Worku et al.

BMC Public Health (2021) 21:1262

https://doi.org/10.1186/s12889-021-11292-9

RESEARCH ARTICLE Open Access

Prevalence and associated factors of HIV

testing among reproductive-age women in
eastern Africa: multilevel analysis of
demographic and health surveys
Misganaw Gebrie Worku1* , Getayeneh Antehunegn Tesema2 and Achamyeleh Birhanu Teshale2

Abstract
Background: Despite efforts made to reduce the spread of the human immune-deficiency virus (HIV), its testing
coverage remains low in low and middle-income countries (LMIC). Besides, information on factors associated with
HIV counseling and testing among reproductive-age women is not sufficiently available. Therefore, this study was
aimed to determine the pooled prevalence and factors associated with HIV testing among reproductive-age
women in eastern Africa.
Methods: Secondary data analysis was conducted based on the Demographic and Health Surveys (DHS) data
conducted in East African countries. We pooled the most recent DHS surveys done in 11 East African countries. A
total weighted sample of 183,411 reproductive-age women was included for this study. Both bivariable and
multivariable multilevel logistic regression models were fitted. Variables with a p-value ≤0.2 in the bivariable analysis
were selected for multivariable analysis. Finally, in the multivariable analysis, variables with a p-value ≤0.05 were
considered as significant factors affecting HIV testing.
Results: The pooled prevalence of HIV testing in eastern Africa was 66.92% (95%CI: 66.70, 67.13%). In the
multivariable multilevel analysis factors such as the age of respondent, marital status, educational level, HIV
knowledge, HIV stigma indicator, risky sexual behavior and women who visit a health facility were positively
associated with HIV testing coverage among reproductive-age women. While women from rich and richest
households, having multiple sexual partners, being from rural dwellers, late initiation of sex and higher community
illiteracy level had a lower chance of being tested for HIV.

* Correspondence: [email protected]
1
Department of Human Anatomy, College of Medicine and Health Science,
School of Medicine, University of Gondar, Gondar, Ethiopia
Full list of author information is available at the end of the article

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Worku et al. BMC Public Health (2021) 21:1262 Page 2 of 9

Conclusion: The pooled prevalence of HIV testing in eastern Africa was higher than most previous studies. Age of
respondent, residence, wealth index, marital status, educational level, HIV knowledge, stigma indicator, risky sexual
behavior, women who visit a health facility, multiple sexual partnerships, early initiation of sex and community
illiteracy level were significantly associated with HIV testing. There should be an integrated strategic plan to give
education about methods of HIV transmission and the implication of HIV testing and counseling. So all the
stakeholders should have an integrated approach by giving special attention to the factors that hinder HIV testing
to increase awareness regarding the benefit of HIV testing and counseling to control the spread of HIV/AIDS.
Keywords: Multi-level analysis, HIV/AIDS, HIV testing, Eastern Africa

