Factors Associated with STI Screening Uptake Among Adolescent Girls and Young Women in Namibia

Abstract

Background: Sexually transmitted infections (STIs) remain a major public health concern among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA). Although routine STI screening is essential for early diagnosis and prevention, uptake among AGYW is often suboptimal and influenced by multiple individual and contextual factors. This study assessed factors associated with STI screening uptake among AGYW enrolled in HIV prevention programs in Namibia. Methods: A secondary analysis of anonymized programmatic data was conducted among AGYW aged 15–24 years who received services through the DREAMS project and REACH PHN activity between 2018 and 2024. Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were performed to identify factors associated with STI screening uptake. Results: A total of 26,689 AGYW were included in the analysis, of whom 97.2% were screened for STIs. STI screening uptake was significantly associated with district of residence, year of enrolment, inconsistent or no condom use, perceived risk of HIV infection, use of family planning, and having had sex under the influence of alcohol or drugs. AGYW who perceived themselves to be at risk of HIV and those using family planning methods had higher odds of STI screening, while those who reported sex under the influence of alcohol or drugs were less likely to be screened. Significant geographic disparities in screening uptake were also observed across districts. Conclusions: STI screening uptake among AGYW enrolled in HIV prevention programs in Namibia was high. While this may reflect the effectiveness of integrated, community-based service delivery models, the results should be interpreted with caution, as they are based on a convenience sample. However, behavioural and geographic disparities persist. Strengthening integrated sexual and reproductive health services, addressing substance-related barriers, and implementing targeted district-level interventions may further improve equitable access to STI screening among AGYW.