on Andersen's Behavioural Model of health services utilisation, 16 previously applied to the study of HIV-related behaviours. [17][18][19] The model included individual, societal and health system levels of analysis for studying health services use and its determinants. 16 20 21 Our study focused on the first level to analyse determinants of HIV testing among youth in Burundi, with three components: (1) predisposing factors such as age and marital status; (2) enabling factors that would increase the opportunities for accessing HIV testing services, including wealth, being covered by health insurance or living in an urban area and (3) perceived need factors which affect (negatively or positively) an individual's care-seeking behaviour, such as the respondent's discriminatory attitudes towards people living with HIV and being sexually active.…”

HIV Testing Autonomy: The Importance of Relationship Factors in HIV Testing to People in Lusaka and Chongwe, Zambia

“…HIV prevalence in Zambia has stabilized at high levels (approximately 11.1 per cent of people aged 15-49 years are living with HIV) (UNAIDS 2020c). This makes Zambia one of the countries with the highest HIV burden (Heri et al 2021). In 2019, 48,000 adults and 5,400 children were newly infected with HIV (compared with 2010 when 47,000 adults and 8,800 children were newly infected), while in 2018, 17,000 people died of AIDS-related illnesses (Avert 2020).…”