Knowledge, and utilization of HIV self-testing, and its associated factors among women in sub–Saharan Africa: evidence from 21 countries demographic and health survey
Authors: Terefe Bewuketu , Jembere Mahlet Moges , Reda Gashachew Bayleyegn , Asgedom Dejen Kahsay , Assefa Solomon Keflie , Lakew Ayenew Molla 
Published: July 2024

Abstract
Background
HIV Self-Testing (HIVST) holds great significance in the fight against the HIV epidemic in Sub-Saharan Africa (SSA). It offers a convenient and confidential option for individuals to know their HIV status and seek appropriate care and support. For women in this region, where stigma, discrimination, and lack of access to healthcare services are prevalent, HIVST can empower them to take control of their health and make informed decisions. However, no study in the region has been conducted on this topic. Hence, this study aimed to fill the evidence, and population gaps by identifying women’s HIVST knowledge, and utilization, and its associated factors in SSA.

Methods
The data used were gathered from the most recent demographic and health surveys conducted in SSA nations between 2015 and 2022. We incorporated DHS data from 21 countries into our investigation. For our analysis, we used a weighted sample of 270,241 women overall was utilized. To handle both individual and community level factors, a multilevel logistic regression was used for the analysis. The adjusted odds ratio and its 95% confidence interval were then presented, and variables with univariate multilevel regression p-values of ≤ 0.25 and in multivariable multilevel logistic regression < 0.05 p value were considered significant factors of HIVST.

Results
The overall prevalence of knowledge, and utilization of HIVST among women was about 2.17 (95% CI: 2.12, 2.23) only. Women aged 25–34 years old (AOR = 1.78, 95% CI: 1.65,1.92), and 35–49 years old (AOR = 1.33, 95% CI: 1.22,1.46), primary education(AOR = 1.25, 95%CI: 1.12, 1.38), and secondary/higher education (AOR = 3.08, 95% CI: 2.79, 3.41), poorer (AOR = 1.22, 95% CI: 1.08, 1.38), middle (AOR = 1.19, 95% CI: 1.06, 1.37), richer (AOR = 1.45, 95% CI 1.45, 1.64), and richest (AOR = 1.81, 95% CI: 1.59, 2.05), employed (AOR = 1.73 05% CI: 1.62, 1.85), mass media exposure (AOR = 1.39, 95% CI: 1.31, 1.49), knew modern contraception (AOR = 2.75, 95% CI: 1.84, 4.13), health facility delivery (AOR = 1.17, 95% CI: 1.02, 1.37), being from urban (AOR = 1.53, 95% CI: 1.63, 1.73), divorced or widowed (AOR = 77, 95% CI:1.13, 1.34), have more than one sexual partners (AOR =, 95% CI: 1.24, 1.41), heard about STIs (AOR 7.47 =, 95% CI: 5.16, 10.81), high community ANC coverage (AOR = 1.46, 95% CI: 1.31, 1.63), high community mass media (AOR = 1.37 95% CI: 1.21, 1.56), Central/Southern Africa (AOR = 0.66 95% CI: 0.59,0.74), and East Africa regions (AOR = 0.87 95% CI: 0.81,0.94) were associated with the knowledge and utilization of HIVST.

Conclusions
The level of knowledge and utilization of HIVST among women in SSA was very low. To improve this situation, maternal health services can be enhanced. This can be achieved by facilitating institutional delivery, promoting access to modern contraception, increasing ANC coverage, empowering women’s associations, creating culturally respectful mass media content, and involving rural and economically disadvantaged women. By implementing these measures, we can enhance women’s knowledge and improve their use of HIVST.