HIV Testing Uptake and Late Diagnosis among Urban Population of Ethiopia: A Multilevel Modeling Approach

Abstract

Background: Expanding HIV testing and early diagnosis requires a better understanding of determinants to uptake and late diagnosis. We investigated factors contributing to HIV testing uptake and late diagnosis. Objective: The aim of this study was to determine level of HIV Testing Uptake and Late Diagnosis among Urban Population of Ethiopia Design: We used data from the Ethiopian Population Based HIV Impact assessment in Ethiopia (EPHIA), conducted in 2017/18. EPHIA was a nationally representative, cross-sectional and household-based study, conducted in urban Ethiopia which used a two-stage cluster sampling design with stratification into small and large urban areas. The EPHIA data were collected from 19,136 adults aged 15 to 64 years. For current study, we considered self-reports first diagnosis to estimate the testing uptake and also consider HIV LAg avidity Vs Viral Load Vs plasma Antiretroviral drug level algorithm to categorize the late diagnosis. In this analysis, a 2-level multilevel mixed-effect logistic regression model was employed using STATA v16. The effects of individual-level predictors were quantified by the estimates from the fixed-effect part of the model with a p-value less than 0.05 or 95% CI. Result: By the year 2017/18, overall 29.4% of people living with HIV (PLHIV) were never tested in urban Ethiopia. Never tested male was significantly higher (32.4%; 95%: 31.0, 33.9) than females (26.4%; 95%: 25.3, 27.5) while it ranged from 28.3% to 47.8% among 45 to 54 and 15 to 24 years, respectively. By the same study period, 25.9% (95% CI: 21.7, 30.2) of PLHIV were lately diagnosed and male was significantly higher (36.8%; 95%: 28.0, 46.6) than females (20.8%; 95%: 17.3, 24.9). Late HIV diagnosis was also heterogeneous by various age group categories. Late diagnosis varies by region which ranged from 38.1% in the Gambella to 5.8% in Benishangul Gumuz. HIV testing uptake and late diagnosis was also significantly affected by alcohol use, income and educational status. Conclusion: Ethiopia was behind the global target for HIV testing uptake. Late diagnosis of HIV constituted one-quarter of all testing HIV positive, and this was significantly higher among adult males. HIV testing offer and early diagnosis strategy need to focus on addressing geographically highly affected regions, and male and young adolescent age groups. The widowed population group, which is highly affected by HIV, and has low level of testing uptake, may require due attention by the HIV program. It is also suggested that HIV care and treatment programs provide a focus to the disadvantaged populations, especially those with limited education and low income.