Background previous studies were conducted at a country level, most

Human immune deficiency virus (HIV) testing and of them did not assess the community-level factors,
counseling is a public health program concerned with which might be related to HIV testing coverage. There-
diagnosing and minimizing the transmission of HIV/ fore, this study aimed to assess the pooled prevalence
AIDS [1]. Currently, about 38 million people are living and factors associated with HIV testing among
with HIV, nearly 36.2 million of them are adults and 1.8 reproductive-age women in eastern Africa.
million children [2]. Globally, 81% of all people living
with HIV know their status and about 19 million
remained unaware of their HIV status, which reduced to Methods
7.1 million in 2019 [1]. The number of people who are Data sources
newly infected with HIV declined from 3.4 million in This study was a secondary data analysis based on data-
2011 to 2.1 million in 2013 [1]. Despite this progress, sets from the most recent Demographic and Health Sur-
HIV/AIDS remains a major public health problem [3]. veys (DHS) conducted in east Africa (Burundi, Ethiopia,
African countries, particularly eastern and southern re- Comoros, Uganda, Rwanda, Mozambique, Madagascar,
gions are greatly affected by HIV/AIDS, which accounts Zimbabwe, Kenya, Zambia, and Malawi). The DHS is a
for two-thirds of total new infections [4, 5]. nationally representative survey that collects data on
Voluntary counseling and testing are considered as an basic health indicators like mortality, morbidity, family
initial step to detect, treat and prevent HIV/AIDS [6, 7]. planning service utilization, fertility, maternal and child
The World Health Organization recommends HIV test- health. Each survey used a two-stage stratified sampling
ing and counseling for all patients showing signs and technique to select the study participants. We pooled
symptoms of the disease [1, 8]. In Africa HIV testing the most recent DHS data done in 11 East African coun-
coverage ranges from 33.5 to 82.3% [9–12]. tries and a total weighted sample of 183,411
According to studies conducted in different parts of reproductive-age women was included for this study.
the world age of the respondent, having multiple sex- The survey year and total weighted sample included for
ual partnerships, early initiation of sex, level of educa- this study were presented in Table 1.
tion, marital status and socio-economic status are
some of the factors that are significantly associated Table 1 Showing the survey year and total weighted sample
with HIV testing [7, 10, 13, 14]. Besides, stigmatized for each country
attitudes, levels of knowledge about HIV/AIDS and Country Year of survey Weighted sample
risky sexual behavior have an association with HIV Burundi 2016 17269
testing and counseling [7, 12, 13, 15–19]. Ethiopia 2016 15683
Even though HIV testing is very crucial for all strat- Kenya 2014 31079
egies related to care, prevention and treatment of HIV/ Comoros 2012 5329
AIDS, it is less practiced among reproductive-age
Madagascar 2008 17375
women, particularly in developing countries [6, 16].
Every individual needs to know their HIV status for the Malawi 2015/16 24562
benefit of themselves and others [1, 20, 21]. Although Mozambique 2011 3061
global efforts had made to reduce the spread of HIV/ Rwanda 2352 13497
AIDS, its testing coverage remains low in developing Uganda 2016 4264
countries [2]. The assessment and identification of fac- Zambia 2018 16411
tors that affect the utilization of HIV counseling and
Zimbabwe 2013/2014 9955
testing help policymakers to design effective strategies
towards preventing and controlling HIV/ADIS. Besides, Total 183,411
Worku et al. BMC Public Health (2021) 21:1262 Page 3 of 9

