HIV voluntary counseling and testing uptake and associated factors among Ethiopian youths: evidence from the 2016 EDHS using multilevel modeling

Nigatu et al. BMC Infectious Diseases (2021) 21:334 https://doi.org/10.1186/s12879-021-06021-x RESEARCH ARTICLE Open Access HIV voluntary counseling and testing uptake and associated factors among Ethiopian youths: evidence from the 2016 EDHS using multilevel modeling Mamo Nigatu1* , Teshome Kabeta1, Abonesh Taye2 and Merga Belina3 Abstract Background: Existing evidence showed that Human Immunodeficiency Virus counselling and testing uptake among Ethiopian youths is low, and factors contributing to it are not well studied. Therefore, this study aims to assess the status of uptake and identify its determinants using the 2016 Ethiopia Demographic and Health Survey data. Method: Data of 10,903 Ethiopian youths were extracted from the 2016 Ethiopian Demographic and Health Survey. The association between the response variable and the predictors was modeled by multilevel binary logistic regression, whereas adjusted odds ratio and confidence intervals were used to measure associations and their statistical significance. The variation in the uptake of counselling and testing of HIV across regions of Ethiopia was quantified by intra-class correlation. Result: The current study revealed that, overall, 34.9% (95% CI: 33.5, 36.2%) Ethiopian youths were ever tested for human immunodeficiency virus. Results show that about 9% of the variation in the probability of being tested for the disease was due to the regional variations. Moreover, having moderate and comprehensive HIV knowledge, being rich, having risky sexual behaviour, having a better educational level, having professional work, being married, owning of mobile, and having access to media were positively associated with human immunodeficiency virus voluntary counselling and testing uptake. On the other hand, being male, following protestant religion, following Muslim religion, and following other religions than orthodox religion were negatively associated with the uptake of human immunodeficiency virus counselling and testing. Conclusion: Voluntary human immunodeficiency virus counselling and testing uptake among Ethiopian youths is very low and varies across the regions which might hamper the ambitious plan of Ethiopia to end the disease as a public health threat by 2030. Emphasis should be given to promoting the youths’ HIV-related knowledge through community-based education, encouraging and empowering the youths to participate in professional works by giving due focus to poor youths, and promoting mass media utilization to better achieve the plan. Keywords: EDHS, Multilevel, Youths, Voluntary HIV counselling, And testing * Correspondence: ; 1 Faculty of Public Health, Department of Epidemiology, Jimma University, Institute of Health, Jimma, Oromia, Ethiopia Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Nigatu et al. BMC Infectious Diseases (2021) 21:334 Background Any person who is in the age group of 14 to 24 years, according to the WHO, is considered as a youth [1]. According to the Ethiopian Federal HIV/AIDS Prevention and Control Office (HAPCO) and Federal Ministry of Health guideline, youths are among the top priority population segments for VCT which is given free of charge since they are vulnerable to the Human Immunodeficiency Virus (HIV) because of the strong influence of peer pressure and the development of their sexual and social identities which often lead to experimentation [2]. HIV, unlike many other diseases, continued to be a major challenging public health problem to prevent and control. Starting from the first occurrence of the pandemic, more than seventy-five million people have been infected by the disease, and it has claimed more than 32 million lives [3–5]. The global community is committed to an ambitious plan of bringing the acquired immunodeficiency syndrome (AIDS) to an end by the year 2030 [6]. In 2014, the United Nations Program on Acquired Immunodeficiency syndromes (UNAIDS) being with other stakeholders launched the three 90s targets of diagnosing 90 % of all HIV-positive persons, providing antiretroviral therapy (ART) for 90 % of those diagnosed, and achieving viral suppression for 90 % of those treated by the year 2020 [4]. However, according to the reports from the 2019 UNAIDS and World Health Organization (WHO), globally, 37.9 million people were living with the disease at the end of 2018, whereas, 1.7 million people and 770,000 people were respectively newly infected and died from the disease-related causes [3, 5]. Even though the global annual number of new infections and death have declined, reaching the 2020 milestone with the current achievement is unthinkable [5, 7]. The disease disproportionally affected Sub-Saharan Africa where more than 70% of the disease’s global burden has occurred. Two-third of the estimated 6000 new infections that occur globally each day occur in SSA [8]. East and Southern Africa is the most affected African region where 20.6 million people had been living with HIV and 800,000 were newly infected in 2018 [9]. The number of people living with HIV in Ethiopia was decreased from the 2016 WHO estimate of 710,000 to 690,000 in 2018 [7, 10]. However, 23,000 people were newly infected at the end of 2018 leaving Ethiopia far off achieving the 2020 target [7]. In 2017, globally, 590,000 youths were newly diagnosed with HIV disease and 3.9 million youths were living with the disease [11]. According to the evidence from 2020 WHO estimates, globally, often people who were newly diagnosed with HIV infection, three persons were youths [1]. Approximately, worldwide, one thousand six hundred youth contract HIV infection every single day, and one young person loss his/her life due to Page 2 of 11 the illnesses related to AIDS every 10 min [11]. In 2018, 21 % of the total 37,832 newly diagnosed HIV cases in the US were among the youth [12]. In 2017, 290,000 youths were newly (...truncated)