Predictors of HIV testing among youth 15–24 years in urban Ethiopia, 2017–2018 Ethiopia population-based HIV impact assessment

PLOS ONE RESEARCH ARTICLE Predictors of HIV testing among youth 15–24 years in urban Ethiopia, 2017–2018 Ethiopia population-based HIV impact assessment Aderonke S. Ajiboye ID1*, Frehywot Eshetu1, Sileshi Lulseged2, Yimam Getaneh3, Nadew Tademe2, Tsigereda Kifle3, Rachel Bray4, Hailegnaw Eshete2, Yohannes Demissie2, Clare A. Dykewicz1, David Hoos4, EPHIA Study Group¶ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Division of Global HIV and TB, Center for Global Health, CDC, Addis Ababa, Ethiopia, 2 ICAP at Columbia Universfity, Addis Ababa, Ethiopia, 3 Ethiopia Public Health Institute, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia, 4 ICAP at Columbia University, New York, New York, United States of America ¶ The complete membership of the EPHIA Study Group can be found in the Acknowledgments. * Abstract OPEN ACCESS Introduction Citation: Ajiboye AS, Eshetu F, Lulseged S, Getaneh Y, Tademe N, Kifle T, et al. (2023) Predictors of HIV testing among youth 15–24 years in urban Ethiopia, 2017–2018 Ethiopia population-based HIV impact assessment. PLoS ONE 18(7): e0265710. https://doi.org/10.1371/ journal.pone.0265710 Youth (adolescents and young adults) aged 15–24 years comprise approximately 22% of Ethiopia’s total population and make up 0.73% of HIV cases in urban Ethiopia. However, only 63% of HIV-positive youth are aware of their HIV status. We describe the HIV testing behaviors of youth 15–24 years and determined the characteristics of those who were most likely to be tested for HIV within the past year. Editor: Hamufare Dumisani Dumisani Mugauri, University of Zimbabwe Faculty of Medicine: University of Zimbabwe College of Health Sciences, ZIMBABWE Methods Received: March 4, 2022 Accepted: July 4, 2023 Published: July 19, 2023 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: The 2017-2018 EPHIA public release datasets and files are available at the ICAP PHIA website (https://phiadata.icap.columbia.edu/datasets?country_id=12). Survey data use manuals and documentation are available for download. For access to datasets, please register for an account and submit a data request form. Using data from the 2017–2018 Ethiopia Population-based HIV Impact Assessment, we provide survey-weighted estimates and prevalence risk ratios for engagement in HIV testing in the 12 months preceding the survey. We model the likelihood of HIV testing one year or more before the survey compared to never testing, using a multinomial logistic regression model. Results Among HIV-negative and unaware HIV-positive youth 15–24 years old (N = 7,508), 21.8% [95% Confidence Interval (CI): 20.4–23.3%] reported testing for HIV in the last 12 months. Female youth [Prevalence Ratio (PR) = 1.6, 95% CI: 1.4–1.8], those aged 20–24 years (PR = 2.6, 95% CI:2.3–2.9), and those ever married (PR = 2.8, 95% CI: 2.5–3.1) were more likely to have tested for HIV within the last year. Adjusting for select demographic characteristics, sex with a non-spousal or non-live-in partner [Relative Risk (RR) = 0.3, 95% CI:0.1–0.8] among males did not increase their likelihood to test for HIV in the prior 12 months. Female youth engaged in antenatal care (RR = 3.0, 95% CI: 1.7–5.3) were more likely to test for HIV in the past year. PLOS ONE | https://doi.org/10.1371/journal.pone.0265710 July 19, 2023 1 / 17 PLOS ONE Funding: This publication has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement award #1U2GGH001226. Competing interests: The authors have declared that no competing interests exist. Predictors of HIV testing among youth 15–24 years in urban Ethiopia Conclusion The Ethiopian HIV case finding strategy may consider approaches for reaching untested youth, with a specific focus on adolescent males,15–19 years of age. This is critical towards achieving the UNAIDS HIV testing goal of 95% of all individuals living with HIV aware of their status by 2030. Introduction Since 1990, under-five child mortality in Eastern and Southern Africa has steadily decreased by 3.7% each year [1]. The reduction in child mortality over the last 30 years in sub-Saharan Africa (SSA) has contributed to what is known today as the African ‘youth bulge’, with 60% of the total sub-Saharan African population under the age of 25 years [2]. The rapidly increasing youth population across sub-Saharan Africa has introduced new challenges in the fight to end HIV/AIDS. Historically, perinatally infected children were assumed to not have survived past childhood. However, recent studies in Zimbabwe and South Africa have shown that an increasing number of undiagnosed adolescents are now presenting at primary care facilities with symptoms of long-term HIV infection [3, 4]. Many new cases of HIV infection are also occurring within the 15–24-year-old age group. As of 2019, those 15–24-years-old made up 36% of all new HIV infections among all adults 15 years and older in sub-Saharan African [5]. In 2017 alone, an estimated 290,000 new HIV infections occurred among those 15–24 years in Eastern and Southern Africa with two-thirds of these infections among young women [2]. If not for the youth bulge, it is estimated that between 2010–2017, there would have been 340,000 fewer new cases of HIV among sub-Saharan African youth, aged 15–24 years [2]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommends a 90-90-90 treatment target for ending the HIV epidemic by the year 2020: 90% of all people living with HIV to be aware of their HIV-positive status, 90% of HIV-positive individuals receiving HIV treatment, 90% of HIV-treated individuals achieving HIV viral-load suppression [6]; these targets were updated to 95-95-95 to be achieved by the year 2030 [6]. A pooled analysis of 2016 population-based HIV surveillance data from Malawi, Zambia, Zimbabwe found that only 46% of all HIV-positive youth 15–24 years were aware of their HIV-positive status [6, 7]. Saharan African youth are achieving less than half of the recommended 1st 90 target and falling behind older adults, who are 78% aware of their current HIV-positive status [7]. Among youth aware of their status, 82% received HIV treatment, and 79% of these achieved HIV viral load suppression. The 2016 analysis shows that for older adults, 90% of those aware received HIV treatment and 90% of those on treatment achieved HIV viral load suppression [7]. As the youth population continues to grow across sub-Saharan Africa, the greatest challenge to reaching HIV epidemic control will be the identification of new and untreated cases of HIV. In Ethiopia, Africa’s second most populous country, on (...truncated)