Variables standard error. Because of the hierarchical structure of

The outcome variable of this study was “ever been tested the DHS data, a multilevel binary logistic regression ana-
for HIV” which was coded as “0” for no and “1” for yes. lysis was used. The Interclass Correlation Coefficient
The independent variables included in this study were (ICC), Proportional Change in Variance (PCV) and Me-
categorized as individual and community-level factors. dian Odds Ratio (MOR) were calculated to assess
The individual-level factors included were: age of re- whether there was clustering or not. In this study, four
spondent, marital status, age at 1st sex, stigmatized atti- models have fitted; the null model- a model without ex-
tude, educational level, household wealth status, HIV planatory variables, model I- a model with individual-
knowledge, risky sexual behavior, visiting of health facil- level factors, model II- a model with community-level
ity and multiple sexual partnerships. The community- factors and model III- a model with both individual and
level factors were community illiteracy level and resi- community-level factors. Model comparison was done
dence. The community illiteracy level of women was based on deviance. Both bivariable and multivariable
generated by aggregating the individual level factor multi-level logistic regression were done. At the bivari-
women’s educational level by considering the proportion able analysis variables with a p-value ≤0.2 were consid-
of women in the community that did not have formal ered for multivariable analysis. Finally, variables with a
education and by categorized this proportion as high P-value of ≤0.05 in the multivariable analysis were con-
and low based on the national median value. sidered as a significant factor associated with HIV test-
ing among reproductive-age women.
Operational definition
HIV knowledge Results
It was generated based on three questions related to Socio-demographic characteristics of study participants
HIV prevention and three questions related to the A total weighted sample of 183, 411 reproductive-age
modes of HIV transmission and graded as low (if a women were included. About 21.54% of women were in
woman answered ≤3 questions correctly), high (if a the age group of 19 years and below. The majority
woman answered 4–5 questions correctly) or compre- (92.13%) of women initiated sex at an earlier age and
hensive (if a woman answered all the 6 questions cor- more than half (56.82%) of them had visited health facil-
rectly) [22]. ities in the last 12 months. Nearly, half (48.65%) of the
study participants attained primary education. Regarding
Risky sexual behaviors HIV knowledge, about 47.81% of respondents had com-
Assessed based on the five questions; having had STI in prehensive knowledge about HIV/AIDS and most
last 12 months, genital sore/ulcer in last 12 months, (60.49%) of them had multiple sexual partnerships. Con-
genital discharge in last 12 months, having at least one cerning risky sexual behavior, the majority (81.70%) of
sexual partner other than the husband in the last 12 the participant had no risky sexual behavior and 71.96%
months, and multiple lifetimes sexual partnership. These of the participants were rural dwellers (Table 2).
were combined into an index of risky sexual behavior
with three categories: “No risk” (if the response is no for Prevalence of HIV testing in eastern Africa
all questions), “Some risk” (if the response is yes for one The pooled prevalence of HIV testing in eastern Africa
of the five questions) and “High risk” (if the response is was 66.92% (95%CI: 66.70, 67.13%) ranged from 7.56%
yes to at least two questions) [22]. in Madagascar to 85.74% in Rwanda (Fig. 1).

