Prevalence and factors associated with HIV self-testing uptake among adolescent girls and young women in middle learning institutions in Dodoma City Tanzania, 2024.a cross-sectional study

Abstract

ABSTRACT

Background In 2015, globally, around 41,000 adolescent girls and young women died due to AIDS-related illnesses, with less than 20% of them knowing their HIV status in Sub-Saharan Africa. To end the AIDS epidemic by 2030, different strategies are required to address previous challenges and barriers toward achieving the universal goal of ensuring that 95% of the people living with HIV know their status. The need to study the magnitude, barriers, and determinants associated with HIV self-testing uptake among adolescent girls and young women in middle learning institutions in Dodoma City, Tanzania, is essential. Methodology A cross-sectional study was conducted involving middle-level institutions in Dodoma city. Ten colleges were identified, from which five were selected using a two-stage cluster sampling technique. Subsequently, three classes representing years of study mainly year one, year two, and year three were randomly chosen from each selected college, and students were randomly selected from these classes. A modified Poisson regression model with robust standard errors was employed to assess factors independently associated with the use of HIVST. This regression analysis yielded prevalence ratios with a significance threshold of p-value <0.05 and a 95% confidence interval. Information from the participants was collected using a structured questionnaire. Results. A total of 771 participants were analyzed, with a mean age of 20.78 years and a standard deviation of 1.85. Among the participants, 360 (46.69%, 95% CI: 43.18%-50.23%) reported having used HIV self-tests. The identified barriers among those who did not take HIV self-testing were 411(53.31%) includes cultural resistance 392 (95.38%), judgment by healthcare providers 372 (90.51%), legal constraints on kit provision 360 (87.59%), fear of testing procedures 291 (70.80%), test reliability 286 (69.59%), fear of test results 283 (68.86%), accessibility of the HIVST kit 280 (68.13%), fear of others knowing they had tested 273 (66.42%), awareness of HIV self-testing being low 193 (46.96%), and not feeling at risk of HIV infection 73(17.76%). Socio-demographic factors associated with HIV self-test uptake among adolescent girls and young women AGYW include having multiple sexual partners and studying health-related courses, with adjusted prevalence ratios (aPR) of 1.23 (95% CI: 1.05-1.45) and 1.14 (95% CI: 1.04-1.27), respectively. Other factors showed a two-fold increase in prevalence ratio, including the availability of HIV self-test kits and having testing experience, with aPRs of 2.83 (95% CI: 2.21-3.62) and 2.65 (95% CI: 2.05-3.43), respectively. Feeling at risk of HIV infection was also associated with HIV self-test uptake, with an aPR of 1.29 (95% CI: 1.11-1.50). Conclusion The uptake of HIVST among AGYW in Dodoma City falls below 95% of the overall target of HIV awareness among PLWHIV. The following factors influence AGYW to use HIV self-testing: having multiple sexual partners, studying health-related courses, availability of HIV self-testing kits, previous testing experience, increased risk of infection, and feeling at risk of HIV infection. The barriers reported by participants include cultural resistance, being judged by healthcare providers, legal issues that prevent healthcare providers from providing kits to adolescents, and fear of test results. Adolescent girls and young women are at high risk of HIV infection and thus need to know their status.