Frequency of HIV-testing and factors associated with multiple lifetime HIV-testing among a rural population of Zambian men

Abstract

BackgroundAcross sub-Saharan Africa, men's levels of HIV-testing remain inadequate relative to women’s. Men are less likely to access anti-retroviral therapy and experience higher levels of morbidity and mortality once initiated on treatment. More frequent HIV-testing by men at continued risk of HIV-infection is required to facilitate earlier diagnosis. This study explored the frequency of HIV-testing among a rural population of men and the factors associated with more frequent HIV-testing.MethodsWe conducted a secondary analysis of a population-based survey in three rural district in Zambia, from February-November, 2013. Households (N = 300) in randomly selected squares from 42 study sites, defined as a health facility and its catchment area, were invited to participate. Individuals in eligible households were invited to complete questionnaires regarding demographics and HIV-testing behaviours. Men were defined as multiple HIV-testers if they reported more than one lifetime test. Upon questionnaire completion, individuals were offered rapid home-based HIV-testing.ResultsOf the 2376 men, more than half (61 %) reported having ever-tested for HIV. The median number of lifetime tests was 2 (interquartile range = 1-3). Just over half (n = 834; 57 %) of ever-testers were defined as multiple-testers. Relative to never-testers, multiple-testers had higher levels of education and were more likely to report an occupation. Among the 719 men linked to a spouse, multiple-testing was higher among men whose spouse reported ever-testing (adjusted prevalence ratio = 3.02 95 % CI: 1.37-4.66). Multiple-testing was higher in study sites where anti-retroviral therapy was available at the health facility on the day of a health facility audit. Among ever-testers, education and occupation were positively associated with multiple-testing relative to reporting one lifetime HIV-test. Almost half (49 %) of ever-testers accepted the offer of home-based HIV-testing.DiscussionReported HIV-testing increased among this population of men since a 2011/12 survey. Yet, only 35 % of all men reported multiple lifetime HIV-tests. The factors associated with multiple HIV-testing were similar to factors associated with ever-testing for HIV. Men living with HIV were less likely to report multiple HIV-tests and employment and education were associated with multiple-testing. The offer of home-based HIV-testing increased the frequency of HIV-testing among men.ConclusionAlthough men's levels of ever-testing for HIV have increased, strategies need to increase the lifetime frequency of HIV-testing among men at continued risk of HIV-infection.

Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors

“…Thirty studies provided the information of the locations where the research were conducted ( Table 1 ). There were three studies [ 13 , 16 , 20 ] conducted in urban areas, four [ 5 , 21 – 23 ] in rural areas, four [ 12 , 16 , 24 , 25 ] in both urban and rural areas, and one [ 26 ] in rural and peri-urban area. Eleven studies [ 4 , 18 , 19 , 27 – 34 ] were conducted in health facilities, such as hospitals, health centers, public sectors, VCT centers, and government clinics.…”

“…Eleven studies [ 4 , 18 , 19 , 27 – 34 ] were conducted in health facilities, such as hospitals, health centers, public sectors, VCT centers, and government clinics. The studies primarily investigated the populations in the following provinces ( Fig 2 ): sixteen in Lusaka [ 4 , 12 – 16 , 23 , 24 , 26 – 29 , 31 , 33 , 35 ], six in Copperbelt [ 7 , 18 – 20 , 30 , 32 ], three in Central Province (including Kapiri Mposhi district) [ 12 , 13 , 24 ], seven in Southern Province [ 15 , 16 , 21 , 22 , 34 , 36 , 37 ], and two in Luapula Province [ 30 , 32 ].…”

Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

“…Identifying the characteristics of men who do not go for HIV testing is needed to plan and implement testing services which can better reach them. Determinants of HIV testing among men has been studied in several reports [18][19][20][21][22][23][24][25], including analyses of Demographic and Health Surveys (DHS) [19,20,22,23]. Existing evidence shows that men who were younger [24,25], had less education [18,20,24,25], did not have an occupation [18], had stigmatising views of HIV [21,22] and who lacked HIV knowledge [22] were more likely to report never testing for HIV.…”

What works – reaching universal HIV testing

“…The factors explored in this article are not exhaustive as other important factors have been reported elsewhere [20,25]. We did not ask about reasons for declining HCT in the first round of the intervention but have subsequently done so in the second round.…”