HIV stigma indicator Random effect model and model fitness

Six questions, which indicate negative attitudes towards As shown in Table 2, the ICC value in the null model
people living with HIV / AIDS were used to this vari- was 0.10, which indicates that about 10% of the total
able. This was categorized as “No stigma” (if we got a variation in HIV testing coverage was attributable to
score of 6), “Low stigma” (if we got a score of 4–5), cluster variability. Besides, the MOR value in the null
“Moderate stigma” (if we got a score of 2–3), and “High model was 1.77, which indicates that there was a signifi-
stigma” (if we got only score 1) [22]. cant clustering of HIV testing among reproductive-age
women. Furthermore, the PCV (0.36) in the final model
Data management and analysis (model III) indicated that about 36% of the variation in
Data extraction, recoding and analysis were done using HIV testing was explained by both individual and
STATA version 14 software. Both descriptive and analyt- community-level factors. The final model (Model III)
ical analyses were conducted. The data were weighted was the best-fitted model since it had the lowest devi-
before doing statistical analysis to restore the representa- ance (Table 3). The model predictive ability was assessed
tiveness of the data and to get a reliable estimate and using the Area Under the Curve (AUC) and Receiver
Worku et al. BMC Public Health (2021) 21:1262 Page 4 of 9

Table 2 Sociodemographic characteristics of the respondents in Table 2 Sociodemographic characteristics of the respondents in
eastern Africa (N = 183, 411) eastern Africa (N = 183, 411) (Continued)
Variables Frequency (%) Variables Frequency (%)
Age (years) At 20 and after years 74,878 (40.83%)
15–19 39,510 (21.54%) Visit health facility
20–24 34,150 (18.62%) No 72,075 (43.18%)
25–29 31,766 (17.32%) Yes 94,857 (56.82%)
30–34 26,992 (14.72%) Community illiteracy level
35–39 21,886 (11.93%) High 90,641 (49.42%)
40–44 16,406 (8.94%) Low 92,770 (50.58%)
45–49 12,701 (6.92%)
Highest education level
Operating Curve (ROC). These are plotted based on the
No education 33,035 (18.01%)
probability of sensitivity and 1 – specificity. Accordingly,
Primary education 89,229 (48.65%) the AUC of the final model was 84.5% and indicated that
Secondary education 51,294 (27.97%) the model’s ability to predict HIV testing was good
Higher education 9,840 (5.37%) (Fig. 2).
Wealth index
Factors associated with HIV testing
Poorest 32,495 (17.72%)
For assessing factors associated with HIV testing, we
Poorer 33,755 (18.40%)
consider the final model since it had the lowest deviance.
Middle 34,934 (19.05%) In the multivariable multilevel analysis factors such as
Richer 37,225 (20.30%) the age of respondent, marital status, educational level,
Richest 45,001 (24.54%) HIV knowledge, HIV stigma indicator, risky sexual be-
Risky sexual behavior havior and women who visit a health facility were posi-
tively associated with HIV testing coverage among
No risk 129,912 (81.70%)
reproductive-age women. While women from rich and
Some risk 20,169 (12.68%)
richest households, having multiple sexual partners, be-
High risk 8,931 (5.62%) ing from rural dwellers, late initiation of sex and higher
HIV knowledge community illiteracy level had a lower chance of being
Low knowledge 17,049 (10.03%) tested for HIV. Women aged 20 years and above had
High knowledge 71,694 (42.16%) higher odds of being tested for HIV compared with
women of 15–19 years old. The odds of testing for HIV
Comprehensive knowledge 81,301 (47.81%)
was 2.67 (AOR = 2.67: 95%CI; 2.60, 2.74) times higher
Marital status
for women visiting health centers in the last 12 months
Unmaried 88,582 (48.30%) compared with their counterparts. Regarding educational
Maried 94,829 (51.70%) level, the odds of testing for HIV was 2.30 (AOR = 2.30:
Number of sexual partners 95%CI; 2.22, 2.38), 2.39 (AOR = 2.39: 95%CI; 2.29, 2.50)
One 72,463 (39.51%) and 3.13 (AOR = 3.13: 95%CI; 2.89, 3.39) times higher
for women with primary, secondary and higher educa-
More than one 110,948 (60.49%)
tional level, respectively, compared to women with no
Stigma indicator
formal education. Being from rich (AOR = 0.93: 95%CI;
No stigma 5,961 (7.15%) 0.89, 0.97) and richest (AOR = 0.80: 95%CI; 0.76, 0.84)
Low stigma 35,612 (42.71%) households had lower odds of being tested for HIV. Be-
Moderate stigma 34,231 (41.06%) ing married had 1.32 (AOR = 1.32: 95%CI; 1.28, 1.36)
High stigma 7,569 (9.08%) times more likely to be tested for HIV compared with
their counterpart. Individuals who initiate sex after 20
Residence
years of age had 33% (AOR = 0.67: 95%CI; 0.65, 0.69)
Urban 51,426 (28.04%)
lower odds of being tested for HIV compared to those
Rural 131,985 (71.96%) who initiate sex early. Regarding stigma, women with
Age at sex higher, moderate and low stigma scores had 1.56
Before 20 years 108,533 (59.17%) (AOR = 1.56: 95%CI; 1.46, 1.66), 2.24 (AOR = 2.24:
95%CI; 2.16, 2.32), and 2.27 (AOR = 2.27: 95%CI; 2.19,
Worku et al. BMC Public Health (2021) 21:1262 Page 5 of 9

