Determinants of Voluntary HIV Testing and Counseling: A Tiered Modeling of the Ethiopian Demographic and Health Survey | BMC Women’s Health


In developing the current National HIV Strategic Plan, the Ethiopian government adopted the global goal of reaching the 90-90-90 targets by scaling up targeted HIV counseling and testing services, achieve virtual elimination of MTCT, optimize and maintain quality care and treatment [16]. This study uses a nationally representative cross-sectional sample of women to investigate individual and community-level determinants that affect acceptance of VCT among women of reproductive age in Ethiopia. Therefore, the results of this study indicate that several determinants at the individual and community level are linked to whether women of childbearing age receive VCT.

In this study, the participation rate in VCT among unmarried women was high compared to never married women. This result is consistent with other studies conducted in Ethiopia [18, 25]. The high screening rate among married women could be because the majority of women think VCT is useful in preparing for marriage [20], and after marriage, women are more likely to visit the health facility for the perinatal service available in most health facilities and therefore for VCT.

The likelihood of having been tested was highest among women aged 35 or older and 25 to 34 years old. The results of this survey are consistent with those of other studies, indicating that VCT use varies with age. [18, 19, 22, 23, 25, 26, 28]. A previous documented study of HIV / AIDS awareness and knowledge among women of reproductive age indicated that the chances of awareness and knowledge about HIV / AIDS increase with the age of women, which may increase the likelihood of HIV / AIDS awareness and knowledge. ” use of CDV [31]. This fact is probably due to the fact that fear of societal stigma and discrimination towards VCT use was less common among older people than younger people. [28].

We found that the use of VCT increased with the level of education and family wealth. This result is linked to other studies carried out elsewhere in which women with a higher level of education [1, 20,21,22,23,24] and higher family wealth [18, 19, 22,23,24] are more likely to be tested for HIV. This result underscored the importance of education and greater wealth for increasing HIV counseling and testing. Possible reasons may be increased awareness and knowledge of HIV among educated women and women in wealthier households [31]. In addition, this association was likely due to the fact that women with higher income and education were more likely to seek maternal health services, to have female autonomy, and to be close to home. ‘information. [32, 33]. Another possible rationale could be that in this study, most women from wealthier families (91%) and higher education levels (94%) had ≥ 4 antenatal follow-ups, which may increase VCT. However, the present study disagrees with a study from China, which shows a negative association between income and VCT use. [27]. This disagreement could be due to differences in the tools used for measuring the wealth index, in which the DHS program used principal component analysis to calculate the wealth index (a composite measure of the cumulative standard of living household), while the previous study used monthly income.

As documented previously, we have observed that women with in-depth knowledge about HIV are more likely to receive VCT [18, 21, 23,24,25,26, 28, 34]. One possible explanation could be that knowledgeable women may be aware of the benefits of getting tested for HIV. This finding suggests that discussing HIV will increase acceptance of HIV testing; therefore, dialogue on this issue and prevention of stigma are essential [35, 36].

Use of VCT was higher in people with risky sexual behavior. This was consistent with studies carried out in different countries [18, 19, 22, 24, 26]. Indeed, women with risky sexual behaviors are afraid and uncertain of their HIV status, which will force them to be tested for HIV than those who do not engage in risky sexual behavior.

In line with previous studies conducted in Ethiopia [18, 19, 22], Nigeria [23], Malawi [21] and China [27], this study found that women who had a stigma towards PLWHA had reduced use of VCT. This association could probably be due to the cultural and moral values ​​attached to sexual orientation which greatly determine the attitude of people towards PLWHIV. People infected with HIV are perceived to be engaged in socially frowned upon premarital or extramarital sex, which could lead to a misconception about HIV testing due to fear of the negative consequences of social disapproval. [37].

This study also assesses the association between determinants at the community level and the use of VCT. Our result indicated that VCT use was higher among women living in communities where the proportion of respondents was more educated than the median and where women came from wealthier communities, which is in agreement with the findings of a study carried out in Burkina Faso. [24]. In addition, this study suggested that women living in communities with high knowledge about HIV were more likely to be tested for HIV, that is, living in communities where HIV is present. actively treated appears to have a strong effect on willingness to be tested. This is similar to previous literature, which indicates that engaging individuals in community group HIV discussions increased the odds of using VCT compared to those who did not participate. [36]. A study has shown that community features / interventions are very effective in increasing the use of preventive measures [35].

Strength and limitations of the study

The main strength of this study is the use of nationally representative data, which was collected using standard and validated data collection tools. In addition, a high-level model (multi-level analysis) was used, which takes into account the relevance of the EDHS data when determining the estimates. However, our study is limitless. Due to the secondary nature of the data, factors such as availability of treatment, factors related to healthcare professionals and support programs were not included in the analysis.


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