Published in PLOS One on 2026-07-16, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Agazhe Aemro, Alebachew Ferede Zegeye, Enyew Getaneh Mekonen, Yilkal Abebaw Wassie, Mequannent Sharew Melaku, Basazinew Chekol Demilew
Source: PLOS One • DOI 10.1371/journal.pone.0354020
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
HIV testing is an essential component of HIV prevention and care, yet lifetime testing frequency remains low in sub-Saharan Africa (SSA). This study examines the factors influencing lifetime HIV testing frequency among reproductive-age women in SSA.
We analyzed the most recent Demographic and Health Survey (DHS) data from nine sub-Saharan African countries, with an overall weighted sample of 158,722 women aged 15–49. The dependent variable was the lifetime number of HIV tests, and Zero-Inflated Negative Binomial (ZINB) regression was used. Model selection was based on Akaike Information Criterion (AIC) or Bayesian Information Criterion (BIC) and Vuong’s test, favoring the ZINB model over other count models. Adjusted incidence rate ratios (aIRRs) for the count and aOR for the inflation part with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05.
The mean number of lifetime HIV tests was 2.49 (SD = 7.67), with a median of 0 (IQR = 0–3). Key predictors of lifetime HIV testing included: age (30–39 years: aIRR = 2.94; 40–49 years: aIRR = 3.14), rural residence (aIRR = 1.10), current or former union (aIRR = 1.37 and 1.30, respectively), education (primary: aIRR = 1.19; secondary: aIRR = 1.35; higher: aIRR = 1.81), wealth (richer: aIRR = 1.30; richest: aIRR = 1.34), and employment (manual labor: aIRR = 1.21; skilled work: aIRR = 1.18). Other significant factors included: comprehensive HIV knowledge (aIRR = 1.37), STI awareness (aIRR = 2.21), media exposure (aIRR = 1.25), access to health facilities (aIRR = 1.26), number of sexual partners (1 partner: aIRR = 4.82; 2–3 partners: aIRR = 5.67; 4 or more partners: aIRR = 6.13), early sexual debut (aIRR = 0.61), and region (East Africa: aIRR = 2.82; Southern Africa: aIRR = 7.25). The inflation model showed very low odds of never testing among women with primary and secondary education, lower odds with media exposure (OR=0.40), but higher odds with higher education (OR=5.26) and rural residence (OR=1.93).
This study indicated that over half of women of reproductive age in SSA have never tested for HIV. Addressing socio-economic, structural, and regional disparities, particularly in West Africa, is crucial, highlighting the need for targeted, equitable, and community-based strategies to expand testing coverage and promote repeat uptake.
Introduction
HIV/AIDS remains one of the most significant public health challenges globally, particularly in Low- and Middle-income countries (LMICs) [1]. Although progress has been made in prevention and treatment, the burden is still substantial. According to the 2023 World Health Organization (WHO) and UNAIDS report, around 39 million people are living with HIV globally [2]. Sub-Saharan Africa remains the most affected region (about 67% of all people living with HIV). This reflects long-standing disparities in healthcare infrastructure, access to services, and social determinants of health [3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Agazhe Aemro, Alebachew Ferede Zegeye, Enyew Getaneh Mekonen, Yilkal Abebaw Wassie, Mequannent Sharew Melaku, Basazinew Chekol Demilew. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Geographic inequalities in HIV testing uptake among young women in sub-Saharan Africa: A hierarchical bayesian spatial analysis
- Evidence brief: Self-reported sexually transmitted infections and related symptoms among women in Ghana
- Evidence brief: Barriers to healthcare access among women in sub-Saharan Africa: A pooled analysis of multi-country DHS data (2019–2023)