Fig. 1 Showing the prevalence of HIV testing across different countries

2.35) times higher odds of being tested for HIV com- from region to region. The regional variations in qual-
pared to those with no stigma. Women with higher ity and access to HIV testing facilities as well as know-
(AOR = 6.44: 95%CI: 6.21, 6.68) and comprehensive ledge related to HIV / AIDS may be the reasons for
knowledge (AOR = 10.7: 95%CI; 10.29, 11.12) about the reported regional variations of HIV testing in east-
HIV/AIDS had higher odds of being tested for HIV ern Africa [9, 14]. The prevalence reported in this
compared with women with low knowledge. Women study was in line with the report in Kenya [12]. The
having high (AOR = 1.78: 95%CI; 1.67, 1.90) and some finding in this study was greater than the study con-
risky sexual behavior (AOR = 1.59: 955CI; 1.53, 1.66) had ducted elsewhere [3, 16, 23] and it was smaller than
higher odds of being tested for HIV compared to women reports from different studies [9, 10]. The observed
with no risky sexual behavior. Women with multiple variations in the prevalence of HIV testing might be
sexual partners had a 36% lower chance of being tested explained by cultural beliefs and lifestyle differences
for HIV (AOR = 0.64: 95%CI; 0.62, 0.66) as compared to across regions [14]. Besides, the discrepancy might be
their counterparts. Women from the rural areas had due to the difference in quality and accessibility of
31% (AOR = 0.69: 95%CI; 0.67, 0.72) lower odds of being HIV testing facilities [9, 14, 24, 25].
tested for HIV compared with their counterparts. Being In this study age of respondent, multiple sexual part-
from communities with higher community illiteracy nerships, marital status, visiting health facility, stigma-
levels had 27% (AOR = 0.73: 95%CI; 0.68, 0.78) lower tized attitude towards HIV/AIDS, HIV knowledge, risky
odds of being tested for HIV compared with women sexual behavior, residence, educational level, wealth sta-
from communities with lower community illiteracy tus, age at first sex, and community illiteracy level were
levels (Table 4). significant factors associated with HIV testing.
The odds of HIV testing was higher among married
Discussion women compared with their counterpart. This finding
The pooled prevalence of HIV testing in east Africa was in agreement with the study done in Ethiopia [22].
was 66.9% (95%CI; 66.70, 67.13%), which varies greatly This might be due to compulsory counseling and
Table 3 Random effect model and model fitness for the assessment of HIV testing among reproductive-age women in eastern
Africa
Parameter Null model Model I Model II Model III
Intraclass correlation coefficient (ICC) 0.10031 0.0692 0.0782476 0.066394
Percentage change in variation (PCV) Ref 0.33 0.39 0.36
Median odds ratio (MOR) 1.77 1.6 1.65 1.58
Model comparison
Log likelihood − 113956.33 −75036.661 −113215.37 −74814.426
Deviance 227912.66 150073.322 226420.47 149628.852
Worku et al. BMC Public Health (2021) 21:1262 Page 6 of 9

Fig. 2 Showing the area under the ROC curve

testing promotion for couples intending to get mar- friendship, family relations, jobs and housing and health
ried by different organizations including religious care due to stigmatization [2, 18, 22]. However, in the
groups [22]. Women who visit health care facilities present study people with stigmatized attitudes had a
had higher odds of being tested for HIV, which was higher chance of being tested for HIV and this might be
supported by another study [16]. This might be be- explained by the variation in the cultural and socioeco-
cause health professionals initiate people who visited nomic status of the population included in this study.
health facilities for HIV testing [16]. In this study, women with risky sexual behavior had
In this study women from higher socioeconomic status higher odds of being tested for HIV. This is supported by
had lower odds of being tested for HIV, which is con- another study [22]. Individuals with risky sexual behavior
trary to another study [7]. This is justified by being rich live under persistent fear and uncertainty about their ser-
may be associated with a greater awareness of risks and ostatus and are usually suspicious and worried that they
with reduced financial barriers to testing [26]. Women might have infected with HIV. This urges them to develop
with primary and above educational levels had a higher habits of seeking VCT service [17].
chance of being tested for HIV, which is supported by Individuals who initiated sex early had a higher chance
different studies [16, 27]. The reason for this discrepancy of being tested for HIV and this is supported by the
might be as education can improve HIV knowledge as study conducted in Malawi [14]. This might be ex-
well as empowers women to make decisions to visit the plained as early age at first sexual intercourse is associ-
health facility and use health services [28]. ated with a higher risk of acquiring the different sexually
Women who had multiple sexual partners had less transmitted disease and risky sexual behaviors that may
chance of being tested for HIV compared with their lead to a higher risk for HIV infection, which in turn
counterparts. However, the finding of this study was in enforce them to know their HIV status [29].
contrast to another study [16]. This difference might be Women from rural dwellers had lower odds of be-
associated with individuals with a history of multiple ing tested for HIV, which was supported by the study
sexual partnerships who might be fear of having HIV conducted in Ethiopia [16]. This may be justified by
and have no interest to know their status. The study at the better availability and accessibility of HIV testing
hand revealed that women with higher and comprehen- facilities in urban settings compared with rural [30,
sive knowledge about HIV had higher odds of being 31]. Women from communities with higher illiteracy
tested for HIV. This is supported by a study conducted levels had less chance of being tested for HIV. This
in South Africa [13]. Different studies reported people finding was supported by studies conducted in
with higher HIV-associated stigma scores had less Ethiopia and Zambia [10, 16]. This might be associ-
chance of being tested for HIV. This is explained as ated with educational attainment may increase uptake
people could be hesitant to test because the disclosure of testing through increased recognition of the im-
of a positive HIV test result may lead to loss of portance of knowing one’s HIV status [20, 32].
Worku et al. BMC Public Health (2021) 21:1262 Page 7 of 9

