Individual and Contextual Determinants of HIV Testing Practices Among Adolescent Girls and Young Women in Sub-Saharan Africa: A Multi-Level Mixed-Effects Analysis.

Abstract

BackgroundAdolescent girls and young women (AGYW) in Sub-Saharan Africa (SSA) face a disproportionate HIV risk. Achieving UNAIDS 95-95-95 targets requires high diagnostic coverage, yet critical gaps persist. This multi-country study evaluated individual- and community-level factors associated with HIV testing across 21 SSA nations.MethodsSecondary data analysis was performed on a pooled sample of 92,935 young women (ages 15-24) from recent Demographic and Health Surveys (DHS) across 1,678 primary sampling units (clusters). Multi-level mixed-effects logistic regression was utilized to assess individual (Level-1) and contextual community-level (Level-2) factors associated with lifetime HIV testing practices.ResultsLifetime HIV testing prevalence was 44.74% (n = 41,576), exposing a 55.26% testing gap. In the fully adjusted model (Model III), age (20-24 vs. 15-19 years: Adjusted Odds Ratio (AOR) = 2.342, 95% Confidence Interval (CI: 2.262, 2.424) and higher formal education (AOR) = 4.975, 95% (CI: 4.548, 5.443) were strongly associated with testing. Marital status showed significant associations, peaking among widowed, divorced, or separated women (AOR) = 5.160, 95% (CI: 4.665, 5.706). Comprehensive HIV knowledge doubled the odds of testing (AOR) = 2.024, 95% (CI: 1.958, 2.093). Contextually, high community media saturation was positively associated with testing (AOR) = 2.803, 95% (CI: 2.295, 3.422), whereas high community-level education demonstrated an inverse association (AOR) = 0.314, 95% (CI: 0.261, 0.378). The residual Median Odds Ratio (MOR = 1.30) indicated moderate cluster-level variation.ConclusionHIV testing practices among SSA young women are associated with nested sociodemographic, cognitive, and community-level factors. Strategies targeting expanded community media engagement, youth-friendly out-of-clinic screening, and discreet HIV self-testing options may help improve diagnostic coverage.