Trend, spatial distribution, and factors associated with HIV testing uptake among pregnant women in Ethiopia, based on 2005-2016 Ethiopia demographic and health survey

Abstract

Introduction: HIV testing during pregnancy is an integral component and first step of prevention for mother to child transmission, initiation of antiretroviral treatment and diagnosis of HIV/AIDS. Although HIV testing uptake among pregnant women has showed variations worldwide, countries in sub-Saharan Africa including Ethiopia have been struggling in achieving the HIV testing target of Joint United Nations Program on HIV/AIDS. However, there is limited evidence on the trend, spatial distribution and factors associated with HIV testing uptake among pregnant women at the national level. Objective: To assess trends, spatial distribution, and associated factors of HIV Testing uptake among pregnant women in Ethiopia between 2005-2016, based on Ethiopia Demographic and Health Survey. Methods: The study was conducted on repeated cross sectional study based on three consecutive demographic and health survey in Ethiopia. A total weighted sample of 4321 in 2005, 4453 in 2011, and 4246 in 2016 women who gave birth within 2 year proceeding each survey year were included in each survey. STATA version 17 software was used .Trends and Logit based decomposition analysis technique was used to examine the change in HIV testing uptake among pregnant women overtime and factors contributing to the change .Coefficients with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the contribution .ArcGIS version 10.7.1 and SaT Scan version 10.1 software were used for the spatial analysis of low proportion of HIV testing uptake among pregnant women using clusters. Ordinary least square and geographically weighted regression was conducted to identify factors associated with low proportion of HIV testing uptake among pregnant women. Results: HIV testing uptake among pregnant women has significantly increased from 0.51% [0.32%, 0.77%] in 2005 to 32.4% [31.0%, 33.8%] in 2016 with 2.9% annual rate of increment in Ethiopia. About 75.9 % of the overall increase in HIV testing uptake among pregnant was due to increases in women’s composition with knowledge of Mother to child transmission of HIV (3.2%),HIV counseling(10.3%),4 or more antenatal care visit (31.4%), health facility delivery(6.3%), not perceiving distance from the health facility as a big problem(1.1%), and urban residence(0.6%). While the rest 24.1% of the overall change was due to the change in coefficient. The change in women’s health care decision making autonomy (7.8%) was the only contributing factors to change of HIV testing over the last decade. Spatial variation of low proportion of HIV testing was non-random (Moran index, p-value<0.05) in all three surveys. Hot spot clusters exhibited in all the three waves includes Tigray and SNNPRs in 2005 and consistent hotspot areas in Benishangul-Gumuz, Somali, SNNPR, and Gambella in 2011 and 2016 EDHS. Lack of knowledge of MTCT of HIV, lack of ANC visit, lack of media exposure, and health facility delivery were significant predictors for the spatial variation of low proportion of HIV testing uptake across regions in Ethiopia in 2016. Conclusion and Recommendation: Over all there has been a substantial increase in HIV testing uptake among pregnant women overtime in Ethiopia, but it still far away from achieving the 2025 HIV testing targets. Knowledge of Mother to child transmission of HIV, HIV counseling ,Number of Antenatal care visit, previous place of delivery, residence and distance to health facility were significant contributing factors for the change in HIV testing uptake. There was geographical disparity in HIV testing uptake across regions in all three EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of ANC visit, lack media exposure, and health facility delivery were significant predictors. Thus, geographic-based health service interventions could be held to increase HIV testing uptake in consistent hot spot areas in Ethiopia. The detailed maps of the hot spots and its predictors will assist decision makers in implementing precise public health interventions.