Table 4 The bivariable and multivariable multilevel binary logistic regression analysis of factors associated with HIV testing in East
Africa in the final model
Variables Ever tested for HIV COR(95%CI) AOR(95%CI)
Yes No
Respondent age
15–19 15383 24122 1 1
20–24 25379 8738 4.70 (4.55, 4.86) 3.67 (3.53, 3.82)*
25–29 25, 043 6664 6.33 (6.11, 6.55) 5.36 (5.12, 5.61)*
30–34 21074 5882 6.23 (6.01, 6.47) 5.49 (5.23, 5.76)*
35–39 16333 5521 5.20 (5.00, 5.40) 4.77 (4.54, 5.01)*
40–44 11673 4714 4.16 (3.99, 4.33) 4.12 (3.91, 4.34)*
45–49 7860 4827 2.78 (2.66, 2.90) 3.03 (2.87, 3.20)*
Visiting health facility
No 34413 37624 1 1
Yes 74386 20401 4.06 (3.97, 4.15) 2.67 (2.60, 2.74)*
Highest educational level
No education 17747 15253 1 1
Primary education 61029 28085 1.84 (1.79, 1.89) 2.30 (2.22, 2.38)*
Secondary education 35471 15781 1.81 (1.76, 1.87) 2.39 (2.29, 2.50)*
Higher education 8488 1347 4.58 (4.31, 4.87) 3.13 (2.89, 3.39)*
Wealth status
Poorest 20082 12353 1 1
Poorer 21473 12245 1.25 (1.21, 1.29) 0.97 (0.93 1.02)
Middle 22840 12054 1.38 (1.33, 1.43) 0.98 (0.93 1.02)
Rich 25606 11585 1.56 (1.51, 1.61) 0. 93 (0.89, 0.97)*
Richest 32745 12231 1.71 (1.66, 1.76) 0.80 (0.76, 0.84)*
Marital statues
Married 69948 24745 1.99 (1.95, 2.03) 1.32 (1.28, 1.36)*
Unmarried 52799 35722 1 1
No of sexual partner
One 52493 19907 1 1
More than one 70254 40560 0.55 (0.54, 0.56) 0.64 (0.62 0.66)*
HIV knowledge
Low knowledge 7414 9619 1 1
Higher knowledge 49482 22146 6.9 (6.69, 7.11) 6.44 (6.21, 6.68)*
Comprehensive knowledge 65773 15416 12.6 (12.20, 13.01) 10.7 (10.29 11.12)*
Stigma indicator
Higher stigma 4375 3194 1.05 (1.01, 1.11) 1.56 (1.46, 1.66)*
Moderate stigma 25817 8414 2.30 (2.24, 2.37) 2.24 (2.16, 2.32)*
Low stigma 27813 7799 2.68 (2.61, 2.76) 2.27 (2.19, 2.35)*
No stigma 4905 1056 1 1
Residence
Urban 38964 12404 1 1
Rural 83783 48063 0.66 (0.64, 0.67) 0.69 (0.67, 0.72)*
Risky sexual behavior
Higher risk 7119 1805 2.21 (2.10, 2.33) 1.78 (1.67, 1.90)*
Worku et al. BMC Public Health (2021) 21:1262 Page 8 of 9

Table 4 The bivariable and multivariable multilevel binary logistic regression analysis of factors associated with HIV testing in East
Africa in the final model (Continued)
Variables Ever tested for HIV COR(95%CI) AOR(95%CI)
Yes No
Some risk 15518 4636 1.80 (1.74, 1.87) 1.59 (1.53, 1.66)*
No risk 86043 43784 1 1
Age at sex
Before 20 years 79591 29772 1 1
At 20 and above years 35500 9309 8.66 (8.37, 8.96) 0.67 (0.65, 0.69)*
Community illiteracy level
Low 64381 26126 1 1
High 58366 34341 0.52 (0.48, 0.55) 0.73 (0.68, 0.78)*
*p ≤ 0.05

Strength and limitation of the study Abbreviations

The study was based on weighted nationally representa- CI: Confidence Interval; CSA: Central Statistical Agency; DHS: Demographic
Health Survey; EA: Enumeration Area; ICC: Intraclass correlation coefficient;
tive data from 11 eastern African countries with a large LLR: likelihood Ratio; WHO: World Health Organization
sample size. Also, the analysis used the multilevel ana-
lysis to accommodate the hierarchical nature of the DHS Acknowledgments
data. Moreover, since it is based on the national survey We greatly acknowledge MEASURE DHS for granting access to the
data, the study has the potential to give insight for Demographic and Health Surveys data.
policy-makers and program planners to design appropri-
ate intervention strategies both at the national and re- Authors’ contributions
GAT, MGW, ABT conceived the study. GAT, MGW, ABT analyzed the data.
gional levels. However, this study had limitations in that GAT, MGW, ABT, drafted the manuscript and reviewed the article. GAT, MGW,
the DHS survey was based on respondents’ self-report, ABT extensively reviewed the article. All authors read and approved the final
this might have the possibility of recall bias. Besides, manuscript.
since this study was based on cross-sectional collected
DHS data, we are unable to show the temporal relation- Funding
ship between HIV testing and independent variables. No funding was obtained for this study.

Availability of data and materials

Data is available online and you can access it from www.measuredhs.com.
Conclusion
The prevalence of HIV testing in this study was
higher than the report from previous studies. Age of Declarations
respondent, marital status, educational level, HIV Ethics approval and consent to participate
knowledge, stigma indicator, risky sexual behavior, Since the study was a secondary data analysis of publically available survey
women who visit a health facility, early initiation of data from the MEASURE DHS program, ethical approval and participant
consent were not necessary for this particular study. We requested DHS
sex, wealth status, multiple sexual partnerships, resi- Program and permission was granted to download and use the data for this
dence and community illiteracy level were signifi- study from http://www.dhsprogram.com. The Institution Review Board
cantly associated with HIV testing among approved procedures for DHS public-use datasets do not in any way allow
respondents, households, or sample communities to be identified. There are
reproductive-age women. Therefore, there should be no names of individuals or household addresses in the data files.
an integrated strategic plan to give education about
methods of HIV transmission and the implication of Consent for publication
HIV testing and counseling. Not applicable since the study was a secondary data analysis already
Also, it is instrumental to bringing behavioral change, collected by CSA.
reducing unprotected sex and helping to reduce early
initiation of sex and avoidance of having multiple sexual Competing interests
Authors declare that they have no conflict of interest.
partners. So all the stakeholders should have an inte-
grated approach by giving special attention to the factors Author details
1
that hinder HIV testing to increase awareness regarding Department of Human Anatomy, College of Medicine and Health Science,
School of Medicine, University of Gondar, Gondar, Ethiopia. 2Department of
the benefit of HIV testing and counseling to control the Epidemiology and Biostatistics, Institute of Public Health, College of Medicine
spread of HIV/AIDS. and Health Sciences, University of Gondar, Gondar, Ethiopia.
Worku et al. BMC Public Health (2021) 21:1262 Page 9 of 9

Received: 27 November 2020 Accepted: 15 June 2021 23. Fikadie G, Bedimo M, Alamrew Z. Prevalence of voluntary counseling and
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